Lori McCarrell

About Lori McCarrell

I am a seasoned quality auditor with extensive experience in Medicare reimbursement and appeals,as well as in the healthcare industry(30 years), durable medical equipment (DME)(5.5 years), medical technology(7 years), medical collections (6 years), medical billing, home care billing and collections, and organ transplant reimbursement. I have 7 years of experience in revenue cycle for hospitals and doctor\'s offices, coupled with 10 years of experience in clinical and administrative appeals. 2 years of customer service I completed a Data Analytics bootcamp at the University of South Carolina where I am acquired skills in Excel for Data Analytics, Oracle SQL, Python, Tableau and Artificial Intelligence. II am also an Air Force veteran and worked as a medical technologist during my years of service.

Experience

1. Quality Assurance Auditor

   Healthfirst

   May 2021 — Present

   Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing proper sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze errors and determine root causes for proper classification, trending, and remediation.• Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure quality.• Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved in a compliant manner.• Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals by collecting data analysis.• Participate in regulatory and audit activities including universe review, universe scrubbing, risk analysis, timeliness assessment, and case walkthrough activities.