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

Contact this candidate