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Healthcare Quality Assurance Auditor Resume Example

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HEALTHCARE QUALITY ASSURANCE AUDITOR
Professional Summary
Healthcare professional with hands-on experience in physician practice business operations, billing and reimbursement, employee training and process improvement. Problem solver with high attention to details and ability to analyze complex data to optimize productivity. Experienced in working with diverse groups of service providers and with co-workers at all levels.
Skills
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)
Work History
Healthcare Quality Assurance Auditor, 03/2006 to 09/2016
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. 





Business Office Manager, 01/1997 to 12/1997
Regent Care Centers – Shenandoah , TX
Managed all aspects of the Business Office of an Ophthalmology practice with five doctors and sixteen staff.

Trained staff on medical billing procedures to decrease the percentage of errors in charge and payment entries. 


Account Specialist III, 08/2001 to 02/2006
  • 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.
Insurance Department Manager, 03/2000 to 05/2001
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.
Operations and Administrative Manager, 02/1998 to 12/1999
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.
Business Office Manager, 01/1997 to 12/1997
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.
Research Assistant Professor, 09/1989 to 12/1992
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.
Account Specialist III, 08/2001 to 02/2006
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.

​

​

​

Insurance Department Manager, 03/2000 to 05/2001
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.

Operations and Administrative Manager, 02/1998 to 12/1999
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.  

Education
MS: Healthcare Administration, 1995
University of Alabama at Birmingham - City, State
Healthcare Administration
MS: Nutrition/Biochemistry, 1984
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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