• Plan audit engagements under the direction of the Chief Audit Executive by preparing risk assessments, redesigning or updating audit work programs in accordance to professional audit standards and best practices and researching or gathering relevant information from the credit union to perform the audit work.
• Perform financial center audits independently with moderate supervision to assess the effectiveness of operation controls and to ensure credit union's policy and procedures along with state laws and regulations are followed.
• Perform compliance audits independently with moderate supervision to identify, evaluate and communicate compliance issues and needed corrective actions to ensure adherence to regulatory requirements or third party agreements.
• Perform operational audits independently with moderate supervision to assess the effectiveness and efficiency of controls over the credit union's systems and business processes and to make best practices recommendations and suggestions to reduce costs, enhance revenue and improve profits.
• Prepare clear, complete, and well-organized work papers and audit reports that document and support the audit scope, audit procedures and audit conclusions made meeting required deadlines.
• Effectively communicate (either written or verbal) risk management issues and internal operations deficiencies including their severity and impact to all areas of the credit union.
• Perform follow-up reviews to verify that necessary corrective actions have been implemented to correct previous findings and/or recommendations.
• Manage and track member complaints from the Better Business Bureau, NYD DFS, Attorney General's Office and other source of complaints.
- Junior Auditor at AmeriCU
- at Adirondack Bank
- AVP-Branch Manager at Adirondack Bank
- Teller Supervisor at Berkshire Bank
8 months at this Job
- B.S. in Mathematics - still
Retrospective Auditing of Healthcare claims via data mining techniques and multiple concepts on behalf of Kaiser Permanente (KP), an Insurance payer to find over payments, define issues found, document and include supporting evidence
● Create custom queries using SQL to develop reports that produce potential overpayments utilizing JOINs and Functions to manipulate data
● Integrated Data from Excel sources, and SQL sources
● Load rules into CAT (Contract Auditing Tool) for contracted facilities, providing a means to setup up the providers contract logic with the resulting data set reviewed for overpayments by the entire team
● Create new rules using SQL case statements to translate new contract language to the CAT pricing logic
● Written and accurate professional response to internal QA, client failures and provider disputes
● Utilize Webstrat and other pricing tools to determine if providers were accurately reimbursed for Medicare and Medicaid members
● Consistently finding new ways to audit, ability to analyze existing build code and translating it into improved SQL queries for intended concepts
● Consistently exceeds the monthly productivity goal of $250,000 in findings while maintaining over 95% on the quality score
- Junior Auditor at Cotiviti Healthcare
- Commission Analyst at Mobile Destination Incorporated
3 years, 5 months at this Job
- Bachelor of Business Administration in Accounting - Accounting
- Tax Consultant & Junior Auditor at Paras S. Shah & Co
- Accounting Analyst & Internal Auditor at J. Vasania & Associates
2 years at this Job
- B.S. in Business Administration - Business Administration
- A.A.S. in Accounting Specialist - Accounting Specialist
- Chartered Accountant
Melrose Park, IL
• Key responsibilities listed above Dates From-October 2010 To April 2012 Junior Auditor, Job Giraffe Staffing Agency - Chicago, IL
• Payment Posting, Bill of landing, Invoicing
• Payment Reversal, Collection notices, Book keeping
• Weekly reports and audit spread sheet maintenance
- Junior Auditor, Job Giraffe Staffing Agency at Telecom Operator, West Lake Hospital
1 year, 4 months at this Job
- Bachelor of Nursing - Nursing
- - Medical Assistant
2014 - Present Participated in auditing small and large sized companies. Ensuring that accounts are presented in conformity with the prevailing legal and regulatory requirements Producing auditing reports. Enrolled in JCPA.
