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department of compliance intern resume example with 3+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Professional Summary

Enthusiastic Healthcare Administrator eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Motivated to learn, grow and excel in the healthcare industry.

Skills
  • Experience in computerized data entry and information processing systems
  • General medical ethics, telephone etiquette, and excellent communication and customer service skills
  • Proficient in Microsoft Office programs
  • Adaptability
  • Claims Investigation And Research
  • Processing Medical Claims
  • Medical Claims Submission
  • Medical Claims Coding
Education
Ashford University San Diego, CA Expected in 02/2021 Bachelor of Arts : Healthcare Administration - GPA :
Community College of The Air Force Montgomery, AL Expected in 11/2019 Associate of Applied Science : Healthcare Management - GPA :
Dakota High School Macomb, MI Expected in 06/2015 High School Diploma : - GPA :
Certifications

Certified Electronic Health Record Specialists-02/2018

Certified Coding and Billing Specialist- Expected 09/2020

Work History
Health Alliance Plan, HAP - Department of Compliance Intern
City, STATE, 04/2021 - Current
  • Review contracts for compliance and privacy-related issues.
  • Monitor compliance with processes, policies, procedures and standards in regards to collection and management of annual contributions from shareholder companies.
  • Assist Sr. Regulatory Auditors to conduct internal and external audits.
  • Attend department meetings and translate information into minutes.
  • Assist Government Program Oversight compliance specialist review Medicaid documentation.
  • Shadow Fraud, Waste and Abuse/Special Investigations Unit on investigation reviews, examinations and documentation reviews
US Air Force - Medical Affirmative Claims (MAC) Clerk
City, STATE, 08/2018 - Current

· Perform audits and deep document reviews to verify compliance with applicable laws

· Sole Medical Treatment Facility liaison facilitating Medical Affirmative Claims for the Hospital and Air Force, Navy, and Army legal offices, increasing hospital revenue by $120,000 per year.

· Train Military Treatment Facilities' staff during in-processing, quarterly and as needed on procedures to identify potential MAC-related encounters and information required

· Collect and review trauma data electronically or with a paper AF 1488, Daily Injury Log, for accuracy and completeness; forward to MCRP (Medical Cost Reimbursement Program) or local JA office daily

· Initiate/track MAC (Medical Affirmative Claims) packet, AF Form 438, Third Party Liability Notification, for all current & future medical documentation pertaining to the case

· In coordination with the Budget Analyst, conduct a monthly reconciliation of MAC (Medical Affirmative Claims) cases to ensure audit of deposits and receipts match closed cases; that all MAC are collected to the correct line of accounting and fiscal year; and that the DD Form 1131, Cash Collection Voucher, are reconciled in CRIS/DEAMS

· Complete quarterly MAC (Medical Affirmative Claims) reconciliation with the MCRP (Medical Cost Reimbursement Program) of open/transferred/ closed cases to resolve any discrepancies

· Maintain MAC (Medical Affirmative Claims) Log to include date sent to MCRP (Medical Cost Reimbursement Program), (JA for OCONUS), status of claim, amount billed, and amount/date collected

· Collaborate with Patient Administration and clinic check-in clerks to ensure all points of service are verifying patient's eligibility of care, and that patient information is kept up-to-date

· Conduct Third Party Collections compliance audit monthly to ensure clinics are complying with the medical facilities' protocols

· Facilitate expeditious collection and documentation of OHI (Other Health Insurance)

· Processing TPC (Third Party Collections) Inpatient and Outpatient Refunds, increasing hospital revenue by $1.5 million per year.

· Process Medical Treatment Facilities' staff requests for Professional Certification Reimbursements

· Review and approve or disapprove proposed trips based on trip data, estimated costs, balance in budgets, and exceptions to DoD (Department of Defense) travel policy as an appointed Certifying Official with the responsibility for the mission and the authority to obligate funds to support temporary duty travel for the mission

· Collaborate with various agencies and workplaces to extend workplace understanding and enhance compliance

US Air Force - Front Desk/Medical Records Technician
City, STATE, 03/2018 - 08/2018
  • Kept accurate log of all requests for medical information and records.
  • Obtained patient releases for dissemination of information
  • Employed medical administrative skills to enforce compliance with Joint Commission and Unit Effectiveness Inspection requirements
  • Monitored incoming and outgoing fax transmissions for medical records requests
  • Performed inpatient record inventory and retirement functions to ensure compliance with Joint Commission standards
  • Validated registration information on patients
  • Processed incoming and outgoing medical records for unit
  • Maintained HIPAA compliance directives
  • Located and extracted pertinent information from medical files, as well as process patient requests
  • Maintained front desk and waiting area
  • Answered and directed all phone calls
  • Ensured receipt, quality control, storage, tracking, retrieval, and retirement for 30,000+ medical records

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Resume Overview

School Attended

  • Ashford University
  • Community College of The Air Force
  • Dakota High School

Job Titles Held:

  • Department of Compliance Intern
  • Medical Affirmative Claims (MAC) Clerk
  • Front Desk/Medical Records Technician

Degrees

  • Bachelor of Arts
  • Associate of Applied Science
  • High School Diploma

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