Megan Whaley
Cincinnati,OH
Summary
Highly organized and dependable individual with a proven track record of effectively managing multiple priorities while maintaining a positive attitude.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Compliance Auditor
Ensemble Health Partners
Cincinnati , Ohio
05.2023 - Current
- Collaborate with cross-functional teams to ensure timely implementation of corrective actions, mitigating potential compliance issues
- Leverage data analytics tools to enhance audit efficiency and accuracy, generating valuable insights to drive continuous improvement efforts
- Develop key performance indicators for monitoring compliance activities, ensuring progress toward established objectives was effectively tracked and reported
- Provide guidance on compliance requirements, ensuring informed decision-making across the organization
- Perform an average of 6 compliance audits per year
- Conduct regular follow-up audits to verify that previously identified issues were effectively resolved or mitigated
- Develop robust risk assessment frameworks to systematically identify, evaluate, and prioritize organizational risks
- Prepare working papers, reports and supporting documentation for audit findings
Denials Supervisor
Ensemble Health Partners
Cincinnati , Ohio
09.2020 - 05.2022
- Oversaw daily functions of Accounts Receivable team
- Monitored work queues to ensure timely and accurate billing, collections, and payment posting
- Monitored production and quality for Accounts Receivable associates
- Identified areas of improvement and implemented strategies to optimize cash flow and reduce denials
- Provided training and guidance to AR staff on billing procedures, insurance requirements and compliance standards to enhance their skills and knowledge
- Collaborated with leaders and other departments to provide excellent customer service to Ensemble clients
Regional Account Manager
Optum
Cincinnati , Ohio
07.2017 - 05.2019
- Managed credit balance inventory for Optum clients
- Reviewed hospital contract information in host system to confirm overpayments
- Processed refunds for Optum clients using internal systems
- Educated hospital staff on recurring billing issues
- Met daily refund quota
- Oversaw and mailed daily check runs averaging $500k
Certified Coder
UC Health
Cincinnati , Ohio
07.2016 - 07.2017
- Conducted billing and coding training for physician and medical staff which included current procedural or coding updates
- Entered charges for Medicare, Medicaid and private insurance providers using office EMR system
- Analyzed reports for accuracy on patient information, recorded date of service or procedure and verified location and physician name and signature
- Reviewed out-patient medical documents of diagnosis and procedures and assigned ICD-10, CPT, and HCPCS according to coding guidelines
Education
Bachelor of Science - Healthcare Administration
University of Cincinnati
2017
Associate of Science - Health Information Management
Sinclair Community College
2015
Skills
- Healthcare Compliance
- CMS Guidelines
- Medical Terminology
- Reimbursement Methodologies
- Payer Policies
- EPIC
- ICD 10
- Excel
- CMS 1500 and UB 04 Billing
- Power BI
- Customer Service
- Team Management
Certification
Certified in Healthcare Compliance (CHC) - Health Care Compliance Association
Registered Health Information Technician (RHIT) - AHIMA
Certified Revenue Cycle Representative - HFMA
Timeline
Compliance Auditor
Ensemble Health Partners
05.2023 - Current
Denials Supervisor
Ensemble Health Partners
09.2020 - 05.2022
Regional Account Manager
Optum
07.2017 - 05.2019
Certified Coder
UC Health
07.2016 - 07.2017
Bachelor of Science - Healthcare Administration
University of Cincinnati
Associate of Science - Health Information Management
Sinclair Community College