Allison Goldstein Email & Phone Number

Greenville, South Carolina, United States

Hand-picked into the role to create new audit rules, demonstrating proactive problem-solving and strategic planning abilities; identified potential savings of over $22.4M through in-depth data analysis and market research.Collaborated cross-functionally with compliance and policy teams to revise and improve Humana policy wording in alignment with CMS.

Led clinical audit processes that ensured all medical services were documented accurately, resulting in optimizing reimbursement process by maintaining strict compliance standards.Identified and addressed high-risk cases including CMS Hierarchical Condition Categories (HCC) and referred them for necessary follow-up care which required a deep understanding.

Improved billing accuracy and compliance by analyzing medical documentation and applying clinical expertise to validate provider coding while ensuring all charges were substantiated and in line with regulatory standards.Consistently achieved highest quality scores of 100% on the team which demonstrated exceptional attention to detail and commitment to.

Cath Lab

Optimized patient care outcomes by assisting physicians during advanced cardiac procedures including cardiac catheterizations and angioplasties, resulting in in-depth knowledge of medical devices and treatment protocols.Delivered critical care to patients with heart disease and during heart attack episodes, showcasing an ability to work under pressure and.

Pediatric Emergency Room

Bachelor Of Science - Bs, Nursing

Minor, Public Health

Activities and Societies: Zeta Tau Alpha