quality assurance manager resume example with 5+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA94105
:
Summary
Seeking to work for a company that offers challenges as well as opportunity for growth
and development as a good professional. A company that offers incentives for higher
education in and out of the healthcare arena. Familiar with healthcare systems,
operations, procedures, regulations, insurance, billing and coding and compliance within a
managed care environment.
Ability Summary
Ability to work with a diverse population, communication and presentation skills, forward
looking, strategic, responsible, energetic and achiever, with the ability to trouble shoot
situations and find quick resolutions. Team player and motivator. Familiar with HIPAA and
other regulatory and compliance statutes, stark laws, billing and coding procedures, and
clinical operations as well as home health operations in all areas of the healthcare
field.
Skills
Accounting
Administrative
Approach
Bookkeeping
Business process
Business processes
Charts
Clinical Leadership
Cold calling
Makes copies
Data entry
Database
Documentation
Filing
Financial
Forms
ICD-9/10
Materials
Mentor
Office
Monitors
Office management
Payroll
Personnel
Coding
Quality improvement
Receptionist
Record keeping
Supervisor
Telephone
Phone
Plan of Treatment
Education and Training
University "Marta Abreu" of Las VillasSanta Clara, CUExpected in 2002 ā āBachelor's Degree
Degree:Laws - GPA:
Review all Medicare and other episodic payers' clinical records at the local level to
assure appropriate documentation for reimbursement.
Oversee the maintenance of clinical records and files to comply with Conditions of
Participation, using measurements, as licensure, certification, and accreditation results.
Audit charts for clinical oversight and compliance and adherence to the Medicare
guidelines.
Identify clinical problem areas and document deficiency trends in a proactive approach.
Educate administrative and clinical associate staff in the correction of these
deficiencies.
Assist with quality improvement and Medicare compliance training program.
Utilize
Gentiva Health Services approved reference materials to resolve inadequacies.
Collaborate with the Clinical Leadership and clinical associate staff in resolving
complex clinical issues.
Review OASIS documents for accuracy and completeness prior to locking and submitting
data electronically.
Explain and mentor clinicians and staff on conditions of
participation and on billable skilled visits.
Educate and mentor clinicians one on one (in person or over the phone) regarding
concerns, questions, accuracy of OASIS data, and other related documents, that are being
reviewed.
Facilitate the ICD-9/10 coding of the Plan of Treatment based on OASIS data and patient
assessment documentation that is assessed at the bedside.
Keeps informed to supervisor of problems or issues, monitors supplies needed.
Perform other duties as assigned.
Crossroads Diversified Services - Case Manager Bakersfield, CA, 01/2012 - 09/2015
Maintain all staff and contract personnel files.
Responsible for sending deficiency notices to personnel.
Maintains personal master files.
Maintains master files of personnel evaluations and makes copies on monthly basis for
the appropriate department supervisor.
Assumes various duties as directed by the administration in reference to personnel and
accounting.
Assist in miscellaneous bookkeeping function.
Responsible for up keeping all evaluation forms.
Submits bills to appropriate health care agencies.
Assist the full time and part time payroll procedures.
Acts as receptionist for the office, answering inquiries of general nature form
applicants, visitors and professional staff, assisting them in a friendly and cooperative
manner.
Meets on a regular basis with the administrator concerning work related problems and
needs.
Performs other duties as directed by the administrator.
Jbs Usa - Medical Front Office Assistant Horsham, PA, 04/2013 - 03/2014
Greet patients as they arrive and provide appropriate information.
Answer telephone and provide information regarding medical procedures.
Schedule and reschedule patients' appointments.
Cancel patients' appointments and provide them with new dates.
Obtain patients' information and record it in the database.
Call up patients and remind them of their appointments.
Manage filing and record keeping activities.
Order supplies and forms for the medical office.
In charge of all aspects of office management: Dealt with patients and medical staff one-on-one to schedule medical visits, cold calling, data entry, filing, and multiple phone line answering system.
Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
M & N Professional Services Home Health Care, Inc - Quality Assurance City, STATE, 06/2010 - 01/2012
Perform audits of claims processed or initial set-up to assess compliance with company
procedures and contract language.
Review existing business processes to identify inefficiencies in processing and
potential weaknesses that may cause inaccurate processing.
Coordinate finding with the
training coordinator for documentation.
Assume lead role in assuring compliance and financial regulations are being followed,
including HIPAA and Best Claims Practices.
Observe internal control procedures and evaluate their effectiveness.
Manage projects, including departmental and division initiatives management
efficiently.
Remain current on technological and business process trends in the industry.
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