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Click here or scroll down to respond to this candidateCandidate's Name
Street Address ~ PHONE NUMBER AVAILABLE ~ EMAIL AVAILABLE PROFESSIONAL HIGHLIGHTSOver 30 years of experience in all aspects of medical billing and o ce management. 18 years of experience with the VA consistently exceeding in all measurements and standards. I have been honored to assist veterans while adapting to an ever changing system during my time. I have strong problem solving skills, have managed multiple responsibilities and work to meet the set guidelines and deadlines. WORK EXPERIENCEVISN 8 POM Customer Service Assistant (August 2021 -Present) Identies and provides evidence with reports of recommendations for Audits JLV, ECAT, ECAMS, FBCA, DATA NET, ARS for compliance for processing claims. Works with VACC sta to ensure authorizations have correct dates of service and comply with regulations to process claims. Analyze reports, verify issues, correct the issues, and provide reports to leadership. Audit accounts for proper payment procedures, teach proper procedures for deciencies, train sta on new and changing procedures on weekly and monthly calls. Listen to calls to audit for proper policy. Provide assistance with workow to reach our daily, weekly and yearly goals. Work as a group or one on one with vendors and customers to show how to attain success by using di erent procedures, processes and software. Assist with presentations to Leadership, clients and team members providing software, techniques and upgrades reach the goals. Provide clients needs/requests for upgrades to software. Assist IT with implementation and provide feedback to Vendor and IT to produce a working product on a national scale. Use software to provide assistance in reaching our budget and production goals. Provide HIPPA compliance with vendors and customers. Create procedures and reports to minimize redundant procedures for payments. Provide vendors and customers with proper procedures for billing, authorizations, attaching records for proper payment standards. Provide knowledge to vendors on locating payments, requesting bill of collections, appealing denials. Work on special projects to assure compliance. Use teams for meetings, IM, and voice calls. VISN 8 POM Supervisor (August2019-August 2021)Designated subject matter Expert for CRM and drafted Procedures for CRM/ACR with leadership guidance. Pioneered CRM/ACR local process in coordination with the National Program O ce. Worked with Vendors to resolve escalated veteran complaints. Supervised team of voucher examiners processing claims errors in eCAMS. Reviewed claims for accuracy and compliance. Trained proper procedures for payment and rejection. Evaluated workows to improve e ciency of services to consumers and vendors. Determined proper authorization and appropriation to clear claims. Trained Reps in ECAMS and associated tools. Trained Reps on compliance with current regulations. Wrote processes to increase claim productivity. Created and implemented scheduled rotation for phones. Acted as support for sta making vendor calls. Used performance software that provided audit material to track daily performance for accuracy. Used audits to provide team members for improvements and set training one on one with each member to attain excellence. Used software to attain workow to achieve budget and monthly production goals. Worked with IT to address needs based on daily tasks, policies and procedures, and regulation changes. Guided vendors and team on adhering with HIPPA Regulations. Received 100 percent compliance award for handling of PII and PHI. Provided daily, weekly and monthly compliance, budget and regulatory reports to leadership.VISN 7 POM Supervisor/Payment Operations Manager (November 2018-August 2019) Implemented appeals system consolidating 8 stations. Processed claims in VACOLS and HAT for all appeals. Supervised appeals department sta . Designed SOP for appeals to determine benets, eligibility, and authorizations. Identied, and resolved legal issues with appeals. Provided Training with cross departmental collaboration to ensure all appeals adhered to VA policies and federal regulations. Designed a correspondence process for rejected claims to streamline communications with veterans and providers. Trained sta on payment methodologies for EDI, MRA and rejections, and reviewed claims for compliance. Evaluated claim integrity and accuracy associated with voucher processes with a wide range of complicating factors. Implemented software to attain processing goals. Used software to provide daily work to the team and track performance for quality and quantity. Reported to leadership on performance and goals. Achieved 100% Compliance handling PII and PHI per HIPPA guidelines.VISN 7 VA Hospital Billing Technician (September 2004- November 2018) Demonstrated ability to accurately process statements of charges in Vista. Billed outpatient services rendered with reimbursable insurance, Processed an average of 75 outpatient claims per day on weekly reports with less than 5 errors, Ensured adherence to regulations, policies, procedures, Demonstrated ability to use Vista Fee Basis, Handled Customer service complaints and concerns e ectively and promptly Estes Northway Nursing Home O ce Manager (May 2002 - September 2004) Analyzed yearly budgets. Set up goals to achieve budgets in each department. Accounts Payable. Assigned fund control points, Monitored & Analyzed each department budgets. Resolved vendor escalations for CRM/ACRs. Monitored & audited payments and refunds on all accounts. Prepared monthly, quarterly, and yearly reports. Applied for all state and federal insurance Human Resource duties for over 200 employees, Chart and billing auditing for all medical claimsEDUCATIONAccounting,2009 Je erson State Community College, Birmingham, AL Diploma, 1991 Seminole High, Seminole FLTRAININGClaims Certicate, 2000 Share point, ACR, CRM, eCAMS, Datanet, JLV, FBCA and VISTA, HSRM, PPMS, ECAT, CPRS, FPPS, NCAT, Microsoft O ce programs, ICD-9, ICD 10 coding & CPT-4 Coding |
