••••• M. •••••, CFE, CIA
SUMMARY OF QUALIFICATIONS
Results-driven Internal Audit Manager and Reimbursement Coordinator with expertise in cost report compliance. Consistently obtained high performance through leadership of compliance audit team. Experienced healthcare professional recognized for completing accurate, detail-oriented Medicare cost reports. Certified Fraud Examiner and Certified Internal Auditor. Valuable innovator who looks beyond the usual business requirements.
HCA (Hospital Corporation of America) Nashville, TN •••••
(A for-profit hospital chain consisting of approximately ••••• hospitals and ••••• freestanding surgery centers in ••••• states and London, England).
Manager, Internal Audit Department (•••••)
Cost Report Compliance team
Led Medicare cost report audit engagements, developed engagement plans, and prepared detailed programs for tests of controls and substantive procedures.
Completed ••••• audits of hospital cost reports and 6 audits of Medicare bad debts at regional Patient Account Service Centers over a five year period.
Identified additional areas of risk not previously emphasized resulting in legal memos and adjusting journal entries.
Implemented reimbursement experience to upgrade the knowledge and analytical capability of the Cost Report team.
Provided guidance to assist three staff members in reaching their full potential.
Utilized ACL, TeamMate, and HFS Medicare cost report software.
Reimbursement Coordinator, Reimbursement Department (•••••)
Prepared and filed Medicare and Medicaid cost reports, responded to proposed audit adjustments, recorded Notices of Program Reimbursement, and maintained good working relationships with facilities and fiscal intermediaries.
Completed over ••••• Medicare / Medicaid cost reports.
Worked on most of the ••••• hospitals that were divested between ••••• and •••••
Obtained an additional $•••••,••••• of Medicare reimbursement by amending a prior year cost report to correct a filing error.
Preserved $•••••,••••• of Medicare reimbursement in a special Federal investigation that would have otherwise been lost, by documenting issue support.
DEACONESS HOSPITAL (A ••••• bed teaching hospital) Evansville, IN •••••
Coordinated the third party reimbursement function including the direction of the Reimbursement Specialist.
••••• M. •••••, CFE, CIA PAGE 2
PROFESSIONAL EXPERIENCE (Continued)
UNIHEALTH AMERICA (A non-profit hospital chain) Burbank, CA •••••
Prepared cost reports and monthly contractual allowances for Northridge Hospital (a ••••• bed teaching hospital) and Coldwater Canyon Hospital (a ••••• bed Psychiatric hospital).
UNITY HOSPITAL (••••• beds) / MERCY HOSPITAL (••••• beds) Fridley/Coon Rapids, MN •••••
Prepared cost reports, weekly Case Management reports, monthly contractual allowances, and created a monthly budget variance report.
ALUM-A-COAT, INC. (Aluminum anodizing) South El Monte, CA••••• •••••
Executive Vice President
Achieved reclassification of waste from hazardous to •••••% non-hazardous.
Obtained a •••••% reduction in electric utility bills by implementing an interrupt service.
Minimized overtime by instituting production scheduling that avoided peak period electric demand.
BLUE CROSS OF CALIFORNIA Woodland Hills, CA •••••
Medicare Auditor, Provider Audit Department
Performed Medicare cost report field audits on hospitals ranging in size up to 2,••••• beds.
QUEEN OF ANGELS HOSPITAL (••••• Beds) Los Angeles, CA ••••• •••••
Gathered cost report data, reviewed physician contracts, and calculated monthly physician fee payments.
HOSPITAL MANAGEMENT SERVICES La Habra, CA •••••
Prepared Medicare, Medi-Cal, and Blue Cross cost reports for hospital clients located in Southern California.
BS in Business Administration, The Citadel Charleston, SC
Certified Fraud Examiner (CFE) - •••••
Certified Internal Auditor (CIA) - •••••
Association of Certified Fraud Examiners (ACFE), Middle Tennessee chapter
The Institute of Internal Auditors (IIA), Nashville chapter