Suzanne Barone
Director, Government Revenue - Risk Adjustment Department at Upmc Health Plan
Based in Pittsburgh, United States
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Seniority
Director
Department
Finance & Accounting
Location
Pittsburgh
Industry
Insurance
Company size
4.5K
Contact information
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s•••••••@upmc.edu
Phone
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Background
About Suzanne Barone
I have been a Registered Nurse for over 20 years and have worked in 2 psychiartic hospitals in the Greater Pittsburgh area. I have held various nursing positions from a staff nurse up to nurse manager. For the past 11 years I have worked in the Health Insurance industry in the Fraud Waste, and Abuse and Quality Department reviewing medical records, policies and governmental policies to determine if providers and submitting claims appropriately for services provided. Most recently I worked as a Clinical Manager with a team of coders and nurses verifying Risk Adjustment codes, assisted with medical record and coding reviews, oversaw high dollar claims review processes including medical records and itemized bill reviews and worked with an external vendor conducting DRG and automated data reviews. In June 2018 I accepted a transfer within UPMC to the Risk Adjustment Department as a Senior Manager to assist with quality initiatives. Specialties: Registered Nurse since 1993, CPC certified since 2008 and CRC certified since 2016
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