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Click here or scroll down to respond to this candidateCandidate's Name
Phone: PHONE NUMBER AVAILABLEE-mail: EMAIL AVAILABLEWORK HISTORYJune Street Address -August Street Address
HCA Patient Account Services - Revenue Integrity/Revenue Integrity Analyst-Work from Home for Parallon Atlanta SSCAnalyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, and eRequestMedical necessity, Correct Coding Initiative, Outpatient Code Editor (OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertisesInteract with ancillary departments to obtain additional information needed to properly bill account based on medical recordIdentify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadershipPerforms assigned SADs Quarterly audits and Focus audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the RIAS systemsServes as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issuesMaintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls perHCA RequirementsPerform other related functions as assignedNovember 2008-May 2010HCA Patient Account Services - Revenue Integrity/Revenue Analyst @ Las Palmas Hospital El Paso, TXAnalyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRTMedical necessity, Correct Coding Initiative, Outpatient Code Editor (OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertisesInteract with ancillary departments to obtain additional information needed to properly bill account based on medical recordIdentify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadershipPerforms assigned audits by researching documentation, analyzing information, and makesrecommendations to improve flow of claim and enters all corrections into the systemsServes as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issuesMaintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls perHCA RequirementsPerform other related functions as assignedNovember 2008-June 2019Physician Office Services AR/AP Manager - Credentialing Coordinator (Part-time) Las Cruces, NMResponsible for all credentialing and contract update for physicianManaged and implemented Cortex EDI billing and AR systems from start-up for medical officeOCTOBER 2007-AUGUST 2008Aegis Science Cooperation - Nashville, TN - Accounts Receivable Manager. (Managed 7-10 employees)Managed AR policies and procedures, managed daily activities related to the AR function for 3rd Party Pain Comp billing, charge posting, analyze trends in insurance denials and worked with insurance companies to resolve denials/rejects. Screening, interviewing, and hiring new employees, arranged for training of new employees, reviewed each staff members productivity, performed annual evaluations, counseled staff with disciplinary and productivity issues, conduct monthly staff meetings, analyze statistics, compile, reconcile, and distribute monthly reports. Other duties included overseeing insurance credentialing for non-par payers. Managed the implementation of Intergy and Practice analytics systems from start-up for the AR department.DECEMBER 2005-OCTOBER 2007Revenue Cycle Solution Project Manager Perot Systems-Advanced Receivables Strategy, Inc. Worked as a team member with implementation of eContracts and ePrime for ARS. Managed TennCare collections/billing, patient accounting, collections and appealed aged TennCare accounts, electronically, when possible. Billed and collected hospital patient accounts including inpatient acute care, comprehensive outpatient rehabilitation facility services, skilled nursing facility services and outpatient psychiatric services. Patient accounting for DC Medicaid - billed, collected and appealed aged Medicaid accounts.JUNE 2003-JUNE 2005OB-GYN Clinic Murfreesboro, TN- Practice Manager/ Audit Nurse (Managed 10-15 employees)Managed all daily activities related to the practice. Audit Medical records, appeal denials, hired and trained all employees, managed customer services, scheduled surgeries, precerted surgeries, verified insurance benefits, daily posting of remits (EOBs), analyzing and reconciliation of patient and insurance receipts, interpreting EOBs and account information, resolving outstanding patient accounts through direct contact with the patient by telephone and in person, obtaining payment on balances and establishing appropriate payment plans, Medicare, TN Care, and private insurance billing and coding, coordinated all billing activities and collection coordination, coordination of posting payments and keying adjustments and identifying additional documentation needs, reconciling receipts summaries, researching credits on A/R accounts, working with third party payers to resolve balances. Responsible for all credentialing and contract update for all providers. Developed a reporting system for collections. And many other duties as needed.OCTOBER 1998DECEMBER 2003HCA Patient Account Services, Nashville, TN TN Care/Medicaid Collection/Billing Manager.(Managed 26 employees)Collections Manager DutiesScreen, interview, and hire new employeesArrange for the training of new employeesReceive and review statistical documents from Information Services and provide that information to the appropriate Collector/Patient Account RepresentativeAssure productivity of each staff memberReview each staff members productivity on a monthly basis and perform annual evaluationsCounsel staff with disciplinary and productivity issuesWork as a liaison between the Collections services staff and other PAS staffResolve issues escalated by patients and/or Collections staffConduct monthly staff meetingsBilling Manager DutiesEnsures that third party billing is submitted correctly and that appropriate follow-up is performedAssures that denials are corrected and filedAssures compliance with billing policies and proceduresAssists the Billing Director in