2268 Crummit Lane
Cranston, RI 2910
Job Objective To obtain a Healthcare Auditor position with dependable company where I can further boost my career in this field.
Highlights of Qualifications:
- Sound knowledge of medical review, chart audits, and quality improvement processes
- Familiarity with Medicaid reimbursement policies and procedures
- Sound knowledge in healthcare coding like CPT4, HCPCS, DRG, ICD-9 and Revenue Codes
- In depth experience with healthcare claim adjudication standards and procedures
- Proficient in Microsoft office products, with expertise in Access and Excel
- Great ability to analyze medical information
- Ability to scheduling own audit projects
- Strong analytical and investigative skills
- Excellent communication and organizational skills
Healthcare Auditor, August 2005 – Present
Connolly, Inc., Cranston, RI
- Performed retrospective chart audits of health care services.
- Collected additional data as necessary to evaluate request applying appropriate clinical criteria.
- Identified payment errors by thorough investigation of medical claim data and records.
- Evaluated audit findings and customer processing guidelines.
- Updated audit findings with the management and assist in error validation process.
- Audited, mentored, supported and suggested improvements and recommendations to meet client satisfaction.
Healthcare Auditor, May 2000 – July 2005
Connolly, Cranston, RI
- Performed audits of health care firms.
- Evaluated, identified, and reported on, quality of health care issues.
- Ensured to determine compliance with health care standards.
- Coordinated with various department managers at health care centre and evaluated internal controls.
- Reviewed financial reports and evaluated recommendations meeting the health care standards.
- Prepared reports to summarize review activity.
Bachelor’s Degree in Nursing, Gwynedd-Mercy College, Gwynedd Valley, PA