Clinical Review Analyst- Corporate Compliance –AnMed Healthcare, Anderson, SC                                          05/2019-Present

·          Develop and prepare routine and special reports of compliance program activities.

·          Research compliance and privacy related topics associated with changes to OIG and CMS regulatory guidelines.

·          Develop and manages audit planning and work plan development, monitoring and educating.

·          Audits/analyze clinical documentation and workflow of all aspects of patient care to ensure following government guidelines including examining billing, clinical documentation, coding and DRG for appropriateness and following regulatory guidelines in all aspects of patient care.

·          Manages and performs financial, operational, process, fraud, clinical and compliance audits for the health system.

·          Responsible for establishing and maintaining a collaborative and consultative relationship with management, staff and physicians.

·          Maintains all organizational and professional ethical standards and completes all internal audit work in compliance with Federal and State regulations.

·          Works under limited supervision with moderate latitude for initiative and independent judgment.

·          Represents Corporate Compliance Team on Revenue Compliance Committee Team.

·          Represent Corporate Compliance on Forms Committee.

·          Trains and advises FCAs on use of ComplyTrack and Risk Assessment Management.

·          Utilizes MediRegs to keep current on regulatory changes.

Quality Coach – Concentrix- Team Cigna, Greenville, SC 01/2017-05/2019

●         Coached processors on insurance claims process by providing expert knowledge and training to improve quality and production.

●         Maintained a learned knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.

●         Tracked trends and developed training needs based on those trends.

Abstractor – US&S – Greenville -contracted

●         Abstracted protected health information from various electronic health records to Epic maintaining the integrity of the information.

Home Health Aide/Caregiver – Right at Home-Upstate, Greenville, SC    04/2015-06/2019

Quality Medical Editor – NUANCE/M*Modal, Remote                                    05/2010- 04/2015

●         Performed qualitative analysis of medical documentation to ensure accuracy, consistency and correlation of recorded data.

●         Followed all HIPAA rules and regulations regarding patient confidentiality.

●         Provided feedback and quality audits