Lauren McCorkle, MBA
Homewood,IL
Summary
Operations/Systems Quality Analyst Summary
Experienced analyst with a demonstrated history of working in the hospital and health care industry; skilled in revenue cycle management, auditing, data analytics, medical insurance and billing practices, Microsoft office, ICD-10 and CPT coding, HIPPA privacy and security guidelines, Compliance guidelines, and medical terminology. Strongly recognized by peers, subordinates and senior leadership for tenacity and the ability to handle the dynamics of a constantly changing environment. Noted as a strong and clear communicator who has an excellent work ethic; all while being a dynamic leader who is a committed and dedicated team player; excels in challenging environments.
Overview
10
10
years of professional experience
Work History
Operations/Systems Quality Analyst
University of Chicago Medical Center
12.2022 - Current
- Provide financial data and analysis for external reporting
- Conduct all external audits for Recovery Audit Contractors (RAC), Medicare Administrative Contractor (MAC) audits, Office of Inspector General (OIG) audits, and all commercial audits
- Manages approximately 700 external audits quarterly
- Completes quarterly compliance reports on data extracted from external audit tool MDAudit
- Coordinates, initiates, monitors and responds to all audit requests/demands
- Report all noncompliance with applicable laws to Executive Director as well as Office of Corporate Compliance
- Acts as liaison between finance, HIM, and compliance office as needed
- Performs research and gathers financial data through various reporting tools
- Works with Executives and other leaders within organization to identify opportunities for improvement
- Creates reports for leadership as well as internal teams as needed
- Uses graphs, infographics and other methods to visualize and find useable information in large data sets
- Analyzes monthly compliance reports for CCS department and make necessary charge corrections on CPT/HCPCS codes
- Manages various claim edit workques to ensure quality and compliance
- Manages all organizational hospital enrollment activities, consisting of creating initial enrollment applications, revalidation's, and any changes of information to hospital information
Team Lead Financial Assessor - Patient Accounting - Revenue Cycle
Northwestern Medicine
12.2020 - 12.2022
- Trained and proficient in Epic Systems - 2014-2022 versions
- Improve financial status by analyzing results, monitoring trends and recommending actions to management
- Served as interim Operations Coordinator completing tasks given by Manager, participated in meetings with potential vendors, scheduled and led departmental meetings, and oversaw various workques
- Interview potential candidates for vacancies within Revenue Cycle department
- Maximize team knowledge and productivity by effectively training, monitoring, and directing employees on departmental practices and regulatory protocols
- Ensure daily organization and delegation of workflow and tasks for all team members
- Efficiently manage patient complaints in respect of billing and collections
- Works closely with Operations Coordinator, Manager and Director of Revenue Cycle, with planning and structuring department workflow and staffing needs
- Lead team meetings discussing departmental issues, trends, and goals
- Conduct audits of all staff to ensure claims are accurately being worked.
Financial Assessor
Northwestern Medicine
01.2017 - 12.2020
- Patient Accounting - Revenue Cycle, Trained and proficient in Epic Systems - 2014-2020 versions
- Entered appropriate documentation of account activity
- Consistently met current productivity and quality standards in timely resolution of all claim edits and submission ensuring timely filing of claims and clean, complete and accurate claims
- Ensured timely follow-up and collection of third party payer receivables including denial and appeal follow-up to ensure payment
- Demonstrated thorough knowledge in compliant follow-up claims and correspondences to third party payers regarding outstanding accounts receivables (i.e Statements, letters, e-mails, faxes, portal mail, etc.)
- Practiced HIPAA privacy standards and ensure compliance with patient health information privacy practices
- Recommended accounts for contractual or administrative write-off and provide appropriate justification and documentation
- Provided individual contribution to overall team effort by achieving department accounts receivable goals
- Trained and orient new staff members on department workflow throughout numerous work queues.
Patient Access Specialist
Northwestern Medicine
03.2015 - 01.2017
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks
- Performed patient pre-admission, admission, transfer and discharge activities
- Contacted insurance companies for patient medical billing operations
- Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services
- Followed document protocols to safeguard confidentiality of patient records
- Recommended service improvements to minimize recurring patient issues and complaints
- Resolved patient financial problems with guidance from documented guidelines and procedures.
Assistant Department Manager
Menards
08.2014 - 03.2015
- Worked actively with management team to create daily and weekly sales plans based on weekly sales trends
- Formulated pricing policies by reviewing merchandising activities and determining additional needed sales promotions
- Ordered inventory and reported discrepancies to control costs and maintain inventory levels
- Developed and implemented plans to maximize sales and meet or exceed goals and objectives
- Motivated associates to consistently deliver effective selling behaviors through coaching and recognition
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement
- Performed routine closings, maintained clean, accurate and accessible records and kept close eye on transaction updates throughout each quarter.
Education
Undergraduate Certificate - Health Information Management
DeVry University
Tinley Park, IL07.2024
Medical Billing and Coding Certificate -
Devry University
Tinley Park, IL04.2023
MBA -
Keller Graduate School of Management
Tinley Park08.2019
Bachelor of Science in Business Management -
Eastern Illinois University
Charleston08.2014
Skills
- Data Analysis
- Workload Management
- Quality Improvement
- Data Validation
- Audit processes
- Decision-Making
- Computer proficiency
- Leadership skills
- Problem-solving abilities
- Time management skills
- CPT, ICD-10-CM, and HCPCS Level II codes
- Medical terminology
Timeline
Operations/Systems Quality Analyst
University of Chicago Medical Center
12.2022 - Current
Team Lead Financial Assessor - Patient Accounting - Revenue Cycle
Northwestern Medicine
12.2020 - 12.2022
Financial Assessor
Northwestern Medicine
01.2017 - 12.2020
Patient Access Specialist
Northwestern Medicine
03.2015 - 01.2017
Assistant Department Manager
Menards
08.2014 - 03.2015
Undergraduate Certificate - Health Information Management
DeVry University
Medical Billing and Coding Certificate -
Devry University
MBA -
Keller Graduate School of Management
Bachelor of Science in Business Management -
Eastern Illinois University