Samantha Hunt
Winter Park,FL
Summary
Dedicated and detail-oriented healthcare auditor with a strong background in data analysis, compliance audits, and risk assessment. Skilled in identifying discrepancies and developing solutions to improve operational efficiencies.
Overview
14
14
years of professional experience
Work History
Performance Monitoring Specialist
Centene Corporation
11.2022 - Current
- Responsible for conducting nonclinical (Appeals) file audits, focusing on identifying areas for improvement of compliance and process workflow
- Generate monthly insights for enhancement and actively participates in reliability meetings
- Contributes to ongoing development of review tools to ensure validity of criteria and accurately captures evidence of expected performance within contractual and Model of Care standards
- Responsible for ensuring compliance with regulatory bodies (NCQA, CMS, federal and state), as well as medical staff bylaws, rules and regulations, policies and procedures, and delegated contracts.
- Auditing of pre-service, post-service, and dismissals for Medicare, Medicaid, and Marketplace plans.
- Managed large-scale projects related to data analytics, ensuring timely completion while maintaining high-quality standards.
- Provided actionable recommendations based on thorough analysis of historical performance trends.
- Created and ran reports to confirm accuracy of data and made corrections according to instructions within specified timelines.
- Attended training programs to deepen professional skillset and assisted in training fellow store associates on existing and new training programs.
- Collaborated with cross-functional teams to achieve project goals on time and within budget.
- Maintained current understanding of market conditions, compliance standards and best practices.
- Created and delivered presentations to internal and external stakeholders to showcase work.
- Conducted thorough research to identify trends and inform decision-making for business growth initiatives.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Increased internal control effectiveness through diligent evaluation of processes and providing recommendations for improvement.
- Interviewed auditees to gather data needed to conduct audits.
- Interviewed business owners to understand needs and explain audit scope.
Assistant Clinical Manager / Radiology Manager
Central Florida Pulmonary Group
01.2021 - 11.2022
- Supported the Clinical Manager in executing both clinical and administrative responsibilities across four practice locations
- Served as the Acting Clinical Manager during the Manager's absence, ensuring seamless operations
- Supervised staff, conducted periodic performance evaluations, and facilitated staff scheduling for X-ray technicians on a weekly basis
- Collaborated with superiors, colleagues, and IT to address operational challenges, including resolving PACS issues
- Developed and implemented streamlined processes to enhance operational efficiency, including designing training materials and conducting training for new hires
- Ensured effective daily management while addressing staffing issues in coordination with HR.
- Evaluated emerging healthcare trends and technologies, making recommendations for potential integration into clinical operations.
- Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to individual patient needs.
- Promoted a culture of safety by implementing risk mitigation strategies and addressing potential hazards proactively.
- Delivered effective onboarding and training to new and existing employees and cross-trained staff members in other job roles to maximize coverage.
Clinical Manager
Harris Internal Medicine
01.2017 - 01.2021
- Led analysis of system hazards and conducted risk evaluations, ensuring safety and quality of patient care
- Promoted culture of quality improvement by emphasizing importance of accurate HEDIS measures.
- Supervised staff, conducted performance evaluations, and maintained client site contacts
- Provided support in patient billing and coding, created weekly staff schedules, and assisted in design document preparation
- Experience in healthcare claims processing medical billing forms and processes
- Identified incorrectly processed claims and completed adjustments to reprocess claims.
- Managed payroll and time off requests for providers and support staff.
- Ensured completion of CEUs and CMEs, designed training materials, and facilitated training for new hires
- Tracked patient data by various criteria and set daily and long-term management objectives
- Oversaw daily activities, and worked closely with patients and staff to resolve various issues
- Administered and aided clinical activities, including phlebotomy, x-rays, and IV therapy, and aided with chart documentation and risk adjustment coding.
- Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
- Oversaw maintenance of medical records by verifying accuracy, completeness and compliance with licensing regulations.
Lead Medical Assistant and Xray Technician
Harris Internal Medicine
01.2010 - 01.2017
- Served as Lead Medical Assistant and X-ray Technician at Harris Internal Medicine, overseeing clinical operations and providing support to physicians and mid-level providers
- Conducted wide range of clinical tasks including EKGs, X-rays, PFT, and Dexa Scans, as well as flu and strep testing, phlebotomy, and injections
- Performed 6-minute walk testing for oxygen levels and facilitated wound care, IV hydration therapy, and suture and staple removal
- Delegated daily duties, communicated effectively between management and clinical staff, and maintained detailed records of medical inventory and injections administered
- Played key role in training new hires, conducting patient education, and providing educational materials.
Education
BS, Business Administration - Healthcare Administration
Southern New Hampshire University
Manchester, New Hampshire04.2024
Medical Assisting and Basic Xray Machine Operating -
Lincoln Technical Institute
Fern Park, Florida10.2010
Skills
- Quality Assessment
- Data Analysis
- Project Planning
- Audit reporting
- Managed Care
- Process Improvement
- Microsoft Office
- Business Process
- EHR Experience (Advanced MD, Athena Health, eClinicalWorks, Allscripts, NextGen, Trucare, Amysis, Prime, CWS)
- Medicaid, Medicare, Market Place
- Billing/Claims
- HIPAA Compliance
- Compliance
- Claim Appeals
- Root Cause Analysis
- Documentation Management
- Analytical Thinking
Accomplishments
- Representative of my department for the BEE Comittee. Collaborated closely with team members from various departments under the guidance of the Executive Director to address employee concerns and develop strategic action plans. As a member of the Business Enhancement and Empowerment (BEE) Committee, contributed to fostering a culture of growth while prioritizing employee satisfaction. Demonstrated strong communication skills and an ability to navigate diverse perspectives, resulting in the successful implementation of initiatives aimed at enhancing company culture and promoting employee engagement.
Timeline
Performance Monitoring Specialist
Centene Corporation
11.2022 - Current
Assistant Clinical Manager / Radiology Manager
Central Florida Pulmonary Group
01.2021 - 11.2022
Clinical Manager
Harris Internal Medicine
01.2017 - 01.2021
Lead Medical Assistant and Xray Technician
Harris Internal Medicine
01.2010 - 01.2017
BS, Business Administration - Healthcare Administration
Southern New Hampshire University
Medical Assisting and Basic Xray Machine Operating -
Lincoln Technical Institute
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