PROFILE: Versatile health care professional with extensive clinical background, third party administration and managed care review experience. * 18 years acute clinical experience in a variety of settings (intermediate ICU, NICU, high risk antenatal, PACU * 13 years utilization review at a major heath care facility. Collaboration with all level of health care professionals * Third party administration experience with knowledge of CPT and ICD-9 coding, provider fee schedules, and facility and practitioner billing * Experience in Medicare quality review and HEDIS review. Knowledge of ERISA guidelines * Utilization of InterQual criteria, appeals and denials along with discharge planning

Highlights:

• Managed Care
• Billing
• Coding
• Compliance
• Computer Aided Software Engineering
• Disease Management
• ERISA
• Health Care Industry
• Managed Care
• Billing
• Coding
• Compliance
• Computer Aided Software Engineering
• Disease Management
• ERISA
• Health Care Industry