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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLEPROFILE SUMMARYResults-driven financial professional with over 20 years of expertise in medical billing practices, reimbursement analysis, and revenue cycle management. Adept at overseeing all operational facets of insurance billing and accounts receivable, with a proven track record of optimizing financial performance. Well-versed in navigating the complexities of healthcare environments, demonstrating the ability to adapt and excel in dynamic settings. Collaborative team player with effective communication skills, capable of working seamlessly across matrix organizations. Possesses in-depth knowledge of medical terminology, Managed Care contracting, reimbursement models, healthcare laws, and third-party reimbursement regulations. Seeking opportunities in roles such as Financial Analyst, Senior Financial Analyst, Account Administrator, or Billing/Collection Specialist to leverage extensive experience and contribute to organizational success.CORE COMPETENCIESProficient in conducting variance analysis and providing insightful recommendations for improvement.Proven track record of optimizing revenue cycles and ensuring timely collections.Ability to manage and reconcile complex financial transactions.Skillful in navigating insurance regulations and ensuring compliance with billing guidelines.Familiarity with healthcare laws and third-party reimbursement regulations.Analytical mindset with the ability to identify and resolve financial discrepancies.Ensures accuracy and completeness in financial records.Familiarity with accounting systems and technologies relevant to the financial domain.PROFESSIONAL SKILLSAccounts Receivable ReconciliationMedical Billing, Coding, CollectionThird-Party Reimbursement RegulationsRevenue Cycle ManagementReimbursement And Variance AnalysesSupervising And Staff TrainingManaged Care ContractingCustomer ServiceHIPAA ComplianceICD-10, CPT and Medical TerminologyHospital And Physicians Billing (UB-04, HCFA)Project ManagementPROFESSIONAL WORK EXPERIENCEMOUNT SINAI HOSPITAL New York, NY 12/2022 - PresentSenior Financial Analyst - International Patient ServicesCollaborate with stakeholders for accurate billing of international patients.Send charge summaries and payment terms to account Guarantors.Ensure timely payment from international patients, coordinating with hospital finance.Update billing formats and submit claims promptly to payers.Review accounts for outstanding balances and take necessary steps for resolution.Validate payer payments, process adjustments, and prepare final billing summaries.Process payments via cash, check, or credit card, ensuring proper fund deposit.Maintain communication with Patient Accounting for Bad Debt referrals and payer issues.Analyze daily reports for International Patient Services to ensure accurate reflection.Interface with international third-party payers, exercising discretion in accepting or rejecting payment guarantees.Collaborate with leadership to improve patient access and satisfaction through workflow enhancements.Assist in hiring, training, and evaluating staff.NEW YORK-PRESBYTERIAN HOSPITAL New York, NY 11/2020 12/2022Financial Representative - Patient Case ManagementGenerated and analyzed ongoing financial reconciliation reports to find denied and underpaid claims.Monitored denials and underpayments in financial reconciliation reports for timely resolution.Conducted root cause analysis and collaborated with other departments to resolve issues.Addressed complex claims issues for multiple Managed Care Organizations (MCOs).Collaborated with clinical teams to obtain referrals and authorizations for claims appeals.Produced monthly and annual financial performance reports for management.Recommended write-offs for uncollectible accounts to management.Tracked payments for overturned denials.Assisted in implementing system updates and configurations.Collaborated with leadership to enhance workflows for improved patient access and satisfaction.NEW YORK-PRESBYTERIAN HOSPITAL New York, NY 06/2009 11/2020Financial Representative - Global ServicesPrepared treatment cost estimates and provided account summaries after care completion.Boosted revenue by accurately submitting hospital and physician bills to various payment guarantors.Examined and tracked statistical data related to accounts receivable.Resolved complex issues by communicating with patients and insurance companies.Billed insurance companies, ensuring correct coding and timely collection.Trained new employees on organizational processes and policies.Clarified hospital financial policies with patients and addressed financial concerns promptly.Submitted files to international collection agency, ensuring effective communication and collection.Trained providers on billing, authorization requirements, regulations, and financial planning for treatment plans.WEILL CORNELL MEDICAL COLLEGE New York, NY 05/2005- 06/2009Account AdministratorProcessed and tracked claims for PPO, HMO, Medicare, and Medicaid, both primary and secondary.Entered physician services data into the IDX system and performed analysis.Checked encounter forms for completeness, making charge corrections as needed.Engaged in communication with insurance companies, offering extended customer service to physicians.Addressed denials from insurance companies and aging reports.Managed and analyzed refund requests and take-backs from Medicare, Medicaid, and commercial carriers.RENAL RESEARCH INSTITUTE, LLC New York, NY 03/2001 05/2005Senior Account Receivable SpecialistProvided supervision for a team of employees during project work.Transferred facility charges from the Proton system to Medical Manager.Generated monthly reports, including treatment count, Payer mix Reports, and payment control breakdown.Conducted month-end close activities for multiple facilities, addressing any errors.Secured pre-certification and referrals from insurance companies.EDUCATIONASHFORD UNIVERSITY San Diego, CA 2020Master of Business Administration (MBA) with a Major in Organizational LeadershipTOURO COLLEGE New York, NY 2018Bachelor of Science (BS) with a Major in PsychologyKINGSBOROUGH COMMUNITY COLLEGE Brooklyn, NYAssociate in Arts (AA) with a Major in Liberal Arts and SciencesGLOBAL INSTITUTE OF TECHNOLOGY New York, NYDiploma in Medical Billing and CodingN.H.A. Medical Billing and Coding SpecialistChange ManagementStrategic PlanningAdaptabilityConflict ResolutionData AnalysisTime ManagementDecision MakingProblem SolvingCritical ThinkingInterpersonal Skills |
