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Project Analyst / Auditor Resume Example

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PROJECT ANALYST / AUDITOR
Professional Summary

26 Years in the Health Care Industry. Extensive knowledge in data collection, data analysis, auditing within KPHC, researching cash variances, and risk assessment for cash control. Participant in many issue resolutions groups, as well as a contributor in several projects and pilot groups. Excellent interpersonal skills. Relates quickly and easily to a wide range of cultures, personalities and business levels. Work well independently or as an active team player. Hard working, professional, organized and a quick learner.

Skills
  • Knowledgeable in KPHC System
  • Knowledgeable in Word, Excel, WIKI, BI Launch
  • Organization skills
  • Project planning
  • Data Collection
  • Report preparation
  • Account reconciliation processes
  • Safeguards assurance
Work History
Project Analyst / Auditor, 05/2014 to Current
Company Name – City, State
  • Responsible for conducting semi-annual audits for SOX compliance and Registration accuracy for all registration locations in the Riverside Service Area. Identify areas of potential risk; provide findings to department management team; and propose remedial action.
  • Research and reconcile of cash drawer variances from Service Rep daily close-outs, as identified by the Service Rep, regional reports, and other reporting methods.
  • Provide support for the Service Reps, to address issues that come up during the patient check-in process; including coverage issues, cash control/payment issues, technical issues; and assisting with identifying and remediating cash drawer discrepancies prior to close-out, to ensure patient payments and refunds are being recorded and processed correctly.
  • Provide local support to Regional Cash Control operations for cash control needs (exchange and change fund needs, deposit services, Smart Safe servicing, etc.).
  • Prepare the monthly SCPMG Dashboard for Financial Leadership review; which consists of audits, analysis and summary of various financial reports, for accuracy and compliance with laws and regulations. Also included are any issues, trends, and potential risks that have been identified, and action plan to remediate.
  • Provide supervisory back-up for Naomi Halsey, Riverside Central Reception and Urgent Care supervisor.
  • Provide local representation to Regional Front Team at meetings, participate in task groups, project teams and pilot projects.
  • Intern/mentor Nipuna Vidanapathirana; communicating KP processes related to Patient Revenue; preparation of SCPMG Dashboard reports; review of audit documentation; managing the Ingenico replacement project; and offering guidance when needed.
PFS Supervisor, 06/2012 to 05/2014
Company Name – City, State
  • Responsible for training employees; reviewing various accounts; reviewing changes in laws and regulations; interpreting policies and legal requirements associated with collections and appeals for commercial payors.
  • Identified system/workflow issues and initiate resolution. Timely follow up when needed, to monitor resolution. Assist with problems and recommends methods to increase efficiency of collection efforts.
  • Reviewed & provided audit results to appropriate staff and plan necessary actions for performance improvement, if needed.
  • Provided supervision & direction to staff.
  • Reviewed a variety of information, reports and data pertaining to collection activities and work with UBT Co-Lead steps necessary to meet AR goals.
  • Ensured that all collection staff is operating in accordance to policies and procedures of the department as well as within the organization.
  • Reviewed changes in laws and regulations affecting collections; may personally handle difficult cases, negotiate difficult repayment agreements and reviews uncollectable accounts to determine the proper course of action
  • Kept informed of provisions of labor-management agreements and their effects on departmental operations.
  • Discussed work problems or grievances with union representatives.
  • Reviewed Appeal letters from collectors and make necessary changes to comply with governing regulatory entity. Ensure staff is using compliant health & safety codes for appeals.
QA Audit Supervisor , 02/2008 to 06/2012
Company Name – City, State
  • Performed audits of Work Queues, ePremis, 571 Reports and Regional reports to ensure accurate, timely filing of claims
  • Prepared & provided audit results to appropriate manager.
  • Provided training to Billers and Financial Counselors based on audit findings, Key Messages, workflow changes and system upgrades.
  • Identified system/workflow issues and initiate resolution. Timely follow up when needed, to monitor resolution.
  • Collaborated with management and staff to achieve and maintain Steady State and department goals.
  • Identified areas of potential risk and edits.
  • Provided supervision & direction to staff.
Revenue Cycle Biller, 11/2006 to 01/2008
Company Name – City, State
  • Responsible for reviewing accounts for coverage and registration accuracy.
  • Posted charges into Health Connect and verify charges are posted correctly.
  • Cleared edits from WQ's and ePremis.
  • Corrected edits. Create accounts, Process TAR's. Request Medical charts. Update/add coverage, demographics.
  • Processed accounts for all lines of business.
  • Worked reports from manager quickly and accurately.
Medical Records Clerk, 05/1995 to 10/2006
Company Name – City, State
  • Processed chart requests quickly & efficiently.
  • Processed loose-filings and chart 'filebacks' with quality and accuracy.
  • Delivery/Pickup of charts to department modules and utilized pneumatic tube system when necessary to deliver charts in a timely manner.
  • Worked closely with physician and nursing staff to ensure chart access.
  • Handled multiple phone calls and resolve customer difficulties.
  • Utilized the following Mainframe systems: OPAS, PCIS, KPDS and Foundations
Education
Bachelor of Science: Business Studies Business Administration, 05/2019
Southern New Hampshire University - City, State
DeVry Institute of Technology - City
BiologyUniversity of California, Riverside - City, State
BiologyUniversity of California - Davis - City, State
Certifications

National Society of Leadership and Success , Member, May 2019

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Resume Overview

School Attended

  • Southern New Hampshire University
  • DeVry Institute of Technology
  • University of California, Riverside
  • University of California - Davis

Job Titles Held:

  • Project Analyst / Auditor
  • PFS Supervisor
  • QA Audit Supervisor
  • Revenue Cycle Biller
  • Medical Records Clerk

Degrees

  • Bachelor of Science : Business Studies Business Administration , 05/2019
    Biology
    Biology

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