Advize
Dena B. is an experienced professional in the healthcare sector with a focus on clinical auditing, practice performance management, and disease management. Currently serving as a Fraud, Waste & Abuse Clinical Auditor at Advize since June 2023, Dena previously held the position of Senior Practice Performance Manager at Optum, where collaboration with healthcare providers facilitated the management of UHC Medicare Advantage incentive programs. Dena’s background includes roles such as Marketing Liaison/Disease Management Program Manager at Blue Cross NC, emphasizing the development of educational materials and mentoring health coaching staff, and Associate Operations Specialist at PPD, involving the evaluation of serious adverse events in clinical trials. An early career as Regional Sales Account Manager at Coram CVS/specialty infusion services demonstrated a strong capacity for achieving revenue and profit objectives. Dena holds an Associate of Arts and Sciences degree in Registered Nursing from Alamance Community College.
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Advize
After nearly two decades of auditing large data sets and performing extrapolation for increased ROI for payers, Advize has shifted focus to building relationships with providers based on data and best practices. Our team has expanded our model of coding and billing audits focused on waste and abuse to examine fraud through Big-4 Data Analytics and OIG best practices. Audit and Support Services – Record Retrieval, Storage, Purge – Onsite record retrieval – Send request letters and other communications with providers – Secure file upload (SFU) – Records are stored securely and discarded in accordance with HIPAA recommendations and requirements – Minimum necessary PHI accessed – Record files are securely returned with audit result delivery – Corporate Integrity Agreements – Statistically valid sampling – Medical necessity and proper coding/documentation review – Audit Management and Quality Assurance Support – QA Review – Reporting and Results Delivery – Overpayment Recovery and Overpayment Support – Legal Support – Case building, expert witness, audit, reporting and testimony Review and Reporting – Reviews performed by highly experienced and credentialed auditors – Audit personnel work with a variety of healthcare personnel and patients. They should always conduct themselves in an acceptable, professional manner and adhere to ethical standards, confidentiality requirements, and objectivity. Auditors trained to completely document their findings and problems. – Perform verification of charges – What citations are important, and what policies are important? – Citation guidebook creation – Review of claims – Generation of preliminary audit results – Results delivery and collaboration with client – Report generation – Final Audit Results: – Contain final audit reporting, this reporting will have included the overpayment amount. – Review the next steps for the provider who was audited.