Sally Hansford Cantu
Tomball,TX
Summary
*Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
*To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Revenue IntegrityAnalyst/Nurse
Parallon
07.2017 - 05.2023
- Analyze and resolve patient claims being held by edits, interact with ancillary departments to obtain necessary information to properly bill account
- Identify charging, coding issues and work with department to resolve
- Perform assigned audits by researching, analyzing information and reviewing documentation
- Managed, reviewed 60-70 accounts per day
- Chargemaster liaison to review CPT codes, revenue codes and communicate with ancillary departments to resolve issues
- Member of Facility Ethics and Compliance Committee as related to reporting charge issues
- Maintain mandated billing education
- Develop and coordinate educational in- services to ancillary staff related to charging and billing issues.
Revenue Analyst/Nurse Auditor
Tomball Regional Medical Center Tomball
12.2014 - 07.2017
- Perform Insurance Defense, Stop Loss, Patient Inquiry,Concurrent
- Retro, Facility Biller request and special department project audits
- OPPS Quarterly audits
- Review and resolve daily bill hold edits
- Daily audit of government infusion/injection calculations/charges to assure accuracy based on
- CMS guidelines
- Daily review of 24 hour observation of government accounts to assure accuracy per billing guidelines
- Educate departments on charging
- Review and assist with setting up of charge codes for CDM/Chargemaster
- Conduct monthly meeting with department directors, CFO, Compliance
- Team to advise/discuss charging issues and trends noted on monthly audits selected by corporate.
Nurse Auditor
Cypress Fairbanks Medical Center
02.2006 - 12.2014
- Audit patient charges for Insurance Defense, Patient Accounting, Risk
- Management, Revenue Cycle and other entities needing completion of audit for reasons of treatment or payment
- Reviewed unbilled and billed accounts for HCPC/CPT, Modifiers other billing issues to correct billing errors
- Daily review of all 24 hour observation accounts – calculating observation hours for billing
- Educate department supervisors/manages on correct documentation to avoid charging errors
- Conduct monthly meeting with CFO and department directors to discuss trends identified during audits
- Complete randomly selected accounts for concurrent review monthly
- Knowledge of APC, DRG Payment rules
- Complete monthly reports indicating percentage of errors of each department as identified at time of concurrent audits.
- Utilized electronic medical record systems to store, retrieve and process patient data
- Input data into computer programs and filing systems
Nurse Auditor
Conroe Regional Medical Center
01.1998 - 12.2005
- Audit patient charges for payer’s onsite auditors, Patient Accounting, Risk
- Management, Revenue Cycle and other network entities needing completion of audit for reasons of treatment or payment
- Reviewed unbilled and billed accounts for HCPC/CPT other billing issues to correct billing errors
- Educate department supervisors/manages on correct documentation to avoid charging errors
- Completed quarterly lab medical necessity report per Medicare guidelines
- Familiar with insurance and billing rules and regulations for Medicare
- Texas Medicaid and Managed Care
- Knowledge of APC, DRG Payment rules
- Knowledge how to set up and maintain facility Chargemaster
- Worked under direct supervision of CFO
Community Relations Coordinator
Milestone – Columbia North
01.1997 - 01.1998
- Performed preadmission assessments on rehabilitation patients to determine level of care needed post discharge from acute care, provided educational information to potential patient and family members.
Case Manager/Utilization Review/Recertification Nurse
Conroe Regional Medical Center
01.1993 - 01.1997
- Reviewed admissions using Interqual criteria to establish appropriate level of care
- Provided follow up clinical review of medical record information to insurance companies to substantiate medical necessity for continued stay
- Worked with admissions department to assure physician’s orders were complete prior to admission on all direct admits
- Worked closely with social services, physician’s, nursing staff and third party case managers to assure appropriate discharge measures for each patient.
Quality Assurance Specialist
Healthcor, Inc, Home Health Care
01.1991 - 01.1992
- Monitor and Audit client charts for updated information both clinical and payer information
- Reviewed all charts for accurate nursing/ancillary care documentation
- Responsible for orientation of new employees
- Scheduled clinical visits for clients
Nurse Auditor
National Healthcare Review, Inc
01.1989 - 01.1991
- Conducted onsite medical record audits, concurrent, retrospective, insurance defense, other third party payers and patient request
- Provided in-service to staff regarding accurate documentation
- Held weekly meetings with department managers and CFO to update revenue loss or gains for week
- Compiled monthly/quarterly reports of chart audit results
- Worked independently at Houston area Hospitals: Park Plaza
- Women’s Hospital , Bay shore , and St
- Joseph
Education
Certificate of Vocational Nursing -
Alvin Community College
Alvin, TX1985
A.A - Liberal Arts and Humanities
Morehead State University
Morehead, KY1980
Skills
20 plus years of medical record auditing experience combined with understanding of insurance and billing requirements for Medicare, Texas Medicaid, & managed care
- Knowledge of HCPC/CPT, ICD-10, APC, Modifiers
- Strong customer service and analytical skills
- Excellent verbal and written communication skills
- Knowledge of laws, rules , regulations and guidelines required to ensure compliance
- Capable of working independently without supervision
- Knowledge of EXCEL, Microsoft Word, setting up spreadsheets and power point presentations
- Knowledge of EXCEL, Microsoft Word, setting up spreadsheets and power point presentations
Certification
- Vocational/Practical Nurse License - 1985
Timeline
Revenue IntegrityAnalyst/Nurse
Parallon
07.2017 - 05.2023
Revenue Analyst/Nurse Auditor
Tomball Regional Medical Center Tomball
12.2014 - 07.2017
Nurse Auditor
Cypress Fairbanks Medical Center
02.2006 - 12.2014
Nurse Auditor
Conroe Regional Medical Center
01.1998 - 12.2005
Community Relations Coordinator
Milestone – Columbia North
01.1997 - 01.1998
Case Manager/Utilization Review/Recertification Nurse
Conroe Regional Medical Center
01.1993 - 01.1997
Quality Assurance Specialist
Healthcor, Inc, Home Health Care
01.1991 - 01.1992
Nurse Auditor
National Healthcare Review, Inc
01.1989 - 01.1991
Certificate of Vocational Nursing -
Alvin Community College
A.A - Liberal Arts and Humanities
Morehead State University
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