Advize
Rachel Jones has a diverse work experience across various industries. Rachel currently serves as the President of Advize since June 2023. Prior to this, they held roles at Clover Health, where they were the Senior Director of Provider and Payment Solutions from March 2021 to June 2023, and the Director of Provider Services from October 2018 to March 2021. Before joining Clover Health, Rachel worked at Highmark Inc., where they held multiple roles including Director of Financial Investigation and Provider Review from December 2015 to September 2018, Manager of Financial Investigation and Provider Review from January 2014 to December 2015, Fraud Consultant from March 2013 to January 2014, Senior Internal Auditor from August 2010 to March 2013, and Internal Auditor II from June 2008 to August 2010. Rachel also worked as an Adjunct Professor at Bethany College from January 2013 to December 2014 and as a Senior Audit Assistant at Deloitte from August 2006 to June 2008.
Rachel Jones has a strong educational background in the field of accounting. Rachel obtained a Bachelor of Science in Business Administration, with a major in Accounting, from the University of Pittsburgh. Rachel attended the university from 2002 to 2006.
Rachel furthered their education by pursuing a Master of Business Administration (MBA) degree with a specialization in Accounting. Rachel attended the University of Pittsburgh Katz Graduate School of Business from 2009 to 2012 to complete their MBA.
In addition to their degrees, Rachel also obtained two certifications in their field. Rachel became a Certified Public Accountant in February 2008, certified by the Commonwealth of Pennsylvania: The State Board of Accountancy. Rachel later became a Certified Fraud Examiner in January 2009, certified by the Association of Certified Fraud Examiners.
Based on the provided information, Rachel Jones has a strong academic background and certifications in accounting, making their a well-qualified professional in the field.
This person is not in the org chart
This person is not in any offices
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.