BRENNAN ROJAS
Flowery Branch,GA
Summary
Experienced in ensuring regulatory compliance with state and federal regulations, including the Centers for Medicare and Medicaid Services (CMS) Federal Conditions of Participation. Utilize strong analytical skills to proactively identify and address potential compliance issues related to state licensure, acute care CMS recertification, organ transplant recertification, validation surveys, EMTALA, ASC, PRTF, and birthing centers.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Acute Care Compliance Surveyor
Georgia Department of Community Health / Healthcare Facility Regulation Division
Atlanta, GA
05.2023 - Current
- Coordinates and conducts investigations involving noncompliance in facilities, community programs, regulated entity operations and other related programs.
- Determines compliance with applicable state and/or federal rules and regulations.
- Develops, implements and evaluates the surveillance of utilization review process to ensure quality services.
- Monitors, tracks, and maintain records on compliance.
- Plans and evaluates outcome studies and/or compliance findings.
- Plans, develops, schedules and implements surveys and complaint investigations for licensure or certification of regulated facilities.
- Plans, organizes, and directs the certification/licensing process.
- Recommends programmatic and/or operational changes based on review, audit or survey results.
- Reviews new rules and service site applications.
- Researches and analyzes state codes, federal regulations and industry manuals regarding forms, policies and procedures.
- Reviews applications for accuracy and compliance with guidelines, regulations and laws. Performs investigations and/or audits according to established rules, regulations and other statutes.
- Conducted compliance audits and reviews to identify areas of improvement.
- Confirmed data and licensing information through investigations and notified violators of required changes to bring operations into compliance.
- Identified gaps in existing compliance processes and recommended updates.
- Managed relationships with regulators, maintaining open lines of communication to ensure transparent operations.
- Assisted with internal and external audits to confirm compliance with applicable laws and regulations.
- Promoted a culture of continuous improvement through ongoing evaluation and refinement of compliance program elements.
Medical Billing Specialist and Manager
Critical Care Medflight
Lawrenceville, GA
07.2015 - 07.2019
- Maintains knowledge of HIPAA regulations and other regulations that are relevant to billing and accounts receivable functions
- Collaborates and cooperates with other departments and affiliated organizations to promote smooth processes and effective interaction
- Increased employee competency with creation of targeted skill development paths.
- Develops consistent paths of communication between administrative, clinical and financial staff responsible for front-end of revenue cycle
- Develops and implements policies and procedures to ensure that all billing and collections functions are performed in efficient and cost effective manner in compliance with applicable regulations and contractual arrangements
- Develops A/R Benchmarking/Trend reporting
- Billing Specialist Duties
- Provided one-on-one mentoring to help individuals reach their full potential within the organization.
- Code data to produce and submit claims
- Work directly with brokers and insurance companies to process invoices and insurance claims
- Promoted a culture of continuous learning by advocating for professional development opportunities.
- Reviewing and appealing unpaid invoices and claims
- Verifying insurance coverage
- Answering billing related questions
- Handling collections on unpaid accounts
- Manage facility Accounts Receivable and Payable reports
- Located errors and promptly refiled rejected claims.
- Prepared billing correspondence and maintained database to organize billing information.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
- Managed collections claims for unpaid bills against estates of debtors.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
- Created document management system to reduce paper usage and improve accuracy of tracking.
Lead Certified Tissue Recovery Technician
Georgia Eye Bank
Atlanta, GA
10.2013 - 01.2015
- Donor tissue procurement
- Aseptic Technique
- Charting and documentation
- Surgical excising of donor tissue
- Phlebotomy
- Provided one-on-one mentoring to help individuals reach their full potential within the organization.
- Promoted culture of continuous improvement by initiating regular training feedback loops.
- Increased employee competency with creation of targeted skill development paths.
- Provided coaching and mentoring to employees.
Lead Certified Surgical Technician
Gwinnett Medical Center
Lawrenceville, GA
05.2006 - 03.2009
- Supported successful surgeries by anticipating surgeon needs and providing necessary assistance during procedures.
- Reduced surgical complications through proper handling and passing of surgical instruments to surgeons.
- Contributed to a positive work environment by collaborating effectively with colleagues across various departments.
- Minimized potential infections by maintaining cleanliness and sterilization of operating rooms before and after each surgery.
- Assisted in complex surgeries through effective communication and collaboration with the surgical team.
- Enhanced patient safety by meticulously following aseptic protocols and sterile procedures.
- Anticipated surgeons needs and handed instruments and supplies to surgeons during procedures.
- Gathered and set up equipment, tools, and supplies and arrange instruments according to surgeons' preferences or instruction.
- Maintained sterile fields by following aseptic techniques and adhering to infection control protocols.
- Followed scrub-in procedures by gowning and gloving correctly to assist in sterile fields.
- Reduced infection risks and protected patients by maintaining sterile fields during procedures.
- Promoted a culture of continuous learning by advocating for professional development opportunities.
- Conducted comprehensive needs assessments to identify gaps in knowledge and skills, informing future program development.
- Provided coaching and mentoring to employees.
- Enhanced trainee and student engagement through interactive workshops and hands-on activities.
Education
Master of Legal Studies - Health Care Law
Vanderbilt School of Law
Nashville, TN05-2027
Bachelor of Healthcare Administration -
Columbia Southern University
Orange Beach, AL12-2024
Associate of Health Science - Surgical Technology
Gwinnett Technical College
Lawrenceville, GA05-2023
Certificate - Medical Billing And Coding
Gwinnett Technical College
Lawrenceville, GA06-2015
Diploma - Surgical Technology
Gwinnett Technical College
Lawrenceville05-2007
High School Diploma -
Boaz High School
Boaz, AL05-2001
Skills
- Data Analysis
- Critical Thinking
- Legal Standards
- Verbal and Written Communication
- Compliance monitoring
- Document review
- Regulations enforcement
- Policy enforcement
- Training and development
- Cross-functional team leadership
- Team leadership
Certification
- Surveyor Minimum Qualifications Test (SMQT) Federal Certification
Timeline
Acute Care Compliance Surveyor
Georgia Department of Community Health / Healthcare Facility Regulation Division
05.2023 - Current
Medical Billing Specialist and Manager
Critical Care Medflight
07.2015 - 07.2019
Lead Certified Tissue Recovery Technician
Georgia Eye Bank
10.2013 - 01.2015
Lead Certified Surgical Technician
Gwinnett Medical Center
05.2006 - 03.2009
Master of Legal Studies - Health Care Law
Vanderbilt School of Law
Bachelor of Healthcare Administration -
Columbia Southern University
Associate of Health Science - Surgical Technology
Gwinnett Technical College
Certificate - Medical Billing And Coding
Gwinnett Technical College
Diploma - Surgical Technology
Gwinnett Technical College
High School Diploma -
Boaz High School