*-*-****

Lori Harris, RN, CMAS

***** ****** ***.

Plainwell, MI 49080

Ph.: 269-***-****

E-mail: ac0b4e@r.postjobfree.com

WORK EXPERIENCE:

**** - ****: RN Auditor – Hospital Bill Auditor / Medical Record Review

(Company Names: Scio Health Analytics and previously EquiClaim Inc.)

Inpatient and Outpatient Hospital Bill Auditing to verify Documentation

Compliance, overcharging/undercharging on hospital bills; medical record

reviews for lost Revenue, auditing of costly surgeries, implants, chemotherapy

drugs and interventional radiology procedures.

Strong working knowledge of Charge Description Master, Hospital Revenue

Codes, UB-04’s, CPT/HCPCS Codes, ICD 9-10 codes, CMS Guidelines, Third

Party Payer Reimbursement Policies.

10 years of Hospital Clinical Experience including ICU step-down, Acute Med.

Surg. and Orthopedics.

Over 25 years’ experience working independently (Remotely, Telecommute

and Hospital/Provider Site visits.)

Experience working with various Electronic Medical Records. (EMR’s.)

Experience with Excel, Microsoft Outlook, Word, Internet Search and other

various app’s. Experience with HIPAA Compliance.

Current Michigan RN License

2016-Present: Patient Financial Documentation Auditor – Metro Health - (University Health)

Hospital. – Experience in Hospital Compliance/Hospital Bill Audits and

Medical Record Reviews. Experience investigating and writing Denials.

2016: RN Contract Nurse for Managed Resources, Inc. -

(Medical Record Review for Observation Project)

2016: Workman’s Compensation RN Clinical Summary Writer for Physician Utilization

Reviewers. - (Maximus Federal Services)

2000-2002: Core Measures - Data Abstraction from Medical Record to assure Provider

Documentation Compliance for Pneumonia, CHF, and Acute MI.- Spectrum Health

Hospital

2001: RN Consultant Project for Physician’s Health Plan:

Facility Site/Medical Record Reviews – Verifying safety standards are

implemented. (i.e. Sterilization/Cleaning of equipment, drug expiration review,

blood born pathogen review material, annual Physical Exams being completed.)

1992 – 1994: Utilization Review / Case Management Supervisor:

(Company: Blue Care Network - HMO)

Daily hospital rounding and chart reviews for medically necessary admissions

and potential discharges, when appropriate, for cost containment and adequate

placement of patients for the level of service and quality of care needed.

(i.e.: Skilled Nursing Facility, Home Care, rehab, etc. )

Daily Utilization Review phone calls to out-lying hospitals for approval/denial

of additional inpatient hospital days.

Experience Writing - Implementing Hospital Discharge Criteria

for inpatients: Medical Surgical, HIV, and Premature infants.

Managing Patients with Chronic Diseases

Quarterly Analysis of ER and high dollar claims – Identifying potential

candidates for medical case management.

1993 – 1995: Skilled Home Care Nurse for: Home Care Plus

1983-1991: Charge Nurse / Staff Nurse / Preceptor for nursing students.

Med. Surg; Orthopedics.

EMPLOYMENT HISTORY and CONTACTS:

2011-Present: Scio Health Analytics – Jacksonville, FL (Audit Co.)

RN Auditor – Hospital Bill Audit, Medical Record Review

Contact: Sharon Eubanks, RN (Supervisor) - Ph. 1-954-***-****

*** Other References available upon request.

EDUCATION:

2016: CMAS Certification Received (Certified Medical Auditor Specialist)

2011: CPC Certification.

2002: Business Law 201 Class Completed.

1995: Clinical Observer Certification. (Instructor for Nurse’s Aide Training Program.)

1994: Train the Trainer certification: (Certified to teach Nurse’s Aide Training Classes.)

1991– 1989: WMU – Community Health Class completed.

1985: KVCC - Registered Nursing License received.

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