Bernard D.

Participated in quarterly compliance audits across branches in New York, Westchester, Massachusetts, Connecticut, and Long Island, focusing on caregiver, recruitment, nursing, and client documentation. Evaluated 150–200+ caregiver files per cycle, profiling up to 1,100 personnel including HHA, PCA, RN, and LPN. Analyzed recruitment, credentialing, medical, compliance, and field nursing documents to confirm adherence to state and agency standards. Developed audit trackers and compliance reports along with quality improvement findings for leadership. Extracted and interpreted WellSky data to assist with audit planning, execution, and compliance oversight. Operated in a fully remote setting while collaborating with QA specialists and compliance teams.

Conducted reviews of up to 20 Utilization Review determinations each day, addressing complex cases involving multiple treatment requests. Ensured the clinical rationale, reviewer intent, guideline references, treatment requests, and documentation integrity were validated prior to release. Detected discrepancies between reviewer findings, documentation, and system outcomes to enhance compliance and audit readiness. Executed thorough documentation quality assessments for completeness and professionalism. Raised recurring quality concerns and process gaps to foster continuous quality improvement.

Reviewed and finalized daily up to 12 physician reports related to claims while overseeing provider revisions and resubmissions. Conducted quality assurance reviews of IME, Peer Review, Addendum, Clarification, and File Review reports, ensuring they met accuracy, completeness, and compliance standards. Verified medical records, cover letters, provider responses, and supporting documentation across a variety of medical specialties. Confirmed that necessary forms like Job Analysis (JA), Physical Capacity Evaluation (PCE), and Occupational Disease History (ODH) were completed. Facilitated communication with providers, claims managers, legal teams, office managers, and medical facilities to gather essential records and clarifications. Acted as a provider support liaison, assisting physicians with report completion. Engaged in quality assurance calibrations, productivity reporting, workflow enhancements, and training programs for new QA staff. Maintained consistently high monthly QA scores.

Performed tele-interviews for insurance applicants, focusing on identity verification and gathering medical, occupational, and lifestyle information. Handled scheduling, follow-ups, and coordination with underwriting and support teams. Ensured accurate documentation while complying with confidentiality and data protection regulations.

Oversaw a team comprising 3 Registered Nurses and 10 emergency responders in supporting mall Emergency Medical Services (EMS) as well as Occupational Safety & Health (OSH) programs. Functioned as Executive Assistant to the Building Administrator/Chief Engineer by offering administrative and reporting assistance regarding engineering, OSH, and EMS activities. Produced and consolidated daily, monthly, quarterly, and annual reports, documentation, coordination, follow-ups, and management requirements associated with safety and emergency medical operations. Responsible for maintaining engineering and safety documentation, logs, trackers, incident records, inspection findings, and compliance files; monitored unresolved action items and coordinated follow-ups with various teams. Conducted facility and workplace safety inspections, documented hazards and incidents, and prepared safety audit documentation. Organized emergency preparedness activities and training while tracking progress and facilitating improvements in safety and emergency-response processes.

Delivered phone and email support concerning account setup, billing, transactions, refunds, and technical troubleshooting. Maintained comprehensive documentation and contributed to process improvement initiatives while fulfilling service-level expectations.

Coordinated patient transport operations along with emergency response activities in collaboration with hospitals and government organizations. Developed training materials and led EMS, first aid, and emergency preparedness programs. Maintained medical records and operational documentation, mentoring new responders throughout their training.

Rendered frontline EMS support during city and intercity response operations. Established a digital documentation and case-tracking workflow to enhance reporting accuracy and efficiency.

Provided technical support for internet and landline services by troubleshooting connectivity and device issues. Ensured accurate documentation and coordinated the dispatch of technicians when necessary.

Handled customer inquiries regarding billing, account setup, troubleshooting, and service plans. Maintained detailed interaction records and performed follow-ups to enhance resolution and customer satisfaction.