Rebecca Tinus

Experienced, self-motivated Registered Nurse currently, with over 15 years in a Medical Review position for SafeguardServices LLC, a Medicare Fraud Contractor. As well as 11 years of supervisory experience as a Medical Review Team Leader and currently, as a Fraud Nurse Manager. Prior to this, I had over eleven years of experience processing pre-payment, post payment and appeal claims as a Medical Review Specialist first for a Medicare contractor, and as a Sub-Contractor to National Government Services.

SafeGuard Services LLC, Camp Hill, Pennsylvania, 04/06/2009, present, Medical Review Specialist for prepayment and post payment review of claims and documentation as well as investigation of complaints in accordance with guidelines set forth by the Centers for Medicare and Medicaid Services (CMS), Maintain case files and entries on all assigned cases into multiple databases to record the progression of cases findings., Perform research and investigate all assigned cases., Mentor role in the orientation of new clinical staff, Resource for staff questions on specific subject matter, Excellent computer skills including knowledge of Microsoft Word, Excel, Outlook, Power Point and MS Access, as well as proficient use of the Internet., Proficient knowledge of the Medicare Claims Processing System (MCS), Excellent time management and organization skills, Continually meet or exceed designated workload targets., Excellent interpersonal and communication skills in dealing with multiple situations.

• Assign cases to MR reviewer and external consultants within a 3-day timeframe.
• Monitor aging cases to assure that all medical review assignments are completed in the established timeframes to meet metrics.
• Monitor reports to assure that cases are timely to identify issues that need to be addressed.
• Act as front-line contact and liaison for all subcontractors
• Staff Coaching
• Assist MR Manager to write action plans for staff who are stalled.
• Identify areas in review processes where efficiencies are indicated and implement 1:1 instruction to MR Nurse regarding workflow process improvements.
• Provide performance feedback to MR Manger at evaluation time and PRN.
• Staff Resource
• Field staff questions and problem solve.
• Be a resource for MR Nurses and investigators regarding the MR review process.
• Trouble shoot any technical issues with output of MR findings report.
• Meetings
• Attend ALJ Hearings as needed.
• Attend all MAC meetings and present issues.
• Help develop monthly MR Staff Meeting Agenda and present assigned topics.
• Take minutes for monthly MR Staff Meeting and post completed minutes in 10 business days.
• Attend all new pre and post pay meetings with investigative team to help determine appropriate size and scope of review.
• Attend other meetings as assigned by MR Manager
• MRCT/UCM Transition
• Attended meetings, provided input, and tested the UCM system to support CMS requirements.

Available upon request