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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLEWORK EXPERIENCEMLO licensed NMLS # 2378525Hospital Auditor- LeadMMC Group 03/2022 To present.Job Description:- Working for a medical auditing firm. Auditing of medical accounts and Medicaid claims. Data Analysis, Reviewing provider information, with provider type and eligibility. Auditing of rates for different provider on different years. Issuing of letters of rates to different providers. FQHC, RHC medical claims auditing. FQHC, RHC pricing audits. Preparation and Auditing of cost reports for different providers. Prepares tentative and final cost settlements in order to accurately determine providers reimbursement rates for processing of Medicaid claims. Auditing financial and statistical data to verify and monitor accuracy with government procedures. Recommends and adopts compliance rules and regulations to propose adjustments to providers financial data or recommend changes to their policies and procedures. Interfaces with medical claims processing systems including internet authorization applications, document processing function, optical character recognition (OCR) scanning process and PLEXIS Claims Manager (PCM) claims processing software application. Verifying claims on Phoenix software and works with excel sheets and pivot sheets, VLOOKUP, and formulas. Auditing cook childrens claims. Extracting and preparing different reports and statements, forecast and budgeting. Ensuring accurate reporting of all financial statements and analyze all transactions for accuracy. Perform weekly comparisons, reconciliations and payments based on large data sets Audits financial and statistical data to verify and monitor accuracy with government procedures. Bank reconciliation of accounts with different statements and reports. Working with credit and debit payment systems . Acts as a subject matter expert for auditing team. Responsible for coordinating various cost report desk reviews and field audits. Prepares, reviews and signs off on tentative and final cost settlements in order to accurately determine providers reimbursement rates for processing of Medicaid claims. Closing of accounts in month end, quarterly and yearly. Also responsible for training, development, and some management responsibilities for staff auditors. Using salesforce applications for daily functioning with CRM and SAP.07/2014 TO 03/2022ATP2 LLC10665 Stanhaven Place, White Plains, MD, 20695 United StatesClaims Auditor- Team LeadJob Description:Main responsibilities including performing accounting transactions including verifying the accuracy and completeness of accounting data. Analyzes bulk claims and determines the appropriate payment amounts. Analyzes documents for accuracy and proper authorizations. Maintain accounts in an integrated double entry accounting system. Reviews both old and new claims to verify the accuracy of payments and request corrected claims if underpaid. Documents financial transactions to ensure a proper audit trail.-Interfaces with medical claims processing systems including internet authorization applications, document processing function, optical character recognition (OCR) scanning process and PLEXIS Claims Manager (PCM) claims processing software application.-Ensures appropriate diagnostic and procedural coding on HCF A-1500, UB-92 and other claim forms.-financial audit & transparency management - Medicaid - under general direction, audits financial and statistical data to verify and monitor accuracy with government procedures.-responsible for coordinating various cost report desk reviews and field audits of childrens hospitals.-uses knowledge of compliance rules and regulations to propose adjustments to providers financial data or recommend changes to their policies and procedures.-prepares tentative and final cost settlements in order to accurately determine providers reimbursement rates for processing of Medicaid claims.-Working on RAS systems and E-cams software to process claims processing and to validate authorizations.-Pricing of claims under Medicare, Medicaid and CMS guidelines.-working with EXCEL AND pivot sheets.-Preparing, reviewing and filing amended payroll tax forms accurately, efficiently and in a timely manner-MAINTAINS GOVERNMENT CONTRACTS SHAREPOINT SITE TO STORE REGULATORY CORRESPONDENCE/REPORTS/MATERIALS.-KNOWLEDGE OF MEDICARE COMPLIANCE REQUIREMENTS-Processing of claims in Ecams software-Managed audit team with training, assigning, presenting, meeting.10/2013 to 11/2016The Summit1034 Liberty Park Drive, Austin, TX, 78746 United StatesCertified Nursing AssistantJob Description:Interact directly with patients, providing comfort and transportation, monitoring their vital signs and assisting with daily living needs. Demonstrates compassion and serves as a vital link between patients, nurses and other facility staff.-Assist with daily living activities including delivering meals to patients, turning and ambulating patients, providing plenty of fresh water, and extra nourishment between meals.-Help patients with personal hygiene.-Provide adjunct care for the patients, including ice packs, non-sterile dressings and therapeutic baths.-Checks vital signs and records daily information in the patients chart.-Assist the nurses and other staff as needed.-Adheres to professional standards, follow policies and procedures and abide by the Joint Commission standards, as well as federal, state, and local requirements.07/2014 to 12/2013Interim Health Care505 E. Hutland Dr., Austin, TX, 78752 United StatesCertified Nursing AssistantSupervisor: Robin SmithJob Description:Interacted directly with patients, providing comfort and transportation, monitoring their vital signs and assisting with daily living needs. Demonstrated compassion and served as a vital link between patients, nurses and other facility staff.-Assisted with daily living activities including delivering meals to patients, turning and ambulating patients, providing plenty of fresh water, and extra nourishment between meals.-Helped patients with personal hygiene.-Provided adjunct care for the patients, including ice packs, non-sterile dressings and therapeutic baths.-Checked vital signs and recorded daily information in the patients chart.