Customer Service Quality Assurance
Resume:
Sara Irwin
Wausau WI *****
OBJECTIVE: Seeking long term employment in a quality assurance auditing position
QUALIFICATIONS:
Performed quality assurance auditing for 18 years
Expert knowledge in coordination of benefits with other health insurance companies
Very familiar with medical terminology, procedure and diagnosis codes
Vast experience in medical billing and current HIPAA law
Homeland security clearance and in compliance with Government standards
Active shooter training
Proficient in Microsoft Office
EMPLOYEE TRAITS:
99.3% accuracy level of auditors audits
Exceptional customer service, sales and communication skills
Work ethic of being proactive with appreciation for follow-though and attention to detail
Hard worker, loyal, dependable and efficiently organized
Professional, team orientated, a leader, trainer and a mentor
WORK EXPERIENCE:
Quality Assurance Auditor 3, Wisconsin Physician Services (WPS) Dec 1997-Dec 2015
oConducted random audits on written and telephone correspondence for all departments: Third party liability, program integratory for fraud and abuse, credit and recoup audits
oResearched and resolved duplicate claims overseas and stateside
oInvestigated claims for Medicare and their denials for military and veteran services
oReviewed and determined outcome of appeals for medical necessity
oPerformed 100% correction of the new employee’s audits
oAssisted with training and program development
oUtilized national provider identification and tax ID numbers to ensure proper payment
oEnsured compliance with HIPPA and corporate policies and procedures
oResponsible for level 3, auditing of high dollar claims over $50,000
Manager and Buyer, Southern Frills Formal Shop, Tulsa OK, 1991-1997
oManaged full service formal shop
oResponsible for staff, payroll, purchasing, inventory and marketing
REFERENCES AVAILABLE UPON REQUEST
Contact this candidate