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ST LUKES UNIVERSITY HEALTH NETWORK - Process Auditor Resume Example

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Lillian Price
XXXX XX XXXXXX XXXXXX , Allentown , PA 18104 | (H) XXXXXXXXXXXX | XXXXXXXXXXXXXXXXXXXX
Summary
A well-trained, organized, and versatile professional who can excel at diverse tasks and flourish within challenging environments. A creative problem-solver who utilizes resources to improve performance and enhance operations. Excellent work ethic and reliability. Motivated by challenge and opportunity. Take pride in achieving goals within time, budget, and quality parameters. A leader by example who utilizes a "hands-on" style of leadership conductive to productive, team-oriented work environments. Can work independently or as part of a team environment. Personal characteristics include honesty, self-motivation, reliability, and integrity.
Skills
  • Administration and Management
  • Critical Thinking
  • Coordination
  • Complex Problem Solving
  • Microsoft Office and Operating Systems
  • Systems Evaluation
Experience
ST. LUKE'S UNIVERSITY HEALTH NETWORK Bethlehem, PA
  • Answer billing questions, adjust claims, add insurance and workers compensation information, and resubmit the claim for processing.
  • Utilize the STAR computer system and work on suspense reports.
  • Performs ongoing analysis response to audit adjustments, review of interim and final settlements.
Process Auditor 01/2003 to 01/2011
HORIZON BLUE CROSS/BLUE SHIELD OF NEW JERSEY Newark, NJ
  • Identification of overpayments through review and investigation of standard and ADHOC audit reporting.
  • Performed overpayment audits utilizing leads received from collaboration with external sources (Operations areas, Network, Care Management, Fraud and Subrogation).
  • Initiated and investigated possible overpayment clues.
  • Recorded overpayment findings within the tracking system.
  • Supported in development of standard and new ADHOC audit reporting requirements.
  • Participated in the testing of new standard and ADHOC audit reports.
  • Communicated findings and resolved audit reporting issues.
  • Ensured adherence to HIPAA policies, procedures and regulations.
  • Federal Employee Program.
Data Entry Specialist 01/1999 to 01/2003
Federal Employee Program
  • Data entry and processed facility and professional claims for PPO and POS products on NASCO and DC claims system.
  • Data entry of primary and secondary claims, as well as referrals into various processing systems.
  • Resolve edits on claims (pending resolution) that may require claim adjustments.
  • Returned claims with unidentifiable information back to healthcare professional/subscriber with letter requesting additional information.
  • Performed general clerical duties to ensure accurate disposition of claims/referrals that could not be entered into the various processing systems.
  • Consistently updated knowledge of company policies and procedures.
Education
Diploma: Medical Coding & Billing Specialist Oct 2012 LINCOLN TECHNICAL INSTITUTE - Allentown, PA
B.S. Degree: Marketing and Management Jan 1998 VIRGINIA STATE UNIVERSITY - Petersburg, VA
Honors/Awards
* Deans List
* TAMM Club
* Human Ecology Award for Dedication and Creativity
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Resume Details

This is a real resume for a Process Auditor in Allentown, Pennsylvania with experience working for such companies as St Lukes University Health Network, Horizon Blue Cross, Blue Shield Of New Jersey. This is one of the hundreds of Process Auditor resumes available on our site for free. Use these resumes as templates to get help creating the best Process Auditor resume.

Previous Companies:

  • ST LUKES UNIVERSITY HEALTH NETWORK
  • HORIZON BLUE CROSS
  • BLUE SHIELD OF NEW JERSEY

Previous Job Positions:

  • Process Auditor
  • Data Entry Specialist

Schools:

  • LINCOLN TECHNICAL INSTITUTE
  • VIRGINIA STATE UNIVERSITY

Level of Education:

  • Diploma
  • B.S. Degree

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