Gary Williams

Revenue Integrity Auditor @Shriners Children\'s

Tampa, FL, US

The Revenue Integrity Auditor will be responsible for auditing claims and charges to ensure compliance with all State and Federal guidelines and regulations, appeals of clinical issues on claims, assisting with the review, analysis and resolution of denied, under-paid, and audited claims, coordinating efforts related to payer audits, and providing feedback to hospital charging departments on documentation, charges and charge master coding. Responsible for maintaining a detailed knowledge of Medicare RAC and corresponding Medicaid Audit procedures. The individual in this role will be responsible for review and compliant filing of responses to all audit requests to include Governmental Audits; analysis and interpretation of Third Party Payors and Governmental Payors clinical/medical necessity denials; and filing compliant appeals in accordance with Third party and governmental contracts.Knowledge of hospital clinical practice standards for health care providers.Knowledge of ancillary service departments, quality control and safety standards.Proficient in criteria sets used to determine eligibility for acute care hospitalization.General familiarity with medical record coding systems.Functional knowledge of DRG and CPT coding systems.Working experience with Utilization Review activities and general knowledge of JCAHO, PRO, HCFA, and other regulatory bodies. Knowledge of third party payer review, reimbursement systems and utilization monitoring requirements for acute care facilities.Experience with reviewing hospital claims, denials and EOB\'s, appealing claims and working on claims in an audit is preferred. Working knowledge of Microsoft computer applications; excel, word, PowerPoint, etc.Working knowledge of 3M system Experience working collaboratively with IT, HIMS, Finance, Compliance, Managed Care, Business and Clinical Operations are important.Shriners Hospitals for Children comprises 22 Pediatric Hospitals across the USA, Canada and Mexico.

City University of Seattle

Bachelor of Science - BS, Nursing Administration

Southeast Whitfield County High School

Diploma

The University of Tennessee at Chattanooga

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Western Governors University

Bachelor of Science - BS, Nursing

Dalton State College

Associate of Arts (A.A.), Education /Nursing

Jacksonville State University

Bachelor of Arts - BA, Liberal Arts and Sciences/Liberal Studies

Georgia Highlands College

Associate of Science - AS, Nursing