-Assisted the nurses and other staff as needed.-Adhered to professional standards, followed policies and procedures and abided by the Joint Commission standards, as well as federal, state, and local requirements.02/2008 to 09/2010St. Davids Hospital, NAMC12221 N. Mopac Exp. Way, Austin, TX 78758 United StatesPatient Care TechnicianJob Description:Provided daily assistance to patients. Helped patients with their basic needs and collaborated with medical professionals to provide excellent patient care.-Kept patient rooms clean and sanitized.-Assisted patient with everyday needs including personal hygiene and grooming.-Monitored vital signs such as temperature, pulse, and EKG signals.-Took fluid samples and other specimens for testing.-Assisted nursing staff in administering basic treatments.-Performed basic nursing procedures including changing bandages.-Ensured rooms had adequate patient care supplies.09/2007 to 05/2008Stonebridge Health Center11127 Circle Dr., Austin, TX 78736 United StatesCertified Nursing AssistantJob Description:Interacted directly with patients, providing comfort and transportation, monitoring their vital signs and assisting with daily living needs. Demonstrated compassion and served as a vital link between patients, nurses and other facility staff.-Assisted with daily living activities including delivering meals to patients, turning and ambulating patients, providing plenty of fresh water, and extra nourishment between meals.-Helped patients with personal hygiene.-Provided adjunct care for the patients, including ice packs, non-sterile dressings and therapeutic baths.-Checked vital signs and recorded daily information in the patients chart.-Assisted the nurses and other staff as needed.-Adhered to professional standards, followed policies and procedures and abided by the Joint Commission standards, as well as federal, state, and local requirements.08/2005 to 04/2006LaQuinta Inn4300 E. Pine St., Deming, NM 88030 United StatesNight AuditorJob Description:Balanced the revenue and expense transactions that occurred during the day at the inn. Responsible for the overall operations and appearance of the front desk of a hotel. Attended to the needs of guests, especially during check-in and check-out times.-Registered guests into the hotel in a prompt and courteous manner using up-selling techniques to maximize room rates.-Greeted, registered, and assigned rooms to guests.-Answered phones in a prompt, efficient, and friendly manner.-Responded quickly to guest requests or complaints in a friendly manner with appropriate action steps.-Followed up with guests to ensure guest satisfaction.-Balanced and audited for accuracy room revenue, room and tax charges, cashiers reports and guest accounts.-Completed and transmitted daily management and accounting reports and supporting documents.-09/2000 to 03/2005Golden Doors, llcWadi Kabir, 112, Mascat, OmanAccountantJob Description:Responsible for maintaining financial records. Analyzed financial information and used that information to prepare reports. Maintained and determined records of assets, liabilities, profits and loss and tax liabilities. Made numerous computations each day, calculated and recorded data.-Examined accounts and resolved difficult reconciliations requiring an analysis of adjustments and corrective entries in the account.-Maintained records of assets and liabilities.-Ensured the maintenance of organizations payroll accounts in prescribed format.-Updated accounts payable and accounts receivables.-Assisted in balancing sheets and income statements.-Assisted with reviewing income and expenses.-Prepared regular reports, creditors list, debtors list.-Created auditing techniques, including new methods to calculate combined analysis of various financial programs and systems.-Budgeting and Forecasting-Preparing, reviewing and filing amended payroll tax forms accurately, efficiently and in a timely manner-Preparing, reviewing and filing amended payroll tax forms accurately, efficiently and in a timely mannerEatco 01/1997 -Wadi KabirSales Supervisor.01/1997 to 12/1999SM DistributorsMumbai, Maharashtra IndiaMarketing ExecutiveJob Description:Responsible for the marketing and sales efforts for the food products to retailers and wholesale outlets.-Responsible for the supplies and sending demand requests to manufactures.-Managed and supervised Sales Team members.-Monitored cash payments.-Kept record of debtors and creditor accounts.04/1994 to 04/1996Al Dahalawi Co.Jeddah, Saudi ArabiaSpare Parts ControllerJob Description:Responsible for all warehouse management activities such as inventory control, receiving and distribution of parts, and arranging parts assigned to various locations. Created bins for new products. Ordered parts from manufacturers and predicted potential demand. Maintained inventory records both manually and by utilizing software.EDUCATION:St. Thomas College Major: AccountingKozhencherry, India Minors: Business, CostingBachelor of Science 3.0 / 4.0 GPADate of Completion: 05/1989Austin Community College Major: NursingAustin, TX, United States Minors: N/ASome coursework completed 3.0 / 4.0 GPAJava, C++, HTML,QA Manual and Automation Tester Course completed and projects completed.Salesforce Training Completed 12/03/2021, coding.Mortgage Loan Originator(MLO) Licensed 4/29/2023ADDITIONAL INFORMATION:PROFESSIONAL SUMMARY:Resourceful and reliable General Clerk with 10+ years of experience organizing and filing large volumes of business-critical information, preparing error-free internal correspondence and leveraging fast typing speed to accomplish office tasks quickly and efficiently. Adept at addressing multiple accounting projects simultaneously with complete professionalism and accuracy. Rich client-based history including serving hospital patients as a Certified Nursing Assistant and assisting businesses as Accountant.SKILLS:Accounting, Financial Statements, Account Payable, Filing Systems and Procedures, Financial Databases, Microsoft Office (Word, Excel with excellent skills in VLOOKUP and pivot tables, PowerPoint, Access, Outlook), Organizational and Time Management Skills, Customer Service, Strong Oral and Written Communications. Well versed with medical terminology. |
