Tina Alexander
Chapel Hill,TN
Summary
Self-motivated Audit Supervisor with excellent experience and success in coaching, training and managing a highly-effective auditing team. Adept in organizing and implementing auditing programs while directing auditors on processes. Detailed in maintaining compliance with laws and ensuring pristine financial recordkeeping.
Overview
24
24
years of professional experience
Work History
AR Representative, Revenue Cycle Operations
SCA Health
Nashville, TN
02.2024 - Current
- Notify clients of payment discrepancies through notices.
- Initiate delinquency process for past due invoices.
- Maintaine positive working relationship with fellow staff and management.
- Displaye strong telephone etiquette, effectively handling difficult calls.
- Set specific goals for projects to measure progress and evaluate end results.
- Monitor operations and reviewed records and metrics to understand company performance.
- Answer questions and resolved concerns for customer support.
- Participate in training sessions designed to improve overall job performance.
- Identify areas for improvement, narrowing focus for decision-makers in making necessary changes.
- Conduct periodic reviews of customer accounts to ensure data accuracy.
- Provide assistance in the preparation of month end closing activities related to Accounts Receivable function.
Quality Review and Audit Supervisor
Cigna
Nashville, TN
08.2020 - 11.2023
- Lead Quality Assurance/Audit team consisting of experienced administrative, operative, and or technical roles in the Professional career track
- Recommended changes in procedures and may be directly involved in complex audits
- Developed audit procedures to test internal control systems and review transactions for accuracy and completeness.
- Assisted in the development of audit policies and procedures
- Coordinated schedules and workflow for the team
- Focused on team completion of assignments and routines
- Ensured the orientation and training of employees
- Provided agent improvement opportunities to Sales managers in order to ensure compliance to CMS Sales and Marketing regulations
- Assisted with the project focused on improving CMS Star Ratings across the organization on Foreign Language/TTY audit over consecutive years by performing audit of Foreign Language/TTY calls
- Provided data to manager to help identify areas of improvement
- Ensured compliance with CMS rules and regulations across call centers across Sales organization by conducting regular telephonic monitoring for both internal and external agents organization-wide
- Provided training on telephonic audits as needed.
- Assessed compliance risk, developed audit work plans and documented findings
- Communicated audit plans to executive management team
- Trained, developed and provided performance management initiatives to audit staff
- Composed clear and concise audit findings to deliver comprehensive audit reports
- Worked closely with management to discuss external audit results and action plans
- Supervised audit staff to align goals with company and deliver excellent internal audit services
Quality Review and Audit Analyst
Cigna Healthspring
Nashville, TN
10.2013 - 07.2020
- Ensured compliance with CMS rules and regulations across call centers across Sales organization by conducting regular telephonic monitoring for both internal and external agents organization-wide
- Assisted with the project focused on improving CMS Star Ratings across the organization on Foreign Language/TTY audit over consecutive years by performing audit of Foreign Language/TTY calls
- Provided data to manager to help identify areas of improvement
- Performed data analyses for both internal and external partners’ performance, identifying positive and negative trending as well as overall CMS compliance risk
- Provided agent improvement opportunities to Sales managers in order to ensure compliance to CMS Sales and Marketing regulations
- Provided training on telephonic audits as needed
- Researched and document cases for the Sales Development Action Committee (SDAC) to ensure agent and agency compliance, adherence to state and federal guidelines, as well as Cigna policies and standards
- Prepared audit reports and communicated findings to management
- Developed audit plans and strategies for assigned projects
- Reported audit results in a timely manner to senior management team
- Conducted audits on internal controls and developed reports on findings
- Presented audit results to management teams, delivering information in non-technical terms for easy understanding
- Researched and implemented best practices to improve audit results
- Liaised with auditors to complete annual audits and maintain compliance with local, state and federal requirements
Medical Biller/Collector
AmSurg
Nashville, TN
06.2012 - 10.2013
- Researched and resolves problems and posts payments, adjustments, denial codes, and non-payment collections for (3) Ambulatory Surgery Centers
- Pursued timely collection of each claim using thorough follow-up efforts appropriate to each payer including but not limited to Medicare, Tricare and BCBS
- Verified benefits, policy number, pre-certification requirements, insurance company contact information, and effective dates of coverage
- Answered incoming and make outgoing patient calls regarding statements and general insurance questions
- Prepared bi-monthly reports for center director on the progress of each center
- Processed patient payments through Instamed
- Kept all (3) ASC facilities within required benchmarks
- Reviewed and processed refunds for both third party payers and patients accounts.
- Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence
- Ensured compliance with HIPAA guidelines when handling confidential patient information
- Maintained accurate records of all billing activity in accordance with departmental standards
- Completed and submitted appeals for denied claims
Compliance Auditor
AmMed Direct, LLC
Antioch, TN
05.2009 - 05.2012
- Assisted external auditors when on site by providing requested documentation, organizing meetings, coordinating the audit documentation team
- Completed weekly QA telephone audits of various departments including DME/Rx Sales, DME/Rx Customer Service, and Customer Accounts
- Compiled documentation for monthly QI audits, including auditing customer accounts, and QA phone calls to ensure that proper rules and regulations were being followed
- Detailed audits of Pharmacy prescriptions, physician information, customer profile information
- Reported audit results utilizing customized logs, according to VP needs
- Ensured that all areas identified as non-compliant in internal audits are communicated timely to the Compliance Manager and appropriate responsible parties
- Communicated staff training related to HIPAA, General Compliance, Departmental Audits and Policies & Procedures periodically with Department Trainers
- Worked with AmMed Trainers to address training opportunities with each department
- Maintained multi-state licensures for both Durable Medical Equipment (DME) and Pharmacy lines of business
- Investigated Compliance Hotline reports and BBB complaints
- Communicated changing regulations (Medicare Parts A/B/C/D, Medicaid, state, federal) to management team
- Performed operational ad hoc audits related to billing and documentation compliance, review of sales procedures and patient concerns
- Reviewed operational policies and procedure as needed
- Reviewed all external payer audits
- Pharmacy Controlled Substance Reporting.
Adjustments Analyst
AmMed Direct, LLC
Antioch, TN
05.2007 - 05.2009
- Collected over $325k in previously adjusted revenue as a result of audits in 2009
- Responsible for the accurate and timely processing of financial adjustments
- Audited random accounts to ensure applicable federal policies and procedures were being followed
- Worked with other departments to increase revenue and reduce adjustments
- Reported adjustment errors to management
- Analyzed adjustments for possible payments from all payers, resubmitted claims as needed
- Met the department standard for productivity and accuracy
- Random audits of Customer Records for current Physician’s Orders, contact and shipping dates were within federal regulations
- Conducted monthly Adjustment Meeting
- This meeting was held with CEO, VP’s and other management staff to discuss the previous month’s adjustments to acknowledge any questions or concerns
- Provided CEO with projections for the next month’s adjustments by category to be sent to Board of Directors
- Special Projects/Troubleshooting: Work reports/claims to ensure systems are working properly; organized and completed special projects as assigned.
Refunds Special Project Lead
AmMed Direct, LLC
Antioch, TN
05.2006 - 05.2007
- Monitored accuracy of payments from insurance companies to determine if refund is needed
- Reviewed voluntary refund requests for CMS and private payers
- Reviewed all refunds prepared by Analyst for accuracy to ensure correct refund if any is sent to the correct payer with completed documentation required
- Monitored daily operations of department
- Managed timecards and daily work assignments
- Ensured entry and completion of all adjustments for returns/refunds
- Maintained files for each individual State Medicaid or private payer with current policies and procedures for refunds.
- Identified, tracked and resolved critical path issues
- Maintained accurate records of all project activities including changes, milestones achieved
Pharmacy Lead
AmMed Direct, LLC
Antioch, TN
05.2004 - 05.2006
- Registered Pharmacy Technician (State of Tennessee)
- Resolved issues with members and pharmacies regarding claims adjudication, premium payments, and formulary
- Served as resource for pharmacy department to assist with resolving member and provider issues
- Provided assistance with inventory management
- Provided assistance processing/filling prescriptions as needed
- Effectively handled daily high volume of calls from members, pharmacies, sales agents, and doctors’ offices.
Medical Biller/Collector
AmMed Direct, LLC
Antioch, TN
10.2000 - 05.2004
- Processed claims for Medicare and private payers
- Retrieved electronic remits
- Compiled documentation for Medicare appeals by contacting the physician’s office for all supporting documentation including medical records to support appeals
- Reviewed insurance benefits and/or statements with customers
- Worked validation reports when claims were unable to be processed due to missing or invalid information
- Followed up with payers on underpaid claims
- Insurance verification.
Education
Antioch High School
Skills
- Microsoft Office products (Word, Outlook, Excel)
- Keyboarding
- Time management
- Meeting Minutes
- Team Development
- Detailed Oriented
- Flexible and Adaptable
- Critical Thinking
- Leadership
- Decision-Making
- Program Performance Analysis
- Work Delegation
- Organizational Performance
- Project Management
- Audit management
- Evaluating employees
- Multi-tasking
- Staff Supervision
- Audit oversight
- Audit Coordination
- Regulatory Compliance
- Finance
- Compliance standards
- Internal Auditing
- Data Entry
- Customer Service
- Multiple Phone Line Systems
Timeline
AR Representative, Revenue Cycle Operations
SCA Health
02.2024 - Current
Quality Review and Audit Supervisor
Cigna
08.2020 - 11.2023
Quality Review and Audit Analyst
Cigna Healthspring
10.2013 - 07.2020
Medical Biller/Collector
AmSurg
06.2012 - 10.2013
Compliance Auditor
AmMed Direct, LLC
05.2009 - 05.2012
Adjustments Analyst
AmMed Direct, LLC
05.2007 - 05.2009
Refunds Special Project Lead
AmMed Direct, LLC
05.2006 - 05.2007
Pharmacy Lead
AmMed Direct, LLC
05.2004 - 05.2006
Medical Biller/Collector
AmMed Direct, LLC
10.2000 - 05.2004
Antioch High School
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