Janet Costello

implementation of new data mining and audit/review for identifying healthcare overpayments and underpayments to providers, and the detection of healthcare fraud, waste. Research local billing and reimbursement policies, client reimbursement practices through review of manuals/regulations and meetings. Organizes, documents, and communicates results. Research of client policy and data to reveal new overpayment recovery. Works with data mining, to identify new overpayment issues for each client. Review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, requirements. Reviews IT programming results for quality assurance and proof of concept validation. Documents results and supports preparation of internal and external documentation and presentations related to research and new overpayment issues. Tracks and follows-up on results and recoveries. Validates workflows and communication tools to best enhance audit production, client satisfaction, and quality assurance. Works cohesively with the audit team and the client develops, maintains. Train others on Validation of concepts for different clients. Gainwell is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We offer clients scalable and flexible solution for their most complex challenges. These capabilities make us a trusted partner for our organization seeking reliability, innovation and transformational outcomes. Reimbursement Analyst II Research analytics to support our recovery audit line of business. Assists in the development and implementation of new data mining and audit/review for identifying healthcare overpayments and underpayments to providers, and the detection of healthcare fraud, waste. Research local billing and reimbursement policies, client reimbursement practices through review of manuals/regulations and meetings, Clients Processing systems, Organizes, documents, and communicates results. Research of client policy and data to reveal new overpayment recovery. Works with data mining, to identify new overpayment issues for each client. Review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, requirements

Research analytics to support our recovery audit line of business. Assists in the development and implementation of new data mining and audit/review for identifying healthcare overpayments and underpayments to providers, and the detection of healthcare fraud, waste. Research local billing and reimbursement policies, client reimbursement practices through review of manuals/regulations and meetings as well as within the Clients processing systems. Organizes, documents, and communicates results. Research of client policy and data to reveal new overpayment recovery. Works with data mining, to identify new overpayment issues for each client. Review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, requirements. Reviews IT programming results for quality assurance and proof of concept validation. Documents results and supports preparation of internal and external documentation and presentations related to research and new overpayment issues. Tracks and follows-up on results and recoveries. Validates workflows and communication tools to best enhance audit production, client satisfaction, and quality assurance. Works with IT to develop and implement technological improvements that will support the audit process. Works cohesively with the audit team and the client Develops, maintains. Train others on Validation of concepts for different clients.

Process claims for Managed Healthcare within the Sr. Business Capitated and Non-Capitated claims fee for service professional claims Par and Non-Par Providers. Medicare, Medicaid experience. Process claims for Managed Healthcare within the Sr. Business Capitated and Non-Capitated claims fee for service professional claims Par and Non-Par Providers. Medicare, Medicaid.

Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Consistently ensured proper sequence of diagnoses and procedures. Review claims for manual pricing, Mentor other examiners, Review and process claims that have been returned from other departments. Review and process claims per NPI information. Demonstrated knowledge of HIPPA Privacy and Security Regulations by appropriately handling patient information. Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Consistently ensured proper sequence of diagnoses and procedures. Review claims for manual pricing, Mentor other examiners.