Teresa Forquer Email & Phone Number

Conduct full desk reviews and audits for all provider types. Perform on-site field work.

Responsible for performing resolution-oriented billing and follow-up to achieve accounts receivable recovery and goals of assigned SNF receivables for 7 Skilled Nursing Facilities.Ensures reimbursement through efficient billing operations and effective accounts receivable management.Conducts pre-billing audit for accuracy of claims.Monitors aged accounts receivable and resubmit bills.Evaluates claims returned for errors and makes corrections and recommendations for follow-up, further investigation or documentation as necessary.Resolves account discrepancies by auditing account detail and payment postings within established time-frame set by department procedure.Follows Company and department policies and procedures to ensure the maintenance of adequate documentation to meet audit requirements of internal audits, Medicare, Managed Care and other Third-party payers.

Performed analytical reviews and completed desk reviews of providers that receive Medicare reimbursement in accordance with Centers for Medicare and Medicaid Services (CMS) regulations and Government Auditing Standards. Prepared documented working papers, developed audit conclusions, prepared audit adjustments and final audit reports. Effectively communicated final audit results to providers, CPA’s and consultants. Implemented functions critical to meeting the needs of the Government Programs Division and general contract obligations including proactively looking for potential fraud and abuse.

Performed desk audits on provider cost reports using Medicare regulations and reimbursement principles. Completed reopening requests sent in by providers. Recommended changes where necessary to the automation procedures to help meet departmental workload goals and participated on action teams to improve work processes. Executed database queries to complete monthly program status reports. Trained new audit analysts and field auditors. Selected to oversee work on the completion of special projects at the request of Senior Management, Corporate Senior Management or the Centers for Medicare and Medicaid Services.