SUMMARY:

Organize and prioritize effectively. Strong analytic skills, detail oriented, proficient in all aspects of medical billing, collections, cash posting, contract compliance and end user workflow training, all aspects of A/R and Revenue cycle systems. Knowledgeable in Medicare, other State Medicaid and AHCCCS plans, TRICARE, Champ - VA policies and related billing requirements, as well as most private health insurance plans with extensive quality assurance of claims processing. System maintenance on applications such as Cerner Millennium in the following applications: Charge services (chargeviewer/cspricingtool/Revenue Cycle/ops jobs/Pro-Fit/Discern Analytic s/HNA user/Panther/Pathnet/CoPath and ESI Logs), AS400/Med Series 4 Billing Editors, data extraction from ms4,CPR+, SSI click on billing, Emdeon and Med Assets clearing houses, HL7 data, Pixys audit reporting. Written and verbal communication skills, group presentations and virtual end user training, support for IT, Cerner Charge Services and inpatient, outpatient, physician billing departments, create desk reference materials based on application and work flow, with occasional travel. Customer service is a very high priority. Knowledge of ICD-9 coding requirements, medical terminology and CPT/HCPCS, 835, 837 (5010 version), 999,270, 271, 276, 277, 485 file understanding and interface scheduling. Remote assignment experience. Inpatient, outpatient, home health therapies, DME, Hospice and Physician services (hardcopy UB04 and 1505 claim form experience).

JOB HISTORY:

Confidential

Infusion Billing Manager

Responsibilities:

• Manage billing/collections/insurance verification/Authorization team members of 8
• Monitor and track all workflows that contribute to Revenue generation
• Payer and contract load in CPR+
• Month end close procedures
• Hiring, continued team education, team building, team disciplinary actions and HR documentation. validate claims on hold and monitor. Billing review claims queues must be kept clean

Confidential

EDI Specialist

Responsibilities:

• EDI enrollment for EFT,ERA and Claims/837P validate provider in both individual and group trading partner id's for all 32-locations across most states and all payers serve as first contact for cash posting department regarding posting problems and automate as much as possible work closely with claims vendor and software vendor to quickly trouble shoot systems issues and resolve web portal administrator, set up end users and educate as needed flexibility and a very high level of customer service is required during prioritization of system fixes and issues reported

Confidential

IT Business Analyst

Responsibilities:

• Primary Billing office IT contact related to revenue cycle teams, daily coaching of registrar, customer service, billing and collections staff pertaining to work flow.
• Epic conversion coach, work in data analysis for implementation of billing clearinghouse from 3- legacy systems in order to move all lines of business onto one, new core system.
• Emdeon build involvement and bridge routine analysis to ensure a smooth transition for all lines of businesses; Inpatient, Outpatient, Home Health, Infusion/factor billing, DME, Physician group billing, Hospital inpatient and outpatient claims requirements. Scenario testing. Help-desk liaison for billing and customer services offices.
• CPR+ data review and reporting extract. Eligibility systems monitored. Daily claims files compilation and troubleshooting of any and all unbilled files to ensure timely filing and statement process completed on a weekly basis (file re-org and SFTP) for all four lines of business. All work queues monitored for any spike trending and resolution.
• Home health Snv, HHA, PT, OT, ST, and MSW billing.

Confidential

IT Data Analyst

Responsibilities:

• Assist with mmdbtool and dcptools for orderable build as they pertain to Surginet. Explorer menu and Discern explorer for reporting, related to charge audit processes and general departmental reporting distribution in conjunction with SQL queries
• Primary function includes system build maintenance of core editor files 5010 version (AS400-MS4, Med Assets, SSI click on billing products and Cerner products) ensuring the functionality and accuracy of 837P and 837I electronic files for both MS4 and Cerner A/R as well as 835 remit file maintenance in MS4. review of HL7 data for troubleshooting. CPR+ database build and validation.
• Involved with System integration and Interface implementation teams, testing and charge auditing documentation when related to billing and or collections, ensuring proper data flow using opsviewmonitor for ESI logs in Interfaces and patient accounting as well as charge services queues relating to any completed and/or failed jobs when trouble shooting any charge related issues
• Provide end user virtual system training and support, maintain billing security levels, Maintain billing software updates in a timely fashion and test in a test environment to facilitate the most efficient system functionality for live environment
• Automate posting and system maintenance jobs using bostonws scripting tool, VB AND some Perl scripting experience
• Primary contact for vendor file transfer protocol to and from all outside vendors relating to outside collections and outside survey information

Confidential, Mesa, AZ

Systems maintenance manager

Responsibilities:

• End user maintenance to ensure appropriate security levels within software (Mestimed and MS4 Dezine products)
• System integration build team related to new core system
• Adding and maintaining contract pricing to minimize write offs due to invalid charges and ensure correct patient co-pay calculations
• Audit the off-site locations data entry for continued education needs. Also monitor error ratio of same locations to recommend and or implement action plan for correction. This is monitored by daily system reporting and review
• Perform random medical records chart audits, all payer types and all 20 off-site locations on a quarterly basis in order to monitor both Government and Contract compliance
• Customer Services department liaison relating to all government health care programs and network contract issues to ensure staff member understanding
• Supervise and train offsite staff in order to maintain efficiency and accuracy by periodic visits and or written communications
• Provide ongoing training/education and produce desk reference tools for the customer service and billing departments on an as needed basis

Confidential, Phoenix, AZ

Provider Education, Senior Specialist

Responsibilities:

• Write articles for Provider newsletters, policy/procedure manuals and maintain educational information for the Provider Education and relations department.
• Various subject matter pertaining to policy changes/updates, as well as clarification of existing billing/coverage policies
• Primary Confidential contact for Home Health, DME and Hospice provider billing issues
• On-line research of program changes with government health care programs, OIG, HCFA, Medicare and managed care compliance and regulation changes in the healthcare industry
• Actively involved in presentation of various internal meetings and offsite Provider in-services to effectively train and educate providers on the authorization, billing and appeals processes for all Tricare plans managed by Confidential Health care alliance

Confidential, Palm Springs, CA

Managed Care Coordinator

Responsibilities:

• Supervise managed care collections staff. Liaison between billing department and clinical staff
• Primary contact for patient education regarding coverage and co-pays. Quality control of patient profile data and maintain authorization services flow.
• Monitor and audit medical records for accuracy of charges and medical necessity guidelines for all managed care contracts in the Home health, Hospice, IV infusion, and DME departments
• Automated home health services visit tracking system, by discipline and coordinated with managed care authorization logs to minimize lost revenue