Jeanne M. McTernan, M.A. OTR/L

*** ** **** ******, ****** Beach Florida 33445

Phone: 561-***-**** ad3g08@r.postjobfree.com

Highly motivated, detailed oriented, Licensed Occupational Therapist, Knowledgeable of reimbursement cycle management, and sound knowledge of insurance company requirements as well as auditing clinical documentation for proof of medical necessity.

SUMMARY OF QUALIFICATIONS

•Proficient with KIPU Health Systems

•Knowledgeable of behavioral health billing, collections, and coding

•Knowledgeable in Compliance, UR, and Auditing charts, claims, and billing

•Knowledgeable in InterQual, ASAM, and APA medical necessity criteria

•Experience and knowledge of all major insurance carrier’s requirement

•Experience in analyzing documentation to get claims paid.

PROFESSIONAL EXPERIENCE

Sanford Behavioral Health Marne, MI 2020-Current

Director of Compliance, Auditing and Utilization Review

Oversee all incident reports for the facility.

Full understanding of all insurance contracts regarding appropriate billing, documentation and coding to ensure the organization is following insurance contract requirements. and procedures

Auditing samples of all programs with another staff member to ensure the organization maintains compliance with documentation for CARF standards and meets HIPPA compliance.

Quarterly reports regarding documentation strengths and challenges

Work closely with the billing/reimbursement department to review claims and ensure they are paid per contract.

Create and maintain spreadsheets regarding authorization denials, appeals, or lost authorization days.

Review of weekly census to identify areas of improvement to bill claims.

Oversee Compliance within the organization in clinical areas, policies and procedures, and CARF Standards

Review medical records prior to sending them to insurance companies or other organizations.

Review weekly census reports and maintain spreadsheet for upper management tracking items that were unable to be billed due to non-compliance in documentation

COAST TO COAST MEDICAL SOLUTION Lake Worth, FL 2014-2020

Manager of Billing, Collections, VOB, Posting, Reporting and UR

Supervise and oversee all department operations for multiple facilities.

Complete weekly audits of reports for facilities contracted with Coast to Coast

Train new UR staff and oversee training of new staff in other departments.

Review weekly reports to facilities for accuracy.

Completed Medical Records Reviews requested by Insurance Companies

Work cross functionally to develop fully informed views and insights into the drivers behind the data, and present findings clearly and concisely to all facilities.

Tenet Corporation Miami Beach, West Palm Beach, Delray Beach, Florida 2002-2014

Occupational Therapist

Evaluation, treatment and discharge planning for all units of hospital including physical disability, psychiatric, ICU and Pediatric units.

Efficient and accurate documentation meeting CMS requirements

Training of patients and families during treatment and prior to discharge

EDUCATION

Bachelor of Arts in Education with Honors – Northeastern University, Boston, Massachusetts

Member of Kappa Delta Phi Honor Society

Member of Boston-Bouve Honor Society

Master of Arts in Occupational Therapy (OTR/L) –Cum Laude Tufts University, Medford Massachusetts.

Master’s Thesis “Screening for Alcohol Abuse: Patients Who Present with Physical Injuries or Medical Conditions

Member of National Association in Occupational Therapy (NBCOT)

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