Sing Tam Lee

Experience

1. External Audit Special Investigation Unit (Siu) Investigator

   Providence Health & Services

   Apr 2019 — Present · Portland, OR, US

   Collaborates with provider contract administration staff, systems administration staff, operations staff, quality medical management staff and provider relations and network development staff on fraud, waste and abuse issues and will actively seek changes required in Health Plan operations and claims adjudication system set up to prevent overpayments for fraudulent and/or abusive billing and coding practices on a pre-adjudication basis.Works closely with Health Plan legal counsel on overpayment recoveries and provider contract terminations related to fraud, waste and abuse audits. This position frequently responds to document production requests from legal counsel in preparation for fair hearings and arbitrations and occasionally serves as a witness under oath in arbitrations related to fraud, waste and abuse activities.Conduct fraud, waste and abuse audits in accordance with compliance and audit work plan and prepare detailed audit reports for management, legal counsel and providers.Identify, investigate and resolve billing and coding related inquiries and complaints from beneficiaries, members, regulatory agencies and internal and external customers through demand for refund of overpayments and education to providers.Perform data analysis of provider and member payment integrity issues and facilitate business process improvement to ensure health plan compliance.Act as a resource on compliance issues or questions related to auditing and monitoring activities.Perform audit activities, including on-site record reviews, at provider offices as required.Participate in and coordinate Provider Appeals process specific to SIU overpayment demands.

Education

• Lane Community College

  Certification, Health Information/Medical Records Technology/Technician, Medical Coding

  2014 — 2016

• University of Oregon

  Bachelor of Arts (BA), International Relations,Diplomacy, Business, Mandarin Chinese

  2007 — 2012

Skills

• Sales
• Direct Sales
• Customer Service
• International Relations
• International Business Consulting
• Chinese Culture
• Cultural Sensitivity
• Cultural Diversity
• Cultural Awareness
• Coordinate Events
• Registration Services
• Supervision
• Marketing
• Translation
• Photoshop
• Microsoft Excel
• Wordpress
• Microsoft Word
• Web 2.0
• Software Documentation
• Filing
• Negotiation
• International Development
• International Marketing
• Strategic Communications
• Marketing Communications
• Research
• Event Management
• Strategic Planning
• International Trade
• Mandarin
• Entrepreneurship
• Business Planning
• Market Research
• International Business
• Export
• Public Relations
• Social Media
• Social Media Marketing
• New Business Development