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Healthcare Quality Assurance Specialist Resume Example

Resume Score: 70%

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HEALTHCARE QUALITY ASSURANCE SPECIALIST
Professional Summary
Auditor, Medical billing and coding specialist with 3 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.
Skills

  • Superior attention to detail
  • Advanced computer proficiency (both PC and Mac)
  • Strong in MS Access and Excel
  • Ethical approach
  • Expertise in invoice and payment transactions
  • ICD-10 (International Classification of Disease Systems)
  • Billing and collection procedures expert
  • Insurance and collections procedures
  • Understands insurance benefits
  • Office management professional
  • Office support (phones, faxing, filing)
  • Excellent verbal communication
  • Records management professional
  • Medical terminology expert
  • Critical thinking
  • Attention to detail
  • Physician billing
  • Team building
  • CMS-1500 billing forms
  • Filing and data archiving
  • Business correspondence
  • Report development
  • Behavioral health billing and collections
  • Strategic planning
  • Decision-making ability
  • Clear communication skills
  • Hospital inpatient and outpatient records
  • Understands anesthesia coding
  • HCPCS Coding Guidelines
  • Patient chart auditing ability
  • Research and data analysis
  • Adept multi-tasker
Work History
Healthcare Quality Assurance SpecialistJan 2016 - Current
DST Health SolutionsBirmingham, AL

Plan, coordinate, and implements the quality management and quality improvement programs for multiple healthcare facilities. Monitors and aids with quality assurance and compliance functions. Provide consultation and direction to ensure programs and services are implemented at the highest standards and patients receive the highest level of care. Ensures policies and procedures are monitored and updated to include regulatory changes. Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations. Strategically planned methods to achieve operational goals and targets. Investigated, provided and submitted information to Quality Department about special incidents, events and complaints.

Account Receivable Specialist Apr 2014 - Jan 2016
DST Health Solutions Birmingham AL
Responsibilities Reduced time and costs and increased efficiency by introducing new accounting procedures. Renegotiated payment terms with dozens of suppliers. Calculated figures such as discounts, percentage allocations and credits. Verified details of transactions, including funds received and total account balances. Suggested process improvements to secure prompt and regular receipts for the organization. Coordinated approval processes of all accounts payable invoices. Opened and assigned new client accounts. Revamped accounting quality system to prepare for important audits. Conducted month-end balance sheet reviews and reconciled any variances. Rectified escalated accounts payable issues from employees and vendors. Researched and resolved billing and invoice problems. Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
Medical Records Technician/ Certified Nursing Assistant Sep 2010 - Apr 2014
Northway Health and Rehab Birmingham AL

Responsible for maintaining the files included in a patient's health information portfolio, including medical history, symptoms, examination results, diagnostic tests, treatment methods, and other services. Communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information. Codify patients' medical information for reimbursement purposes. Assign a code to each diagnosis and procedure by using classification systems software.

Responsible for assisting the professional staff by performing various resident care activities and related nonprofessional services necessary in caring for the personal needs and comfort of the residents. Responsible for the delivery of resident care (baths, personal grooming, feeding) as directed by the Instructor, Manager, RN, or LPN. Maintained departmental policies and procedures, objectives, quality assurance program, safety, environmental and infection control standards. Strives to incorporate the philosophy and mission of The Facility and to incorporate the Facility's goal of quality care in a personal manner with total regard for individual human dignity.

Additional Information
  • Authorized to work in the US for any employer
Education
Associate of Science: Healthcare Reimbursement2015
Virginia CollegeHomewood, AL
Bachelor of Science: Healthcare Management Current
American InterContinental University 231 N. Martingale Road, 6th Floor Schaumburg, IL 60173
Certifications
  • Certified Patient Account Representative
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Resume Overview

Companies Worked For:

  • DST Health Solutions
  • Northway Health and Rehab

School Attended

  • Virginia College
  • American InterContinental University

Job Titles Held:

  • Healthcare Quality Assurance Specialist
  • Account Receivable Specialist
  • Medical Records Technician/ Certified Nursing Assistant

Degrees

  • Associate of Science : Healthcare Reimbursement 2015
    Bachelor of Science : Healthcare Management Current

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