Summary
Overview
Work History
Education
Skills
Timeline
GeneralManager

Tyra Mason

Frisco,United States

Summary

Methodical Quality Assurance Auditor successful at standardizing compliance review and correction across all business areas. Efficient and accurate team player with demonstrated success in working in Healthcare environments over 12 years. Detail-oriented Quality Assurance Auditor, Hardworking and organized professional with in-depth understanding of evaluation processes and audit procedures. Pursuing new professional challenges with an expanding operation.

Overview

8
8
years of professional experience

Work History

Senior Quality Assurance Auditor

Optum
Eden Prairie, MN
12.2020 - 07.2021
  • Delivered third-party audit services at client locations, keeping operations in compliance with regulatory requirements and ISO standards.
  • Completed timely quality reports highlighting deficiencies and recommending corrective actions.
  • Compiled clinical research data into audit reports and shared with research teams and lead investigators.
  • Prepared for clinical research audits and conducted follow-up assignments reviewing documentation for Internal Review Board submissions, informed consent approvals and eligibility criteria.
  • Participated in compliance inquiries and provided interpretation of data to guide investigators in creation of Corrective and Preventive Actions.
  • Supervised team of up to 10 representatives.

Quality Auditor

AIS Healthcare
Dallas, TX
10.2018 - 11.2020
  • Developed monthly, end-of-quarter and other statistical reports for leadership team and quality improvement programs.
  • Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
  • Collected and analyzed activity data and initiated, developed and recommended improvements to systems, processes and procedures to increase productivity and reduce cost.
  • Developed and maintained quality assurance procedure documentation.
  • Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training.
  • Increased Quality scores over 50% by implementing Quality improvement programs

Medical Claims Analyst

UnitedHealth Group
Irving, TX
04.2014 - 09.2018
  • Managed large volume of medical claims on daily basis.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Reviewed provider coding information to report services and verify correctness.
  • Checked documentation for accuracy and validity on updated systems.
  • Coordinated with contracting department to resolve payer issues.
  • Processed and recorded new policies and claims.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Communicated effectively with staff members of operations, finance and clinical departments.

Account Receivables Specialist

MPS
Dallas, TX
01.2013 - 02.2014
  • Responded to correspondence from insurance companies.
  • Reviewed provider coding information to report services and verify correctness.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Posted payments to accounts and maintained records.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.

Education

High School Diploma -

Oakland Technical High School
Oakland, CA
06.1998

Skills

  • Audit process management
  • Quality Control Processes
  • Root Cause Analysis
  • ISO 9001
  • Corrective action planning
  • Standards Compliance
  • Reporting and analysis
  • Medical terms and procedure knowledge
  • Thorough claims review
  • Ability to compile data
  • Reporting skills
  • Corporate Compliance
  • Impact Assessment
  • Policies And Procedures
  • Process Improvement
  • Improve Performance
  • Operational Management
  • Case Management
  • Call Center Operations
  • Recommend Strategies
  • Project Reports
  • Excel
  • Project Management
  • Ability To Work Independently
  • Clear Communication
  • Analytical Expertise
  • Technical Specifications
  • Prioritization
  • Task Management
  • Negotiation Skills

Timeline

Senior Quality Assurance Auditor

Optum
12.2020 - 07.2021

Quality Auditor

AIS Healthcare
10.2018 - 11.2020

Medical Claims Analyst

UnitedHealth Group
04.2014 - 09.2018

Account Receivables Specialist

MPS
01.2013 - 02.2014

High School Diploma -

Oakland Technical High School

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Tyra Mason