Advize
Nana Grant, MSN, RN, currently serves as a Nurse Auditor at Advize, focusing on Medicare and Medicaid fraud, waste, and abuse-related initiatives. Previous experience includes roles as a Clinical Nurse Consultant and Concurrent Review Nurse at E-Solutions and Manage Staffing, respectively, where responsibilities involved critical evaluation of clinical data for medical service precertification. Nana Grant also worked as a Revenue Cycle Consultant at Cognizant and held positions in prior authorization and case management at organizations such as Blue Eagle Consulting, AMN Healthcare, and Baptist Memorial Health Care. With a strong foundation in managing complex care and expertise in Medicare and Medicaid guidelines developed over a decade of experience, Nana Grant holds a Master of Science in Nursing with a focus on Nursing Informatics and a Bachelor's degree in Nursing Science.
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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.