Reimbursement Consultant resume example with 20+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Executive Profile
Thirty years of administrative experience in small and large health care settings, combining decision-making with a professional attitude. Possess strong interpersonal communication skills resulting in a high degree of client satisfaction.
Skill Highlights
Guest services
Inventory control procedures
Merchandising expertise
Loss prevention
Cash register operations
Product promotions
Core Accomplishments
Professional Experience
Reimbursement Consultant, 09/2009 - Present Banner Health – Phoenix, AZ,
Prepare parts of written reports to clients.
Perform Medicaid Audits for Graduate Medical Education.
Work on the proposal writing teams, including writing sections, coordinating efforts, and preparing proposal submissions.
Assess best practices and compliance errors and provide technical assistance to a wide variety of stakeholder and clients.
Submit appeals for audited cost reports and request reopening of filed cost reports as needed in order to obtain reimbursement maximization.
Recovered $2,500,000 in Bad Debts underpayments for fiscal year 2011 for DHH Behavior Health Hospitals.
Recovered $40,000,000 in DSH underpayments for fiscal year 2010 for the DHH Behavior Health Hospitals.
Recovered 50,000,000 in DSH underpayments for fiscal year 2013 DSH Audit Examination for DHH Behavior Health Hospitals.
Responsible for the planning and performance of scheduled audits, follow-up audits, and special audits requests from Louisiana State University System.
Performs the inspection of cash controls records, Payroll records (Peoplesoft) and other selected financial activity as needed.
Work with outside fiscal intermediaries on Medicaid/Medicare Cost Audit Issues.
Perform Medicaid Audits for Graduate Medical Education.
Supervise the observation of the physical inventories of supplies and moveable property conducted by the hospital staff to fulfill the Louisiana Administrative Code requirements and financial statement requirements.
Participate in audits performed by external auditors, fiscal intermediaries, government oversight agencies and the Legislative Auditor's Office.
Perform the examination of financial statements (General Ledger System), reconciliation's journals and other financial transactions for executive management.
Assist in preparation of materials for training seminars administered by the agency.
Conduct extensive policy and procedures research.
Assist in the preparation of draft reports and documentations for System Audit Committee's.
Corporate Director, 01/2007 - 07/2007 Medical Management Options – City, STATE,
Managed four subordinate supervisors who supervised a total of three to six employees in Payroll, Accounts Payable, Billing and Account Receivables.
Responsible for the overall direction, coordination, and evaluation of business units.
Carried out supervisory responsibilities in accordance with the organization's policies and applicable laws.
Interviewed, hired and trained employees: planning, assigning, and directing work; appraising performance; rewarding and discipline employees; addressing complaints and resolving problems.
Directed preparation of budgets, collections, and prepared necessary supporting documentation and justification.
Generated all billing and reimbursements projections using Excel and Great Plains software.
Prepared reports required by regulatory agencies.
Reimbursement Auditor, 01/1999 - 01/2007 Blue Cross/Blue Shield Of MS Dba Tri Span Health Services – City, STATE,
Train, evaluate, oversee, and direct audit team activities.
Posses advanced organization and time management skills to conduct multiple projects and deadlines.
Posses a detailed knowledge of Medicare/ Medicaid Reimbursement regulations, guidelines, procedures, bulletins, interpretations, and has the expertise to apply the knowledge in conjunction with generally accepted accounting and auditing procedures.
Prepare parts of Medicaid Cost Reports for Critical Care Hospitals, Teaching Hospitals, Rural Health Clinics, and Mental Health Clinics.
Supervise the field auditors.
Use advanced technology to process financial transactions and analyze results for regulated and non- regulated business.
Provide financial and audits result and communicate findings to management and the Department of Health and Human Services.
Provide financial transaction and information delivery systems including standard reporting tools to the business and government units.
Provide analytical support for external audits and regulatory filings.
Special projects to develop new accounting policies/processes and analyze corporate performance.
Education
MBA: , Expected in May 2005 - University of Phoenix - , PA GPA: 3.85
: , Expected in 1996 - Management Training Institute Louisiana State University - , GPA:
Bachelor of Science: Business Accounting / Business Management, Expected in 1982 - Southern University - , GPA: Business Accounting / Business Management
Professional Affiliations
National Association of Accountants, America Association or Internal Auditors, National MBA Association, Girls Scout of America, Alpha Kappa Alpha Sorority, Alumni Board President- Redemptorist High School, School Board Member -Redemptorist High School, Louisiana Department of Health and Hospitals Fiscal Task Force Member, Health Financial Management Association Member.
1
Interests
Tri-Span Health Services - Employee of the year 2001, 2002, 2003, 2005
Girl Scout Troop 952 - Volunteer of the year: 2000, 2002, 2003, 2004, 2005
Skills
accounting, Accounts Payable, Administrative, agency, auditing, Billing, budgets, Critical Care, clients, delivery, Department of Health, directing, direction, documentation, executive management, external audits, financial, financial and audits, financial statements, General Ledger, government, Great Plains software, inspection, materials, Mental Health, Excel, Office, Payroll, Peoplesoft, policies, processes, proposal writing, proposal, reporting, research, seminars, supervisory, Teaching, technical assistance, time management, written
Additional Information
AWARDS:
Tri-Span Health Services - Employee of the year 2001, 2002, 2003, 2005
Girl Scout Troop 952 - Volunteer of the year: 2000, 2002, 2003, 2004, 2005
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Resume Overview
School Attended
University of Phoenix
Management Training Institute Louisiana State University