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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Whitehaven CircleHighlands Ranch, CO Street Address
PHONE NUMBER AVAILABLEPHONE NUMBER AVAILABLE (cell)Objective:My objective is to join an organization that offers a challenging position, which will utilize my skills and talents to meet business objectives.Work History:Centura Health CHPG SAH Clinic Financial Liaison/Financial Counselor 01/01/2015 to 04/12/2019Liaison for all Speciality Clinics for patients and Centuras Revenue Management Department.Correct Coding and Revenue Management issues for Physician Billing Issues.Expedite requests for Adjustments and Refunds for patients.Centura Health-CHPG Chatfield Womens Care - 04/2014 to 12/31/2014Office SpecialistSchedule appointments as well as Procedures that will be done at the clinic.Verified insurances and eligibility for all commercial insurances.Day end closing, make sure that the Cash Drawer is posted and accurate and all end of day reports are completedChart preparation as this clinic is not on EMR as of yet.Centura Health CHPG Aspen Ridge ENT 07/26/2013 to 04/2014Clinical SchedulerSchedule all Surgeries and Procedures either done in the Operating Room or in the Procedure Room at the Clinic.Verify all Insurance eligibility and obtain all prior authorizations for surgeries and procedures.Knowledge of CPT and ICD 9 codes are essential for this position in order to obtain correct authorizations and billing reimbursements.Excellent Customer Service plays an important role in this position as there is a great deal of patient contact explaining the details of surgery and Pre Admission information.Centura Health Revenue Management 04/01/2012 07/24/2013Customer Service/Disputes TeamCentral Insurance TeamHigh call volume from patients, Centura facilities and from physicians offices requesting assistance with disputes and questions on claims and EOBsKnowledge of CPT, Revenue Codes and ICD-9 codes are necessary for proper billing and claims.Verify eligibility and authorizations with Medifax, or the Web Portal for the individual insurance companies.Interaction with hospital HBAs and Financial Counselors are required daily to update patient eligibility and authorizations.Written communication of all disputes and resolutions plays a major role in this position. All disputes must be resolved in a timely manner.Centura Health Porter Adventist Hospital 04/11/2011 04/01/2012Practice CoordinatorPorter Practice ManagementPractice Coordinator for Centura Medical Consultants which is for three full time physicians and one physician assistant. This group is unique as they are Hospitalists as well as they see the patients for Pre-Admission Evaluations before the patient has their surgery.Scheduled Procedures at the Cardiac Cath Lab for Dr. Christopher Stees. Procedures ranged from Cardiac Aversions to Cardiac Ablations and Defibrillators. CPT coding and ICD-9 codes had to be correct and accurate for reimbursement.In depth knowledge of Meditech and LSS is required as well as Revenue Management procedures and billing fundamentals. Interaction with these physicians as well as interaction with other Porter practices played an important role as well as excellent customer service for our patients.Assisted with LSS billing issues with other practices such as Colorado Joint Replacement, Aracea Womens Care, Harvard Park Family Practice.Accurate ICD 9 coding as well as CPT coding were essential for accurate billing to be sent to the Coding Hub for timely billing and reimbursements.Supervised Kronos edits for payroll for three practices as well as working the Connance queues for bad debt for Centura Medical Consultants, Dr. Stees, Colorado Head and Neck and trained the Practice Coordinator for CJR on this process.Centura Health Central Billing OfficeCustomer Service -07/2008- 04/2011Contract Compliance - 02/2007 - 07/2008 Account Specialist/Account AnalystHigh call volume from patients, Centura facilities and from physicians offices requesting assistance with disputes and questions on claims and EOBsKnowledge of CPT, Revenue Codes and ICD-9 codes are necessary for proper billing and claims.Verify eligibility and authorizations with Medifax, or the Web Portal for the individual insurance companies.Interaction with hospital HBAs and Financial Counselors are required daily to update patient eligibility and authorizations.Written communication of all disputes and resolutions plays a major role in this position. All disputes must be resolved in a timely manner.Centura Health At HomeDenver, COHealth Benefits Advisor/Customer Service Lead - 09/2004 02/2007Lead Account Analyst
Responsible for verifying and obtaining prior authorizations on incoming referrals from Centura Home Oxygens three branches.Worked Prior Auth reports for all insurances making sure that authorizations were obtained for all necessary insurances and equipment. Worked Prior Authorization Report for Medicaid and sent PAR requests to physicians for completion and then submitted these requests to Medicaid for approval.Supervised Accounts Receivable for Centura Home Infusion. Knowledge of CPT coding, ICD coding and medical terminology were crucial in this position. Worked claims, EOBs and all reimbursement reports as well as all aging reports for IV Department.Supervised three other AR Representatives to ensure proper billing and reimbursements from Government and Commercial insurances.Dr. Leviss, Hirsch, Bissinger and GoldsteinParsippany, NJOBGYNOffice Administrator 2000- 08/2004Managed all front office procedures, policies and staff for four OBGYNs. In charge of all prior authorizations, referrals and the scheduling of surgery for patients, as well as all coding for procedures and office visits.Knowledge of all commercial insurance contracts as well as Medicare guidelines were required. Clinical knowledge of birth control products as well as the scheduling of laboratory tests, amniocentesis and ultrasound scheduling for OB and GYN patients as well as knowledge of medications were essential. Heavy phone contact with patients, physicians, hospital personnel, and insurance companies. An excellent working knowledge of Medic and MediTech was essential in this position as well as managing all charges posted and reimbursements received.AtHome Medical formerly Alliance Home Care 08/94 - 2000Morris Plains, NJLead Patient Care Coordinator 1994-1998Customer Service Supervisor 1998-2000Responsible for referrals from Physicians, patients and Case Managers from all of the Atlantic Health Care Systems as well as hospice organizations. Knowledge of Durable Medical Equipment, Respiratory Equipment, Enteral and IV equipment were essential.Responsible for coordinating supplies and deliveries of all IV medications and Enteral supplies under the supervision of the Director of Nursing. Responsible for obtaining Certificate of Medical Necessity documentation on all Enteral patients.Assigned to Accounts Receivable for a period of time to supervise IV and Enteral billing and coding, as well as following up on prior authorizations. A professional telephone and Customer Service attitude had to be maintained at all times. This position required a full working knowledge of MestaMed computer system.During my time as Customer Supervisor there were fourteen employees that reported to me directly. Responsible for doing the Customer Reps yearly review as well as their quarterly review.Interests: My major in college was Medical Lab Technology and I have taken Medical Terminology courses as well as completing a course for Pharmacy Tech and ICD 9 and CPT Coding. I have experience on Mestamed, Fast Track, SCS, Meditech/LSS and other related medical software programs as well as extensive Customer Service experience. I am a member of AHIMA and will continue taking courses to obtain my Certification for Clinical Coding. I have taken ICD - 9 classes as well as CPT classes and Anatomy and Physiology. I am currently taking an online course to learn ICD10References:Available upon request |
