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Click here or scroll down to respond to this candidateCandidate's Name
Street Address - PHONE NUMBER AVAILABLEEMAIL AVAILABLE LinkedIn Profile https://LINKEDIN LINK AVAILABLESummary-Accomplished Results-Oriented Medical Billing Analyst who consistently meets deadlines, and increases company revenue. Highly Skilled at increasing productivity through cost detailed analysis.APRIL 2018 CURRENTREVENUE INTEGRITY MANAGER- COMPLIANCE DEPARTMENT, University HospitalsDaily Responsibilities Include: Oversees revenue integrity team daily duties, including: Submitting claims to payers on Quadax/Expeditor (Billing System)Tracked, analyzed and interpreted trends in billing error data.Designed cost efficient staffing solutions for the hospital using E-Solutions resource management software.Applied payments, adjustments and denials into medical manager systemEnsured timely and accurate charge submission through electronic charge capture, including the billing and account receivables Medi-Tech, and Epic Hyperspace system & clearinghouse.Ensure Claims are accurately coded, billed and processed within time frames.Working with different departments (Lab, HIM/Coding, Cardiology, Radiology & others)To find errors and create streamlined processes to avoid them going forward.Work with vendors/third party companies and correct errors on claims, or send appeals/corrections if needed.Daily, Weekly, Monthly Goals are met within revenue integrity dept. to reduce aging & N status within revenue cycle dept.DATES FROM JANUARY 2016 TO MARCH 2018PATIENT ACCOUNTING SUPERVISOR- COMPLIANCE ANALYST- ST. VINCENT CHARITY MEDICAL CENTERSupervised the patient acconting team on their daily duties, and cross trained new employees of the systems and procedures. Reproted to the Manager of Revenue Integrity performed performance evaluations of employees also. Trained Team Leads and new analysts on Quadax/Expeditor billing system daily to reduce unbilled claims to Medicare.Billed MSP (Medicare Secondary Payer) claims, adhered to specific rules and guidelines.Sent appeals online on the MyCGS website, along with medical records and aging appeals (6653 forms) to Medicare.Sent quarterly reports for entire Hospital to Medicare with signatures from manager, Director, CEO and assured accuracy to avoid delay in payment on future payments.Attended yearly CGS meetings for St. Vincent to obtain and relay updated policy and procedures for that calendar year to rest of medicare team.Set up online access for all Medicare team for CGS, trained how to upload documents and appeals online, along with claim submission.Daily Responsibilities Include: Submitted claims to payers on Quadax/Expeditor (Billing System)Ensure Claims are accurately coded, billed and processed within time frames.Working with different departments (Lab, HIM/Coding, Cardiology, Radiology & others)To find errors and create streamlined processes to avoid them going forward. Work with vendors/third-party companies and correct errors on claims, or send appeals/corrections if needed.COMPLIANCE ANALYST-, St. John Medical Center- UHDATES FROM MAY 2014 TO JANUARY 2016Responsible for initiating process improvements with UH Departments related to Medical Necessity and CCI Requirements.Carefully reviewed medical records for accuracy and completion as required by insurance companies.Demonstrated analytical and problem solving ability by addressing barriers to receiving and validating billing & patient information. Recorded and filed data and medical records.Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and pathology reports as well as clinical studies) in support of existing diagnoses. Examined diagnosis codes for completeness, specificity, and appropriateness according to services rendered. Acquired insurance authorizations for procedures and tests ordered by the attending physician.Consistently ensured proper coding, sequencing of diagnosis codes and procedures.Acted as a liaison between the business department, billers, and third party vendors in resolving billing and reimbursement accuracy. Demonstrated knowledge of HIPAA privacy and security regulations by appropriately handling patient information. Received, organized, and maintained all coding and reimbursement periodicals and updates.PATIENT ACCOUNTING SUPERVISORREPPA & ASSOCIATES *MERGED WITH REVENUE GROUPMAY 2011- MAY 2014 - MIDDLEBURG HTS, OHIOOffered specific training programs to help employees maintain and improve job skills. Evaluated training materials prepared by instructors. Monitored training costs and created budget reports for management. Developed training process to resolve future denials.Submitted 1500/Physician bills, ADA Dental Forms, UB-92, & UB-04 claims to both Ohio & Out of State Payers.Ensured claims, appeals were kept timely and followed PHI guidelines to ensure patient info was kept safe.Worked with CFO to maintain monthly, quarterly and yearly goals, quotas.Account Specialist/Medical BillerReppa & AssociatesJan 2007 to May 2011Middleburg Hts, OhioSubmitted claims daily to Ohio Medicaid, Medicaid HMOs, Commercial Insurance companies & Out of State Payers.Ensured claims were billed correctly within the time frame for each payer.Reviewed denials, worked with payer on resolving issues and corrected claims and resubmitted with revisions.Attended quarterly, and yearly Ohio Medicaid Hospital conferences to stay updated with any changes & trained co-workers on the new material.Extensive knowledge in Quadax, Emdeon, Availity, Medicare- CGS (My CGS) Medicaid (MITS) & most other payers.Used multiple PCs & hospital systems for notating accounts, pulling records, and adding/updating coverage info.Supported the accounting department during monthly closings.EDUCATION-MAY 2007ASSOCIATE OF ARTS, accounting/Buisness Cuyahoga Community College- parma heights, ohioJUNE 2003HIGH SCHOOL DIPLOMA, LINCOLN WEST HIGH SCHOOL- CLEVELAND, OHIOCollege Advanced Accounting Credits (40 credit hours) 2002-2003Advanced ChemistryCheerleading/Dance 1999-2003Track & Field 2001-2003SKILLSWorks with billing team as a resource with any questions, or issues and provides assistance with resolution.Attend Quarterly, Yearly Hospital training classes for Ohio Medicaid (ODJFS) & Ohio Medicare (CMS/CGS).Knowledgeable in specialty claims (bariatric surgery, Pacemakers, Diaphragm Pacing Claims, and Carotid Stenting Claims.Ensures all claims and medical documentation are submitted per payers requirements, and within timeframes.Review denied claims, research for appeal options. Work with HIM regarding coding concerns.Obtaining requested information (correcting coding errors, submitting with specific medical records via appeal or reconsideration requests.Learn new rules and regulations and relay to co-workers and train as well.Learn new rules and regulations and relay to co-workers and train as well.Knowledgeable in specialty claims (bariatric surgery, Pacemakers, Diaphragm Pacing Claims, and Carotid Stenting Claims.Understanding/Reviewing Complex Inpatient claims that need to be submitted with specific medical records (History and Physical, Physician Orders, Progress Notes, etc.)ACTIVITIES & HONORSHIM- Health Information Management Certificate- American Health Information Management Association (AHIMA) 04/24/2015 (34 Credit Hours)CMS- Center for Medicare & Medicaid Services Certificate for Advanced Ohio Medicare Billing Certificate08/30/2016Medicare ABN Certificate of Completion- Ohio Hospital Association & CGS/CMS 10/17/2015CMS- Center for Medicare & Medicaid Services Certificate for Advanced Ohio Medicaid Billing Certificate 11/05/2012 |
