Healthcare Quality Assurance Auditor Resume Example
| Microsoft word, Excel, Power Point Office applications: Microsoft Word, Excel, Lotus Notes Medical Billing systems: Medisoft, Practice Manager DOS and Windows versions, AWD (electronic records) |
Regent Care Centers – Laredo , TX
Analyzed performance of Business Process Departments using practice management software to ensure adherence to company procedures and insurance payers policies.
Recommended steps to improve workflow and maximize quality and productivity standards.
Managed special projects with department managers to optimize physician reimbursement.
Led all the departments to achieve optimum performance consistent with the company goals and objectives.
Regent Care Centers – Shenandoah , TX
Trained staff on medical billing procedures to decrease the percentage of errors in charge and payment entries.
- Managed the receivables and special projects for the largest medical client of an healthcare outsourcing company: Resolved commercial, government and HMO outstanding medical claims for clients in multiple states.
- Appealed insurance denied claims and patient disputes with 100% success.
- Coordinated with department managers to develop and maintain internal protocols.
- Trained employees to apply processes correctly, and to improve quality metrics in claim billing.
- Consistently maintained receivables aging to less than 60 days.
- Nominated for Company Excellence in Physician Practice Services Award.
University Of Kansas Medical Center – Manhattan , KS
- Managed the Corporate Insurance Department of an Optometry practice with six satellite offices: ometry practice with six doctors: Supervised account receivables, balanced charges and payments, and generated monthly billing reports.
- Provided insurance training and computer support to all clinic managers and staff.
- Developed a comprehensive company notebook of insurance billing and reimbursement protocols.
SCHAEFFER EYE CENTER – City , STATE
- Managed the daily operations of an independent diagnostic laboratory with nation-wide customers: Reorganized the billing office: installed a new billing software, set up electronic billing and developed protocols to minimize billing errors.
- Managed account payables, reconciled budget and generated monthly financial reports.
- Served as liaison with the Board of Directors and venture capitalists during company buy-out.
ATHEROTECH INC – City , STATE
- Managed the business office of an Ophthalmology clinic with five doctors and sixteen staff:.
- Reduced the percentage of errors in charge entries and payment postings by 15% within the first six months.
OMEGA EYE CARE CTR VISION AMERICA – City , STATE
- Designed a research program to study cell growth using molecular biology techniques.
- Obtained an intra-mural grant to establish a laboratory.
- Published nine articles in peer-review journals.
UNIVERSITY OF ALABAMA AT BIRMINGHAM – City , STATE
Managed the receivables and client projects for the largest medical client of a healthcare outsourcing company.
Resolved commercial, government and HMO claims for physician practices in multiple states with a 100% success.
Nominated for Company Physician Practice Services Award for achieving optimum client satisfaction.
DST HEALTH SOLUTIONS – City , STATE
Managed the Corporate Insurance Department of an Optometry practice with six satellite offices.
Supervised account receivables, balanced charges and payments and generated monthly financial reports,
Skillfully developed department procedures in order to provide billing software and physician reimbursement training to clinic managers and staff.
SCHAEFFER EYE CENTER – City , STATE
- Organized the business office of an independent diagnostic laboratory to meet the production objectives set by the Board of Directors.
- Installed a new billing software and developed protocols to maximize turn-around.
- Balanced monthly budget and achieved a substantial increase in profit within the first five months.
University of Alabama at Birmingham - City, State
Healthcare Administration
Pierre & Marie Curie University - City
Nutrition/Biochemistry
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Resume Overview
School Attended
- University of Alabama at Birmingham
- Pierre & Marie Curie University
Job Titles Held:
- Healthcare Quality Assurance Auditor
- Business Office Manager
- Account Specialist III
- Insurance Department Manager
- Operations and Administrative Manager
- Research Assistant Professor
Degrees
- MS : Healthcare Administration , 1995
MS : Nutrition/Biochemistry , 1984
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