BRUCE V.

ZATKOW
111 Passaic Avenue, Apt A42, Nutley, NJ 07110
973-320-5495
bzee41cc@westpost.net
Medicare Audits/Recovery
_COMPLIANCE CONSULTANT ~ MEDICAL TERMINOLOGY ~ INSURANCE
REGULATIONS_
Results-driven and versatile Medicare Compliance professional
seeking a new application of focused skill set including Operational
Support and Development, Training and Assessment as well as
comprehensive Data Analysis. Eager to apply these skills for a
company in need of a highly organized and experienced specialist who
can streamline processes and increase productivity.
*
CMS / HIPAA Knowledge
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Quality Assurance
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Accurate Coding (CPT/HCPCS)
*
Medicare Law / Compliance
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SOP Development
*
Billing Discrepancies
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Program Integrity
*
Fraud & Abuse Investigations
*
Medical Necessity Assessment

QUALIFICATIONS PROFILE
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Strong organizational background with the ability to work
independently on multiple projects simultaneously, including
FORMULATION OF POLICIES AND PROCEDURES, TRAINING AND DEVELOPMENT
PROGRAMS, MEETING DEADLINES, IN-DEPTH PROBLEM ANALYSIS AND SOLUTIONS,
PROCESS IMPLEMENTATION, AS WELL AS DEVELOPMENT AND EXECUTION OF
STRATEGIES THAT ENSURE COMPLIANCE WITH MEDICARE MANDATES.
*
Extensive knowledge and experience adjudicating provider
billing/coding issues, blending well-honed communication skills with
CPT/HCPCS/Medical/Pharma expertise.
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Thorough knowledge of the proper use and application of medical
terminology.
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Liaised with myriad medical and professional consultants.
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An adept writer and editor, integrating laws, regulations, and
corporate policy to produce effective SOPs.
TRANSFERRABLE COMPETENCIES
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Effectively strategize with senior management to resolve complex
issues related to billing, coding, and documentation.
*
Excel in defining and implementing policies, procedures, and
operational systems that boost productivity, efficiency, and quality
of operations.
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Utilize extensive knowledge of administrative practices and data
organization.
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Consistently evolve the highest standard of delivery methodologies.
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Proven ability to adapt strong technical skills to diverse corporate
needs.
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Skilled at communicating cross-functionally to improve knowledge
sharing between departmental lines.
*
Apply knowledge of various administrative functions and company
protocols to support and advise management.
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Embrace corporate culture and actively promote and lead company
initiatives.
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Frequently act as liaison between clients and company to pinpoint
problems and seek solutions.
*
Technology savvy with knowledge of multiple software applications
and platforms.
SELECT ACHIEVEMENTS
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Synthesized laws and regulations into readable paragraphs that
ensured compliance with Federal/HIPAA directives and coding
guidelines.
*
Developed parameters and conducted correspondence audits that
improved quality and accuracy of the company's responses.
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Examined an array of issues including overpayments, underpayments,
coverage, and medical necessity, completing crucial projects within
stringent time-frames.
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Trained new Hearing Officers regarding the complexities and minutiae
of appeals.
PROFESSIONAL CAREER TRACK
MEDICARE HEARING OFFICER / ADJUDICATOR, QAdministrators 2006-Present

MEDICARE HEARING OFFICER / ADJUDICATOR, Pinnacle Medicare Services

2003-2006
MEDICARE HEARING OFFICER / ADJUDICATOR, Group Health Incorporated
1992-2006
MEDICARE HEARING OFFICER / ADJUDICATOR, United Health Care 1995-1999

EARLIER EXPERIENCE
_- MEDICARE HEARING OFFICER / ADJUDICATOR__, AdminaStar__ _
_- MEDICARE HEARING OFFICER / ADJUDICATOR__, Empire Blue Cross Blue
Shield__ _
ACADEMIC TRAINING
*
M.S. a" PHYSIOLOGY/ZOOLOGY, Rutgers University
*
B.S. a" BIOLOGY, Fairleigh Dickinson University