Coordinate pre-disbursement audits (quality review) of targeted claims, providers, or processes, such as interest payment, misdirected claims and auto adjudicated claims.Maintain a 99% quality and accuracy on all CMS-1500 and UB04 claims audited quarterly. Maintain a 99% quality and accuracy with zero findings on CMS-1500 and UB04 claims when audited by Mazars quarterly.Contribute to successful audits with zero findings when being audited by the California Department of Managed Care.Run Virtual Examiner (VE) Software to create reports and perform data analysis to identify unbundling, incorrect coding, inappropriate billing, and possible fraud for services provided by vendors.Complete tort liability reporting by compiling all necessary third party liability claims information and submit to Department of Health Services.Audit claims with payment amount over $10,000 for both professional CMS-1500 and hospital UB04 Claims.

Applied knowledge and critical thinking skills to pay Professional CMS-1500 and Hospital UB04 claim forms in a timely and accurate manner by conducting the proper research and analyzing billing inconsistencies.