Jesus Velasquez Email and Phone Number

Create policies and procedures that protect the health system from any gaps that have been identified and linked to local laws and state regulations. Build an alliance alongside the human resource department to create a culture of compliance that has helped promote the use of our anonymous lines of communication which has promoted contact with departments that has led to compliance-related investigations and resolutions. Author training and education material that are mandated by law such as the Fraud Waste and Abuse training that is decimated yearly to over 10,000 employees. Authored other training material across the health system that meet billing, coding, and regulatory benchmark standards based on CMS as well as Florida statute regulations. Create quarterly financial reports for the EEC and EOC based on risk-based audits. Report to each of the departments risk based audit findings guided by our yearly work plan.

Plan and audit the University Of Miami Hospital for compliance issues in a wide range of focused reviews. Identify and address compliance issues and correct such matters applying Medicare and Medicaid guidelines to determine proper IPP and OPPS reimbursements. Review ICD-10 Hospital Coding, APC, CPT, HCPCS and process proper ICD-10 coding as described by coding conventions and guidelines as needed. Adjustment and refund claims accordingly after identifying improper compliance issues and analyze ongoing compliance and regulatory trends. Assemble Compliance Committee Meeting data from reviews and demonstrate all findings to hospital leadership.

Research and resolve incorrect payments EOB and other rejections and other issues with outstanding accounts Set proper ICD-9 to physicians and apply correct service codes to ensure proper billing. Submit claims both electronically and by paper claims if older than 12 months. Review A.R. report and resubmit claims by diagnosing the reason for rejections. Consult with management partner to address vendor issues. Obtain Authorizations and Plan of Care from medical offices in order to submit claims

Processed all requests for release of information by locating and retrieving corresponding medical information pertaining to each request. Reproduced requested information according to service level agreement and in accordance with authorization and/or legal requirements. Managed walk-in requests from physicians and patients. Formulation of all files into the electronic medical record system.

Assembled and index loose reports/documents identified as critical to coding. Trained physicians on Portal/health Care and EPIC systems. Captured all necessary signatures needed for patient treatment.Verified physician orders and attach to patient medical records. Mapped patient charts once discharged and retrieve patient medical record.