• In the Quality Assurance Department: I audit sizable daily sample of claims processed by both Repricers as well as the system pricing. To ensure claims were repriced correctly. With great leadership ability by assigning the QA Claims department their weekly work assignments for daily auditing. To conduct this audit, I’m reviewing the contract and the system rate sheet. Some of my findings are as follow: billing errors, coding errors, fee schedule or rate sheet loaded incorrectly, over/under priced, provider matching incorrectly, rejected claims because non contracted provider, and workflow wasn’t properly followed. Identifying any discrepancies and trends. Enter all findings in HUB database. I also audit loaded rate sheets and Client contracts to assure that they correctly loaded in the host system. Maintaining weekly spreadsheets of all my findings, and reports are presented the Manager.

• In the Revenue Management Department: Auditing zero balance accounts as well as accounts with a variance to assure correct reimbursement received for all Managed Care, Blue Cross, and Workers Compensation claims. Tools utilized for auditing: UB's, itemize bills, appropriate contracts, and EOB's. Auditing of $5-8 million dollars of charges monthly.Some of my findings on an audit: billing errors, incorrectly coded, failed to follow up timely, and or no follow up taken place. I will identify any trends and address the issue(s) to the Manager during the monthly meeting. Any trends identified or discrepancies are logged as I will conduct a process of improvement workshop for related department.• Contract Build: Reviewing the contract and each service type. Applying the correct terms to assure correct reimbursement in the Host system. Using PCON software. • One of my special Focus Projects results: My observation was a pattern of unpaid Implants in which contract(s) shown as a rev code exclusion. I ran a SQL report in ECARE of various payors and notified my contact of my findings, obtained invoice and additional information. Resulting in recovery of over $200,000.00 dollars within a couple of months.• Manually applying adjustment when needed to capitated services, when the Host system didn't adjust.• Daily SQL reports from McKesson, IRM Database, and ECARE, for my daily auditing.

• I appealed all under paid or denied claims for additional pay or if denied for reimbursement on all Managed care, Workers Compensation, Blue Cross accounts. My daily results were: A high percentage on additional reimbursement recovery, and when under paid 65% of the denied claims were overturned. • Worked very closely with the Case Management Department, to verify authorization and obtain any retro-authorization as needed.• Maintained monthly spreadsheets of all underpaid and denied claims, to track all recoveries during month end reportings and presented to the Assistant Director and Manager.

• Daily I billed and collect on all Blue Cross Blue Shield, Managed Care, and Self pay Billing/Collections for the Home Care Department with a high reimbursement percentage. • Daily follow up on claims.• Called for insurance verification. • Accounts payable processor: Weekly processing all vendors invoices for payment. • Payroll Clerk: Bi weekly processed the entire Home Care Department as well as the contraction Therapist payroll. • Data Entry: Cash posting, and refunds applications daily. • Assisted the Referral Coordinator: Contact the Managed Care Groups regarding the initial visit, for Nursing, Therapy, or Social Workers. • Public Aid Assistant: Assisted periodically the Public Aid team with prior approvals.• Maintained monthly spreadsheets to track all billed claims and recoveries during month end reportings.