Medical Billing
Resume:
CAREER OBJECTIVE:
A position as a Director for a healthcare facility, bringing excellent record of nursing education and training, hands-on internship experience, excellent time management, outstanding interpersonal skills, while utilizing diverse experience in nursing profession to contribute to the total well-being of patients.
EDUCATION:
2012 – University of Phoenix – online Doctorate of Industrial Organizational Psychology. Completed 3
years.
2010 – University of Phoenix, Fort Lauderdale Campus – Master of Business Administration.
2006- University of Phoenix, Fort Lauderdale Campus- Bachelors in Healthcare Administration
2002 – Cumberland County College, New Jersey – Associate in Science in Social Service.
Continuing education courses:
Death, Dying, and Bereavement: Fundamentals Concepts – Online 07/2017
Recognizing and Reporting Impairment in the Workplace for Florida Nurses – Online
Protecting Patient Safety: Preventing Medical Errors – Online
Florida Laws and Rules Governing the Practice of Nursing – Online
Coding and Compliance Training
LICENSURE/CERTIFICATIONS:
Licensed Practical Nurse, #PN 5169686 since 1987
EXPERIENCE:
UnitedHealth Group/Optum
Nurse Auditor/Fraud Waste and Abuse Claim Reviewer 12/2007 to 06/2017
Started as a Nurse Auditor with United Healthcare Group on December 2007, and on 2015, I was transferred to new position as a Fraud Waste and Abuse Claim Reviewer by Optum.
Reviewed and audited providers chart to determine billing accuracy and appropriate coding.
Responsible for chart reviews, hospital bills audits for Neonatal ICU, implants, cardiac stents reviews with prior vascular authorization, trained new employees on implants reviews, facility liaison of reviews. Telecommuter with Optum for 2 years.
Implemented new policies and procedures for my job duties as Implant Team Lead Reviewer.
Created and updated department policies and procedures with current medical coding and claims reviews for Fraud, Waste and Abuse.
Quality analysis skills, utilization management, clinical experience, medical management experience.
Maria E Tirado Resume
Page 2
Matrix
Disease Management 2006 to 2007
Call Center to follow-up on clients with chronic health conditions. Educating the clients in nutrition, exercises, smoking cessation, and medication intake.
IVF Florida 2000 to 2006
Front office medical records, laboratory testing, nursing assistant.
Business office, charge entry, with prior authorization, billing, IUI Coordinator, collector, Auditor
Created invoices and collected account receivables on past due accounts
OTHER SKILLS:
Bilingual (Spanish/English), detailed oriented, reliable, hardworking, energetic, flexible, and adapt easily to change of environment and work schedule, excellent organizational skills and self-starter, typing 60 WPM, exceptional interpersonal and communication skills; personable with a positive attitude; interface effectively with patients, families, and nursing staff.
Creative, self-disciplined and capable of identifying and completing critical task independently and with a sense of urgency required
Strong problem solving, follow through and analytical skills in evaluating and recognizing potential employee situations
Maintain critical thinking skills essential to providing competent and dignified patient care.
Known as a patient advocate and team player; believe in empowering patients by delivering health education and nursing care that enhances wellness and quality of life.
Utilize knowledge of medical billing, medical terminology, DSM-5, ICD-10, Interqual criteria, Milliman Care Guidelines, HCPCS and CPT coding in processing claims
Proficient in MS Office Suites, MS Dos, Adobe Workshop
*References available upon request
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