Cornelia Hamilton Email & Phone Number

Texas

Sr. Analyst managing clients Group Plans in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines for Part D. Oversee one of our largest revenue clients. Various systems include FACETS, RxClaims, SalesForce, EDI WebTransport, Microsoft Teams and other systems as it relates to beneficiaries reconciliation.

Dallas/Fort Worth Area

• Audit hospital's Medicare and Medicaid cost reports for appropriate reimbursement· • Determine appropriate inpatient and outpatient interim reimbursements rates and other payments by analyzing financial and statistical data of PPS hospitals and providers to approximate Medicare liability· • Perform rate reviews, tentative settlements, desk reviews, cost report appeals, and other audits as needed· • Audit Hospital and clients physician time studies, Organs, GME/IME, Bad Debts, DSH etc.· • Prepare required data and related work papers in accordance with Government Accepted Auditing Standards (GAAS)• Communicate effectively with Audit and Reimbursement personnel to reconcile items on the Cost Report• Verify the hospital's cost reports are in compliance according to CMS guidelines and regulations. • Utilize practical experience with the Medicare program in applying principals, theories and concepts • Perform variance and trend analysis for the revenue and expense numbers listed on the financial statements of the client providers • Recommend improvements to audit program to the development of risk-based audit plans· • Report audit findings to CFO's, CEO's, Directors of Accounting, Internal Auditors, Consultants and Business Office staff etc.· • Review policies, procedures, and contracts to ensure they are in compliance with CMS guidelines• Achieved optimum reimbursement results while meeting CMS deadlines