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Location:
Bennington, Nebraska, 68007, United States
Salary:
55,000
Posted:
February 05, 2018

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Resume:

LAETARE A. SHOO

**** * ***** ****** 402-***-****

Bennington, Nebraska 68007 ac4cpe@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

Self-motivated and resourceful professional with extensive experience and a strong educational background in Healthcare Auditing, System Information Security, Network Security, Computer system and business administration; strong analytical and problem-solving skills; ability to manage multiple priorities in fast-paced, deadline oriented environment.

Education Bachelor of Science March 2013 – May 2015

Bellevue University

Major in Cyber Security

Minor Computer Information Systems

Masters in Business Administration Nov 2008 – Nov 2012 Bellevue University

Concentration in Finance

Bachelor of Science March 2004 – May 2008

Bellevue University

Major in marketing management

Certification: Certified Internal Auditor (CIA) and CISA – In progress

Experience

Associate Security Consultant, January 2016 – Present

NTT Security /Solutionary, Omaha NE

Support lead consultants on HIPAA, NIST, PCI-DSS, and/or ISO 27001 audit review.

Conduct policy/ document reviews, configuration review and interviews against compliance requirements and best-practices.

Develop recommendations for remediating risk and compliance gaps.

Work with lead consultants to scope, develop time, cost estimates and write deliverable reports.

Work with client’s teams to execute the plans and solutions to achieve great results.

Report project status to internal and external team members.

Program Integrity Analyst, April 2015 – December2015

Computer Evidence Specialist at AdvanceMed, Omaha NE

Perform in-depth evaluation of potential Medicare and Medicaid fraud investigations

and develop investigations that involve monetary losses, for referral cases to CMS,

OIG and law enforcement.

Utilize data analysis techniques to detect aberrancies in Medicare claims data, and

proactively seeks out and develops leads received from a variety of sources.

Complete written referrals to law enforcement and takes steps to initiate recoupment

of overpaid monies.

Make potential fraud determinations by utilizing ZPIC's internal guidelines, Medicare

provider manuals, Medicare regulations, and the Social Security Act.

Participate in onsite audits in conjunction with OIG and law enforcement.

Medicare Cost Report Reopening Specialist, November 2013 – April 2015

Wisconsin Physicians Services, Omaha, NE

Reviewing, reopening and revised complex financial and statistical records in compliance of Government Auditing Standards (GASB) and CMS regulations.

Prepare detailed sets of financial exhibits to defend /revise Medicare Audit decisions.

Coordinate the completion and analysis of Medicare financial data for special projects directed by CMS, General Accounting Office or Medicare Management.

Assist Management in identifying new GASP, GAAP, HIPPA and FOIA policies and implementing process for improvements.

Auditor Medicare Cost Report, April 2008 – November 2013

Wisconsin Physicians Services, Omaha, NE

Complete Cost Report Audit review and reconcile Medicare Provider financial data to source documents.

Prepare detailed sets of exhibits of Audit work papers and audit adjustment reports.

Establish interim payment rates for use in claims, periodic interim and level payments

Monitor and ensure all Medicare providers are compliance with Governmental Accounting Standard Board (GASB), GAAP and HIPAA privacy rules.

Reimbursement Analyst, January 2007 – April 2008

Mutual of Omaha / Wisconsin Physicians Services, Omaha, NE

Calculate and ensure provider received and pay correct Medicare Payments.

Identify overpayments, initiate and collect Medicare funds from Provider.

Identify potential areas of incorrect payments to Provider Medicare funds.

Skills

Proficient in Microsoft Excel, Power Point, Word, Access and C# Programming.

Proficient in Healthcare Financial Systems (HFS), QuickBooks, FISS & IBM Higlas.



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