Licensed Agency Billing Compliance Auditor Resume Example VISITING NURSE SERVICE OF NEW YORK

LICENSED AGENCY BILLING COMPLIANCE AUDITOR

Professional Summary

Driven and compassionate health care professional with over 12 years of hands-on experience in fast-paced home care company, Manager, Supervisor Compliance auditor. Experience accountable and responsible with a strong focus on patient wellness. Strong decision maker who understands the importance of compassion and patience.

Education and Training

High School Diploma : Business Management Park West High School － New York City, Ny Business Management

Diploma : Business Management Bronx Community College － Bronx, New York

Business Management

Skill Highlights

Proven patience and self-discipline
Microsoft Word 1 & 2, Word Perfect, and Excel, Power Point Confident public speaker
Conflict resolution
Office equipment: Copy, Fax, Postage Meter, and Patient-oriented
Microfiche, Typing Personal and professional integrity
Relationship and team building
Sound decision making
Critical thinking proficiency

Professional Experience

Licensed Agency Billing Compliance Auditor
January 2014 to July 2014 VISITING NURSE SERVICE OF NEW YORK － NY

Audited, analyzed and reviewed VNSNY systems and workflows to ensure the accuracy and compliance of paraprofessional services billed to VNSNY by licensed agencies.
Conducted regular audits of VNSNY systems and system applications to ensure that paraprofessional visits were processed timely and to ensure that third party payers are billed accurately.
Interpreted, evaluated and assisted with the resolution of inquiries from Contract Administration and licensed agency staff pertaining to the functional operations of all VNSNY systems.
Communicated all complex and unresolved issues to supervisor for intervention as necessary.
Researched discrepancies for all un-reconciled paraprofessional visits in a timely manner in collaboration with regional clinical staff and licensed agency staff.
Conducted regular on-site audits at licensed agencies to ensure that agencies adhere to VNSNY and State visit compliance standards and expectations.
Conducted follow up audits as necessary when licensed agencies did not meet guidelines.
Prepared documentation after each audit to support audit results, conclusions and plans of correction.

Account Manager
April 2012 to January 2014 VNSNY CHOICE HEALTH PLAN

Managed all provider contracts in designated territory, including recruitment, credentialing, re-credentialing and relationship maintenance through regular visits and ongoing contact with existing and potential providers.
Oversee implementation of contracts including entry on VNSNY computer systems, introduction to Regional and health plan staff, and inclusion in provider directories.
Prepared materials for and orient providers to contract terms and operating requirements; VNSNY CHOICE program and eligibility requirements, and service coordination.
Administered changes and renewals to provider contracts in conjunction with the Provider Relations management staff.
Monitored contract performance of network providers and serve as a liaison between the Regional Operations and the Providers to ensure that policy and procedures are being adhered to.
Coordinated site visits on a periodic basis.
Coordinated Regional provider needs assessments to ensure that provider network meets the Regions' needs.
Participated in special projects and performs other related duties as assigned.
Trained new staff on how to recruit new doctors on to our VNSNY CHOICE Network Audited Social Day Care's in our VNSNY CHOICE Network to ensure they are in compliance with our contract.
Analyzed facility activities and data to properly assess risk management and improve services.
Supervised and evaluated the activities clerical, service, maintenance and other personnel.
Routinely evaluated the overall resident care within the facility and diligently enforced high standards.
Incorporated evidence-based care into practice environment to ensure high quality care for patients and their families.
Observed strict confidentiality and safeguarded all patient-related information.

Supervisor/Quality Monitoring Auditor
September 2001 to April 2012 VISITING NURSE SERVICE OF NEW YORK － NY

Monitored Licensed Home Health Care agencies overall performance including conducting on-site announce and unannounced audits, to ensure contract compliance and to monitor over all quality of service.
Collected and analyzed findings to department licensed agencies and Quality management services department.
Wrote up narratives, observation and recommendations for licensed agencies in areas where they fell below the benchmark.
Audited licensed Home Health Care agencies on their billing process and ensure that they billed VNSNY appropriately.
Recouped Home Health visits that are billed incorrectly to VNSNY.
Audited Pharmacy companies that are contracted by VNSNY to ensure Quality of service to our VNSNY patients.
Assisted in the design and execution of programs that contributed to a 5% growth of the organization in the 2012 fiscal year.
Cooperated with other health related agencies and organizations in community activities.
Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
Diligently monitored the QA (Quality Assurance) program to improve performance and maintain high standards of care.
Minimized staff turnover through appropriate selection, orientation, training, staff education and development.
Established and maintained positive relationships with government regulators, residents, families, other area health care providers, physicians and community at large.
Coordinated the daily operational activities of the department.
Ensure that all units are appropriately staffed and that adequate staff available during hours of operation.
Ensured that all calls received in the department are answered timely and professional manner.
Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.
Reviewed and approved time cards for processing by payroll department.
Carefully selected, developed and retained qualified staff, as well as trained 10 new staff annually.

Languages

Bilingual English/ Spanish Advanced and fluent Staffing management ability

Skills

agency, billing, clerical, Conflict resolution, Contract Administration, contracts, Critical thinking, decision making, documentation, Bilingual English, Fax, functional, government, team building, materials, Excel, Power Point, Microsoft Word 1, Network, Office equipment, payroll, personnel, Postage Meter, public speaker, Quality, Quality management, QA, Quality Assurance, recruitment, risk management, Sound, Spanish, Staffing, supervisor, Typing, Word Perfect

Resume Overview

Create a job alert for [job role title] at [location].

About About

Help & Support Help & Support

Languages Languages

Customer Service Customer Service

Licensed Agency Billing Compliance Auditor Resume Example

Resume Score: 90%