establishing and monitoring productivity standards, quality improvement and direct staff in meeting department goalsAssists the Billing Director in preparing timely month-end closing activitiesScreen, interview, and hire new employeesArrange for the training of new employeesCounsel staff with disciplinary and productivity issuesWork as a liaison between the Billing services staff and other Patient Account Services staffResolve issues escalated by patients and/or Billing staffConduct monthly staff meetingsHCA Patient Account Services, Nashville, TN. - Clinical Appeals/Revenue Integrity/Auditing Nurse Manager (Managed 16 employees)Appeals Manager DutiesAnalyze trends in insurance denials and work with insurance companies to resolve underlying reasons for denialsManage recurring coding or clinical documentation issues and correct the underlying causes for errors.Perform Q/A for Clinical Appeals functionScreen, interview, and hire new employeesArrange for training of new employeesReview each staff members productivity on a monthly basis and performing annual evaluationsCounsel staff with disciplinary and productivity issuesWork as a liaison between the Clinical Appeals staff and other Patient Account Services staffResolve issues escalated by Clinical Appeals staffConduct monthly staff meetingsAuditing Manager DutiesAssist with the processing of payroll for his/her direct reports by maintaining employee edit requests, PTO requests, etc.Maintain accurate attendance records for employeesMaintain QA statistics as needed and reports results to the Regional Revenue Integrity ManagerAssist with or performs employee evaluations with input from Regional Revenue Integrity ManagerDirectly oversee the daily activities of the RI Analyst to ensure department standards are metContinually educate staff of any changes pertinent to their rolesWhen appropriate, relieve staff members during employee sick/vacation timeWork closely and professionally with nursing and ancillary departments in an effort to maintain a teamwork approachExcel in all functions performed by Revenue Integrity ManagerResponsibilities to ensure adequate staffing and problem-solvingSchedule and assist with evaluation processes; helps resolve employee concernsAssist Regional Revenue Integrity Manager to ensure all personnel and department policies and procedures are followedInforms Regional Revenue Integrity Manager of all issuesSupervise and maintain effectiveness of workflow and staff responsibilitiesRecommends sufficient number of qualified/competent staffActively seeks ways to control costs without compromising patient safety, quality of care of the services deliveredAttends in-service presentations, and complete mandatory education week including, but not limited to, infection control, patient safety, quality improvements, MSDS and OSHA StandardsDemonstrates knowledge of occurrence reporting system and utilizes system to report potential patient safety issuesHCA Nashville Memorial Hospital, Nashville, TN. - Patient Account Representative, HMO/PPO Collector/Appeals Representative - Review managed care insurance claims denials for possible appeal, review medical record for clinical information to support an appeal, resolution of bad debt claims, customer service, prompt pay discounts, analyze remits for correct payment per contract, and direct communication with insurance company and patients regarding payment of hospital bills.AUGUST 1996-OCTOBER 1998Baptist Hospital, Nashville, TN. - Claims Resolution Specialist, HMO/PPO Collector/Private Pay Collector-Direct communication with insurance company and patients regarding payment of hospital bills, developed training manual for patient representatives, trained patient reps, verified and processed charity applications.JUNE 1994-MARCH 1996Millennium Medical Trust, Nashville, TN. - Billing/Collection CoordinatorManaged accounts receivable/payment, insurance billing and follow-up for a solo physician clinic, and direct communication with patients regarding bills.JANUARY 1993JULY 1993Middle Tennessee Medical Center, Murfreesboro, TN. - Quality Care Review NurseAudited and Reviewed Home Health patients charts to meet Medicare Guidelines before billing, billed Medicare/Medicaid and third party claims.SEPTEMBER 1984-JANUARY 1993Concord Psychiatric Clinic, Knoxville, TN. Psychiatric Nurse/Clinical Director (Managed 20 employees)Audited Medical records, appealed denials, maintained all accounts receivable, account payable, payroll, general ledger, franchise taxes, hired and trained all employees, managed customer services, assisted the physician, billed all insurance claims, CPT/ICD-9 coding, data entry, bookkeeping, self-pay and insurance follow-up. And other duties as needed.SEPTEMBER 1984-NOVEMBER 1985University of Tennessee Memorial Hospital, Knoxville, TN. - Staff Nurse/Medical Surgical - Patient care for Medical Surgical steps down Unit.EDUCATIONMiddle Tennessee State University, BSN, 5/6/2006Meharry Medical College School of DentistryTennessee State University, Nashville, TN. - Nursing/Chemistry, AD in Nursing, 8/11/84Eastern Michigan University, Ypsilanti, MI. - Chemistry/Pre-MedMeharry Medical College, Nashville, TN. - Summer Biomedical ProgramTennessee State University, Nashville, TN. - Chemistry/Pre-MedAlabama A&M University, Normal, AL. - Chemistry/Pre-MedSYSTEMS USEDIntergy by SagePractice Analytics Reporting by SagePatient Accounting (HOST)RDARSRevenue Integrity Audit System (RIAS)CollectionsMeditechPatient Care Inquiry (PCI)MSM (Medqual)VoicertMicrosoft WordMicrosoft ExcelMicrosoft AccessMicrosoft Power PointMicrosoft OutlookClear AccessMed InformatixePremisAffinityMedisoftPassportCDM ViewerMSC (DET/RMT/CRT)SSD EtranKronosOnbase DEIRevenue Cycle ProCLUB AFFILIATIONSToastmaster InternationalCTM (Competent Toastmaster)CL (Competent Leader) |
