Registered Nurse Training
Resume:
Education
Bachelor of Science ****
Temple University, Philadelphia PA
Work Experience
Cotiviti – Payment Accuracy Specialist II
Payment Accuracy Specialist 5/2013 – 4/2014
Contract compliance Audit
oAnalyze monthly/weekly data download(s) from various clients by running custom queries and setting criteria to identify possible incorrect claim payments
oValidate the incorrect claim through verbal or written verification with providers
oEnter and document the incorrect payments in accordance to procedure through Cotiviti internal systems and clients’ systems
oDevelop new hires by providing training and mentorship and quality review of the work
oManage reports/queues to ensure my work-flow buckets are being processed and moving along the appropriate channels/statuses
oOffer clinical knowledge to other specialists to integrate with their audits to determine the potential for a recoveries
oPerform chart review verification for all commercial account claims
CMS Audit
oAnalyze monthly data download from CMS by running custom queries and setting criteria to identify possible incorrect claim payments
oPerform complex medical chart review, interpret and apply clinical and coding guideline knowledge to determine potential dosage and/or billing errors
oEnter and document the incorrect payments accurately and efficiently in accordance to CMS guidelines
oDevelop new hires by providing training, mentorship and quality review/ control of the work
oManage work distribution, productivity and quality of work among different team members
oUpdate reports and queues to ensure reviews are done within our mandated 60 day review period and maintaining our accuracy rate above 95%
oPrepare responses to providers, MAC, any higher level disputes from CMS and Monthly Accuracy Reports from the RVC
oProvide support and the SME for any inquiry regarding any pharmacy claims from the local team
oPrepare and present presentation to CMS regarding our underpayment concept and attend any possible hearing(s) for escalated disputes
oInvolved in developing, implementing and evaluating current and/or prospective concept
Stonebridge Bank – Teller II/ Internal Audit 11/2012 – 5/2013
Provides account services to customers by processing deposits, withdrawals, payments and refers to other bank services
Perform branch, tellers and vault audits by identifying any discrepancies with cash counts, over/short records, CTR, transaction history and ensure that all security compliances are met
Prepare audit reports for management review
TD Bank – Teller II/Internal Audit 6/2008 – 11/2012
Provides account services to customers by processing deposits, withdrawals, payments and refers to other bank services
Perform branch, tellers and vault audits by identifying any discrepancies with cash counts, over/short records, CTR, transaction history and ensure that all security compliances are met
Prepare audit reports for management review
Develop new hires by providing training and mentorship
Certification/License
Pennsylvania Registered Nurse 2017
Related Experience
Clinical Rotation & Student Nurse Intern 8/2008 – 5/2012
Worked under the supervision of an RN providing bedside care, treatment and consultation for
assigned patients on the unit. Handled medication administration, dressing changes, IVs,
assessments and all other aspects of nursing care. Facilitated admissions, discharges and transfers;
prepared chart notes, MAR and other documentation and participated on interdisciplinary rounds.
Shriner
Belmont Hospital
Masonic Village Nursing Home
St. Christopher
Temple Hospital
Mollen Immunization – Immunization Nurse 8/2012 – 1/2013
Administer immunizations and provide patient education if needed
Process payments and/or paperwork to bill patient’s insurance
References
Upon request
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