Allison Goldstein Email & Phone Number

Charlotte, Nc, Us

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 guidelines which reflected strong leadership skills and the ability to drive cross-functional initiatives.Identified $14M in savings by leveraging strong analytical skills to streamline Emergency Room (ER) billing practices, as well as analyzing medical records to verify service provision which was crucial in correcting billing errors.Achieved cost-savings of $2.5M by participating in an audit for ESRD dialysis treatment compliance which involved developing queries that ensured adherence to treatment protocols.Optimized payment structures in ER operations by adjusting observation unit billing rules which aligned reimbursements closely with actual services provided, resulting in cost savings of $358K.Implemented Trauma Activation Review protocols, leading to more accurate billing processes for specialized trauma response services and capturing $130K in savings.

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 of patient needs and healthcare guidelines.Drove change management and process optimization by conducting root cause analysis on audit discrepancies and providing necessary recommendations on process enhancements.Achieved continuous 100% quality score in audit reviews which demonstrated commitment to excellence and accuracy.

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 standards of excellence in auditing emergency room records and billing practices.Steered and gained approval for ER E/M-only project, focusing on addressing and rectifying overbilling issues by auditing and adjusting provider billing practices based on actual service delivery.Engaged in critical and high-priority case research including resolving manual leveling and legal claims by utilizing a deep understanding of complex billing issues and regulatory compliance.Acquired significant experience in using CRM, CISpro, EHUB, Excel, PowerPoint, MRM, Mentor, and CCP Service Read.

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 manage complex patient conditions.Interacted with medical sales representatives and gained insights into the sales process and device features.

Pediatric Emergency Room

Bachelor Of Science - Bs, Nursing

Minor, Public Health

Activities and Societies: Zeta Tau Alpha