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Click here or scroll down to respond to this candidateCandidate's Name
Street Address
Mobile: PHONE NUMBER AVAILABLE Email: EMAIL AVAILABLEREVENUE RECOVERY ANALYSTSeeking a permanent remote position with potential growth opportunities and a chance to impact the Healthcare bottom line through revenue recovery.PROFESSIONAL EXPERIENCEExperienced Medical Coding Specialist GraduateProject Management & Credit Balance AnalysisOver 12 years of revenue recovery, contract negotiation, patient-payor relationship buildingAggressive Physician A/R service long-term patient account reconciliation, working aging accounts 45 days to 150 days delinquentRevenue recovery -90% revenue recovery rate and a monthly goal averaging $180,000 collected on large facilitiesEffectively working Coding denials received from third-party payors, Medicare & MedicaidAssign appropriate evaluation & management levels for professional servicesQueries physicians when code assignments are noted as straightforward or documentation in the records is inadequate or unclear for coding purposesAMSURG, Envision Healthcare Inc. Nashville TNAR Specialist (2-2022 to present fully remote)Minimal 5 years experience with medical billingExcellent communication skills and strong customer service skillsExtensive working knowledge of managed care networks and insurance carriersExtensive working knowledge of accounts receivable functions, including CPT and ICD-10 codingMust have worked with EMR softwareMEDHOST INC, Franklin TNContract Management Specialist (11/ 2020 01/ 2022 Remote contract position)Maintaining reimbursement rules and supporting data tables for use in hospital contract management software through research and defining methods of revenue recoveryDeveloping methods (logic) for accurately valuing inpatient & outpatient claims with a focus on Medicare valuationsAnswering valuation-related support tickets from clientsAnalytical skills, Focus, Accuracy, and Timelines are paramount qualitiesResearch and define evaluation logic primarily for Medicare hospital claims valuation, with commercial payer websites for adjudication rulesDownland provider manuals, reimbursement policies, and medical policies for use in hospital and applicable commercial payer valuationsProvide internal consulting for enhancement of Hospital Claims Scrubbing applicationCreate and maintain a schedule of download frequencies necessary for timely and accurate valuation of claims maintain a schedule for updatesThe CONVERGENT USA, Gainesville, GAAccount Specialist (02/2019 -08/2020 Fully remote position)Think critically through the implementation of plans to identify gaps and make necessary changes and adjustments45 daily accounts worked to resolution in efforts to recover facility unresolved balances surrounding all denial types from all payersInvestigates and Resolves claim variancesResolves client and audit issues to completion with attention to detail and the highest level of professionalismRounding each area of the service center to learn processes (Billing AR follow-up, Denials, Cash Posting) to assistwith the determination of process improvementNAVIENT/XTEND HEALTHCARE, Hendersonville, TNInsurance Collector III (08/2018 01/2019)Claim denial review and correctionsRequesting Retro authorizations for services rendered requiring an authorizationAppeals for not medically necessary, not classified, or experimental proceduresClaim review for coding denial for diagnosis, modifier use, and inappropriate procedure code due to payer-specific guidelinesContract coherence per contract review per capitated health versus medical plans for correct billing based on levels of responsibility surrounding yearly Dophers.VANDERBILT UNIVERSITY MEDICAL CENTER, Nashville, TNVarious Roles (4/2014-04/2017) RemoteAccount Reimbursement Specialist III (02/2017 04/2018)Coding, Authorizations, AppealsProvides feedback to physicians and providers based on documentation reviewedOffers suggestions for improvements based on coding/billing requirements and coding policies (CMS VS AMA)Demonstrates knowledge to work coding denials, received from third-party payers including MCO, Medicaid, & MedicareHigh-Volume Third-party billing, claim to correct, addressing daily correspondence directly related to workers compensations and auto accidents inquiries, billing, and lawsuits for reimbursement and collection effortsAccount Reimbursement Specialist II, (10/2015 04/2016) RemoteMaintain follow-up on patient accounts to include unapplied payments within established guidelinesPharmacy billing, collecting, and editing of CMS 1500 claims through conversion on HCPCS codes to NDC units for reimbursementTelephones or sends formal letters in the initial stages of the collection process to the delinquent accountAnalyzes each payor and patients outstanding accounts receivable, re-bills, refunds, and denials to obtain maximum reimbursement.Re-bill patient insurance and other third-party carriers for charges per company/division per company and customary charges special contract or letter agreement pricingManaged collection claims for unpaid bills against the estates of debtors; evaluated and verified benefits and eligibility; posted and adjusted payments from insurance companies; identified and resolved patient billing and payment issues.Recovery Analyst Consultant II, (04/2014 10/2015)Manage 45-60 aged accounts per day from 2012 to resolve all recovery issues and request pre-authorization, retro authorization, and extended authorization to extend in-patient stays.Handle claim corrections, edits, audits, and claim resubmission and work closely with subrogation accounts, third-party liability, pre-existing conditions, and worker compensation.Complete thorough follow-up on claim denials, and submit claim appeals for denied claims for timely filing, investigational, experimental, and splitting claims when necessaryWork with claims that deny a total number of hours versus the procedure on facility claims to create a corrected claim per billing guidelines, allowing recovery on services excluding room and board.Utilize Epic, Medipac, Star Panel, and Hyperspace as resources for necessary documents needed to attach to appeals.References Available Upon Request |
