Barbara Biondo, RN

**** ***** ***** ****, ***********, PA 17301 ● 717-***-**** ● ac8e7h@r.postjobfree.com

Exceptional Multi-tasking ● Research Professional ● Detail Oriented● Commitment to Excellence Obtain a position that will utilize my medical review documented skills, abilities and experience to contribute to the Company’s success. Experienced in medical record review for fraud, waste and abuse utilizing professional research skills, multi-tasking, and detail oriented with a commitment to providing excellence in my work. SKILLS/EXPERTISE/QUALIFICATIONS

• Investigation and verification through research

• Utilize nursing process and nursing theory skills in the audit process

• Interpret, analyze medical records for fraud, waste and abuse

• Apply complex rules and regulations utilizing National Coverage Determinations, MAC Local Coverage Determinations and government statutes via Centers for Medicare and Medicaid Services (CMS) IOM manuals, Social Security Acts, Code of Federal Regulations (CFR), Commercial guidelines and addition practice standard documents

• Utilize coding books: ICD-9; ICD-10; HCPCS Level 1 (CPT) and HCPCS Level 2

• Detail oriented, research and in-depth data mining

• Excellent writing skills

• Training peers and customers

• Experienced nursing positions: ICU, CCU, PCU, medical, surgical, ER, community nursing, Home Health and Nursing Supervision, Rotating Charge Nurse

• In-depth knowledge of medical terminology

• Self-motivated and Home Office/Work at Home

• Work and travel independently and/or team work

• Excellent customer service utilizing analytical and interpersonal skills

• Proficient with PC application: MS office, PowerPoint, Outlook and Business Skype

• Knowledgeable in Excel

• Completed Extern-ship at Kaplan University, Manager Consulting Department EMPLOYMENT

Medical Review Auditor July 2018-October 5, 2018

Piper Companies/Contract to Verscend 1410 Spring Hill Road, Suite 300 703-***-**** McClean, VA 22102

Contract employees laid off; lack of work. Performed medical reviews of Medicare, Medicaid and Commercial claims for medical necessity, fraud, waste and abuse. Medical Reviewer/Analyst February, 2015 to July 13, 2018 Safeguard Services (SGS), LLC 1250 Camp Hill Bypass, Camp Hill, PA 17011

(Subsidiary to Perspecta)

SGS, a NE UPIC Medicare contractor. Reviewed Medicare and Medicaid provider claims identified as outliers within the industry standard:

• Analyze claims for fraud, waste and abuse

• Make referrals to the QIO

• Prepare reports/Consultant Summaries

• Participate in provider onsite interviews as a member of the team

• Team work with investigators, data analyst, administrative aids and peers Barbara Biondo 2

Nurse Analyst/Appeal May, 2014 – February, 2015

Novitas, Inc. 2020 Technology Pkwy., Mechanicsburg, PA 17050

(Medicare Administrative Contractor (MAC))

Novitas, a MAC, contracted to the Centers for Medicare & Medicaid Services.

• Review and reconcile denied appeals on first level of Medicare Appeals/Redetermination

• Review appeals and medical records, identify and reconsider claims to be paid utilizing additionally submitted documentation with Local Coverage Determinations, National Coverage Determinations, Articles and government rules, regulations and statutes

• Prepare reconciliation letters to providers

RN Medical Auditor/Revenue Recovery March, 2002-August, 2013 MLECO and Associates 61 McMurray Road Pittsburg, PA 15241 Eleven and one-half years worked with a revenue producing company initiated new jobs both on site and remote, reviewed hospital claims/bills through medical record interpretation. Recovered tens of thousands of dollars in lost revenue for various providers in errors, defense audits or denied claims.

• Interpret and analyze hospital claims/bills utilizing medical records as contractor to various providers

(Johns Hopkins, University of Maryland, AtlantiCare, Fredericksburg General Hospital, Northern Westchester Hospital, Mary Washington Hospital, Health South Hospital, etc.).

• Charge capture lost charges, identify errors in concurrent audits and defense audits for outliers.

• Prepared and analyzed audit results; prepared report summaries

• Reviewed, researched, data mine.

• Utilize nursing process and nursing theory skills in the audit process and certified medical audit skills.

• Wrote appeals for denied claims from insurers and government for various providers and reversed denials

• Knowledge of CPT, ICD-9 and HCPCS codes

(Company has been dissolved-owners retired. Contact Jennifer Barker, Manager, Medical Auditors.) RN – Travel Nurse 1999-2000

Avicenna Nursing Personnel, LLC 3405 Jennings Chapel Road Woodbine, MD 21797 As a traveling nurse I utilized nursing theory and skills to perform my nursing functions. Worked at community hospitals, state hospitals and teaching hospitals each in a variety of specialty units.

• Complete nursing shifts as needed – intervention and caring for patients

• Utilize nursing skills and nursing process in caring for patients

• Prepare and fulfill patient care plans, participate in discharge planning

• Instruct and teach CNAs and peers

• Flexible travel to various Maryland hospitals

Barbara Biondo 3

Registered Nurse – Staff position December, 1988 – December, 1999 Northwest Hospital Center 5401 Old Court Road Randallstown, MD 21133 Eleven years at this hospital in a variety of units working and developing my theory and skills. Performed bedside nursing in CCU, Interventional Radiology, ER, Progressive Coronary Unit and prn shifts in the rehabilitation unit.

• Patient focus - daily care and intervention

• Fulfill and prepare care plan and discharge planning

• Perform patient, family and peer teaching

• Redirected to various department to fill open positions (i.e. radiology)

• Volunteered as a computer trainer/instructor for my peers. COMMUNITY SERVICE

• Cross Keys Fellowship • New Hope Ministries

EDUCATION

Kaplan University

Bachelor of Science Business Administration 1801 E Kimberly Road Davenport, IA 52807 Graduation, September, 20143.91 GPA

Community College of Baltimore-Essex 7201 Rossville Blvd. Baltimore, MD 21237 Associates of Arts-Nursing

Graduation, May, 1984

LICENSE/CERTIFICATIONS

Registered Nurse

State of Maryland origination 1984 renewal date: 02/2019 State of PA origination 1985 renewal date: 04/2019 American Association of Medical Audit Specialist

Certified Medical Audit Specialist (CMAS) renewal date: 04/2020 American Academy of Professional Coders

Certified Professional Coder (CPC) renewal date: 05/2020

Contact this candidate