At Cotiviti, I designed and implemented payment integrity audit concepts across multiple lines of business. My work identified over $2 million in validated recovery opportunities.
I analyzed commercial and Medicare claims across DRG, OPPS, Skilled Nursing, LTCH, ASC, and Home Health reimbursement models. I also interpreted payer contracts and CMS guidelines to support defensible audit findings.
As a Payment Accuracy Specialist, I partnered with reporting and engineering teams to enhance SQL-based audit analytics and automation. I also developed training materials and mentored new analysts.
Earlier, at The Rawlings Company, I investigated commercial insurance claims for national health plans, applying NAIC Coordination of Benefits rules to determine primary payer responsibility. I also supported CAQH initiatives and developed onboarding and training materials.