- Junior Auditor, Accountant at Audit Bureau For Public Accountants & Consultants
- Accountant, Intern at Jordan Islamic Bank
5 years, 5 months at this Job
- B. S - Accounting
Use of Standard reports & custom queries to Audit Healthcare Providers paid claim data to generate recoverable claims
• Review provider contracts, interpret terms & determine if overpayments exists in the paid data
• Indentify duplicate payments, terminated members, billing & coding issues
• Prioritize assignments, meet monthly and report based productivity goals
• Price or Adjudicate Medicare Risk related claims with CMS PCPricer & Ingenix Webstrat. Price Medi-Cal related claims using the APR-DRG pricer
• Communicate with our external client regarding claim and file issues, new concept reports & effectively rebut non- approved claims
• Train & guide the collection team on professional & successful claim presentation to providers to maximize speed & recovery results
• Consistently meet ID goals of $3,400 in claim recovery while maintaining a 99% audit quality rating
- Junior Auditor at Connolly Healthcare
- Customer Service Representative/Training Manager at Dish1up
- Caregiver at Denton State School
7 years, 9 months at this Job
- diploma - medical assistant
- diploma - english
Apply policy specific guidelines to individual claims and processes complex claims according to that policy and internal guidelines. Identify issues with claims and communicates those issues back to the claimant. Verbally / electronically communicate policy specifics to claimants and providers. Communicate and collaborate across all departments to identify and resolve issues within the LuminX system. Test Beta versions of system improvements to ensure functionality for departmental use and assist in implementation of system-wide upgrades. Key Contributions:
• Achieve and exceed a consistent monthly financial accuracy of 99% on all processed claims.
• Obtain and surpass a claims accuracy of 95% on all processed claims.
• Perform daily claim functionality at an average of 60% above required output.
• Lead resource for other examiners when questions arise on proper claims processing practices.
• Perform quality control audits for financial and claim accuracy.
• Analyse, identify, and formulate resolutions to claims issues using reporting methods.
• Maintain lines of communication with hundreds of clients to apprise them of the status of outstanding claims.
• Assist management with various job duties and oversight of other examiners.
• Manage team mailbox and route external and internal requests to the proper individuals.
- Excess Major Medical Examiner/Junior Auditor at AIG
- Surgical Coder/Appeals Analyst at Associated Orthopaedics
- Medical Coder and Clinical Manager at Sutton Place Physical Therapy
- Medical Coder and Patient Accounts Manager at Children's Hospital Boston
4 years, 5 months at this Job
- - BABAM Business Administration
- - BAADM Business Administration
• Responsible to perform payment and variance and review activities related to incorrect processing of claims across Ensemble Health Partners,
• Understanding insurance contract terms, and reviewing under payments to determine if additional payment amount can be requested.
• Taking responsibility of client relationships with a variety of clients to build positive relationships.
• Managing multiple terms and providing performance feedback to all members of those teams when engagements end. It takes dedication, but we believe in you and value your feedback.
• Anticipating and addressing client concerns and resolving problems as they arise.
• Promoting new ideas and business solutions that result in extended services to existing clients.
• Prepare detailed contract value analysis reports monthly which includes a comprehensive analysis on site review of each and every contract with our hospital and physician groups.
- Junior Auditor/Medical Billing and Collection at Plan 2 Account
- Office Assistance Specialist at Encircle Inc
1 year, 5 months at this Job
- High school
Review and verify enrollment data of charter school student population in accordance to Department of Education standards.
● Evaluate school register information to determine entire population has been accounted for including students that transferred in and out during the course of the academic year.
● Evaluate lunch status classifications of respective students to determine if they were done in accordance to Department of Education Guidelines
● Review special education student documentation (individual educational plans, social work case files to determine if they were properly classified under department of Education regulations
● Review certifications of teaching staff to determine if they have the necessary qualifications (Praxis test scores, degrees from accredited colleges/university)
● Review sampled purchase orders from various school vendors to determine if purchases; were properly authorized, correctly listed on school ledger and fund accounts and were approved by Board of director in monthly meeting minutes.
● Prepare detailed reports on school audits and help develop necessary solutions to discrepancies encountered.
● Audit of financial statements and internal controls
- Junior Auditor at ILori CPA LLC
- Tax Preparer at VIP Tax Services
- Intern at Newark Community Economic Development Corporation
- Loan Specialist at Wells Fargo Home Lending
1 year, 9 months at this Job
- - Accounting
- B.A - Business Administration
Supervisor: Campaigns; Flying fish, Castle Milk Stout, Miller, Carling Black Label, Castle lite. Connexit marketing promotions and events
- Junior Auditor at
- Junior auditor/Team leader at Energy audit at King Edwards
- Brand Ambassador/Supervisor at Masingataville
- Supervisor at Campaigns
4 years at this Job
- Bachelor Of Arts - Media communications & Management studies