Experienced with insurance contracts and interpreting claim reimbursement situations such as DRG, Coordination of Benefits (COB), adjustment to charges etc. * Knowledge of hospital computerized accounting systems (SMS, McKesson, Epic, etc.) and ability to navigate insurance systems (Availity, Navinet, Diamond, Facets, etc.). * Conducted meetings with health insurers and healthcare providers to report audit results. * Exceeded client expectations by establishing goals and performance reporting. * Partnered with CCF to research and negotiate settlements with health insurers. * Personally recovered 1,232 claims ($1.5M) in 2011 and 764 claims ($1.1M) in 2012. * Restructured the audit team to increase recoveries overall from 8,429 overpayments for $8.5M in 2011 to 12,901 overpayments for $8.5M in 2012 to 13,997 for $8.8M in 2013. * Increased recoveries for a collection project from $384k in 2011 to $702k in 2012. In 2013, an additional $615k was recovered and the project was successfully closed.
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