Medical Management

Brian Li

***-* ********* ***. • Monterey Park, CA 91755 • C: 562-***-**** • *********@*****.***

Professional Experience

QTC Management Diamond Bar, CA

Medical Case Specialist January 16 2016 – Present

Triage daily download of referrals and ensure appropriate worksheets are assigned to corresponding conditions as identified by Veteran’s Administration

Verify appropriate CPT, DRG, ICD-10 and CLIN codes are assigned to each case

Communicate directly with claimants and providers

Confirm consultative reports and diagnostic test results are received in a timely manner

Meet or exceed contract timeliness guidelines in both the scheduling and case management with QTC/ VA approved software and E-Clinical Works

Claims Analyst 2013 – January 15 2016

Review claims for accuracy and analyze service connected claims pertained within VA guidelines for Agent Orange exposed Veterans and report any inconsistency back to the VA

Coordinate with QTC and VA Agent Orange approved Providers to diagnose and conclude if claimant shall receive additional compensation

Presented in meetings and final meeting upon final completion of project 165,000 claimants have received compensation through QTC’s and VA’s approved guideline documented procedure

Verify appropriate CPT, ICD-10 and CLIN codes assigned to each case

QTC Management Diamond Bar, CA

Medical Records Reviewer 2010 - 2013

Modeled comprehensive fee-for-service hospital contracts and assisted with the development of contractual terms.

Developed financial summaries to forecast the impact and to reduce the risk of provider discussions relating to reimbursement methodologies.

Verify appropriate CPT and CLIN codes assigned to each case

Molina Healthcare Whittier, CA

Healthcare Administrator 2007 - 2009

Managed relationship between stakeholders and union during contractual negotiations and disputes. Resolved issues relating to payroll, safety, and labor.

Kaiser Permanente Bellflower, CA

Medical Records Clerk 2006 - 2007

Coordinated and led a cross-functional project team in assessing and revising core business work processes in conjunction with the deployment of automation technology.

Customized new analytical tools to evaluate operations using methods such as data mining and data modeling. Applied analytic methods and tools to understand, predict, and control current business processes.

Education

Pasadena City College 2001-2004

Associates Degree

Skills And Interest

MS Excel, MS Word, MS Outlook, MS Access, MS Publisher, Emptoris, Cognos, Adobe Professional

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