Peggy Dunaway
Lakeland
Summary
Detail-oriented and dependable professional skilled in managing multiple priorities while maintaining a positive attitude. Accomplished auditor recognized for ensuring financial accuracy and regulatory compliance, consistently delivering comprehensive audits that identify key areas for process improvement. Collaborative team player dedicated to achieving results and adept at adapting to evolving needs. Expertise in financial analysis and problem-solving underscores a commitment to reliability and adaptability in dynamic environments.
Overview
29
29
years of professional experience
1
1
Certification
Work History
LPN/ VA OMLA Project Team/Medicare Part C Auditor
Maximus
01.2019 - Current
- Engaged as a contracted consultant to provide expert guidance and strategic insights.
- Conducted comprehensive reviews of standard care protocols for licensed practical nursing.
- Conducted comprehensive reviews of CPT/HCPCS claims for Medicare Part C to ensure compliance and accuracy.
- Evaluated claims submitted by hospitals to verify compliance with DRG payment guidelines and standards.
Care Coordinator/Auditor
Medical Assoc. of West Florida (IPA)
01.2017 - Current
- Assisted healthcare providers and office staff in reducing hospitalizations. Contacted patients for follow-up appointments after hospital stays.
- Reviewed physician encounters for accurate ICD-10 and HCC coding. Assisted in HEDIS abstraction and documentation processes.
- Contributed to effective monthly IPA physician board and general membership meetings by documenting minutes. Delivered timely updates to support informed decision-making.
- Collaborated with medical assistants and physicians to ensure precise reporting of HEDIS measures and effective diagnosis coding.
- Achieved improved medication adherence rates through comprehensive training for staff and physicians. Enhanced patient engagement by providing clear guidance on medication management. Drove initiatives that significantly increased patient compliance with treatment plans.
Director- Director/Nurse
Courtyard Estates of Walcott Assisted Living
Walcott, IA
01.2014 - 01.2016
- Assisted with payroll processing and employee onboarding. Supported hiring and termination procedures. Conducted employee performance reviews. Aided in sales and marketing efforts. Managed tenant admission paperwork. Facilitated training sessions and conducted employee background checks.
- Facilitated training sessions for new employees on HIPAA compliance protocols.
- Assisted nursing staff in providing patient care on the floor. Supported daily operations by maintaining cleanliness and organization of patient areas. Helped monitor patient conditions and report changes to nursing staff.
- Conducted thorough verification of credentials for nursing professionals and assistants.
Medical Claims Auditor
Xerox
01.2011 - 01.2014
- Conducted nationwide travel to audit medical insurance claims for fraud and abuse across diverse medical and pharmacy providers.
- Produced detailed audit result reports that enhanced provider compliance. Optimized travel arrangements and improved efficiency in expense reporting systems.
- Facilitated retrospective audits in remote and onsite settings, identifying areas for improvement and ensuring adherence to standards.
LPN/Branch Manager
American Home Patient
01.2001 - 01.2011
- Directed management of medical equipment branch office to enhance operational effectiveness.
- Assisted with payroll processing for branch revenue and medical insurance. Supported team in maintaining accurate records and compliance with regulations. Contributed to efficient operations by organizing documentation and data entry.
- Facilitated comprehensive training for patients on the operation and maintenance of durable medical equipment.
LPN/M6
United States Army Reserve
01.1997 - 01.2008
- - Deployed to Bagram, Afghanistan
- - Medical care for US Soldiers, Coalition Forces, Local Civilians and Taliban
- - Experience with IV;s, phlebotomy; wound care; discharge planning; physicians with bedside procedure; chest tubes; vents and intubation
- - Deployed to Sendai, Japan for medical support during a mock war training exercise
Education
CMCN -
AAMCN
01-2024
Medical Billing and Coding - undefined
Excelsior College
01-2015
LPN, EMT, CNA - undefined
Scott Community College
Pleasant Valley, IA01-1997
Skills
- Medical claims reviewer
- HCC and HEDIS coding training
- Implementation of managed care strategies
- Assistance with durable medical equipment installation and training
- Clinical nursing expertise
- Proficient in Microsoft Excel, Word, and Outlook
Certification
- Licensed Practical Nurse (LPN) Compact multi-state license
- Certified Managed Care Nurse (CMCN)
- Certified Professional Coder (CPC)
Timeline
LPN/ VA OMLA Project Team/Medicare Part C Auditor
Maximus
01.2019 - Current
Care Coordinator/Auditor
Medical Assoc. of West Florida (IPA)
01.2017 - Current
Director- Director/Nurse
Courtyard Estates of Walcott Assisted Living
01.2014 - 01.2016
Medical Claims Auditor
Xerox
01.2011 - 01.2014
LPN/Branch Manager
American Home Patient
01.2001 - 01.2011
LPN/M6
United States Army Reserve
01.1997 - 01.2008
Medical Billing and Coding - undefined
Excelsior College
LPN, EMT, CNA - undefined
Scott Community College
CMCN -
AAMCN