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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Lebanon AvePhiladelphia, PA Street Address
Phone PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWORK EXPERIENCE:Patriot Home Care Inc. Philadelphia, PATImesheet/Billing Dec 2019MCO Coordinator Feb 2020Denials & Recoupment Jan 2022 - Present Huntingdon Valley, PAProvide support to MCO departmentDevelop rapport with MCOs for Networking purposesContact OLTL for reinstatements of CHC waivers along with CAOsContacts Coordinating Agencies on patient changes, i.e. Hospitalizations, EIMsDevelop strong relationships with different departments to be compliantRevenue Cycle Management for denials and hospitalizations, fraud cases report OIG, etc.Crozier Keystone Health Systems Sept 2019- Dec 2019 Chester, PAAccounts Receivables SpecialistPromise billing of outstanding claims varying in disciplineSecondary billing and denial management for outstanding balancesUtilized Excel for reporting of denials and AR flowLady of Fatima Health ServicesBilling Admin Sept 2017 to Sept 2019 Philadelphia, PACare coordination including schedulingClaims submissions weekly, Medicare/ CGS for RAPSMedicaid waiver program billing, HHA ExchangeContacts Coordinating Agencies on patient changes, i.e. HospitalizationsInterviewing of Potential HHA, DCW,CNAs, RNs, LPNsAide placement and follow-up with Clients regarding care for reporting purposesLYFT DRIVER: 10/2015 to 7/2018Thomas Jefferson University HospitalPhiladelphia, PAInsurance Verification & Authorization Supervisor (Aug 2015 to Sept 2017)Responsible for 17-member staff of insurance verifiers, authorization specialist, pre-registration and registrarsHandled high dollar reports- resolution research for denialsHandled newborn admissions and obtained authorization for NICUObtained all Neurology, Rheumatology and Gastroenterology & Herpetology authorizations for Infusion Therapy patients in a timely manner as allowed by Insurance; submitted appeals for denied authorizations representing Hospital and Physician,Verified insurance utilizing Navinet, Emdeon, Medicare, Promise and various online sites,Fresenius Vascular Care TEMP Ascendo Resources Malvern, PAPatient Account Representative/ Accounts Receivables Specialist (March 2015 to Aug 2015)Responsible for receivables of center in North CarolinaHands on processing of Medicaid, Managed Care, Medicare and Commercial claims,Successful collections meeting goals achieving highest collections over 100% since taking over client siteSuccessful appeals process with Medicare, managed care and commercial claims.Identify payer denial trends, issues with Medicaid fee schedule for NCTracks Medicaid billing system/ Palmetto GBA.Responsible for obtaining authorizations and referrals in a timely manner and having authorizations and referrals backdated as allowed by insurance.Utilized clearinghouse for claims corrections for commercial claims via Navinet, Navicure and Palmetto GBA and NCTracks Medicaid billing system,Silver Lake Rehabilitation Centers Bristol, PARevenue Cycle Manager (Sept 2014 to March 2015)Responsible for full cycle revenue management specializing for Skilled Nursing facility, for Physical Therapy, and Speech Therapy for Post- Acute and Special Needs Short/ Long Term Care.Hands on processing for Medicaid, Medicare, Managed Care, Commercial, Workers Comp, charges and invoicing for ancillary charges.Responsible for month end close process, report metrics, collections, system efficiencies, initiating appeals, and maintaining accurate HIPAA compliant document standard.Monitor and promote effective patient relations and respond to patient concerns.Identify claim denials and errors, research and correct all discrepancies in a timely manner for resubmission.Strong understanding of ICD9/ HCPCS coding, insurance eligibility and authorization verification processing.Ensure cash collection goals are maximized and bad debt is minimized.Greater Philadelphia Health Action, Inc. Philadelphia, PAReimbursement Specialist (April 2014 to September 2014) Temporary Provides support for behavioral health billing and collections department-charge entry, payment posting reconciliation, denial management, appeals processing, and reporting. Analysis of payer trends of Medicaid, Medicare, and Third party payers identifying potential risk.Responsible for completing charge corrections, applying adjustments, resubmission of claims and AR follow-up.Simpson Senior Community Philadelphia, PABilling Manager *fill in* (December 2013 to April 2014) (temporary assignment) SNI FinancialSupervises staff of 4 billing coordinators in all aspects of revenue cycle.Analyze payer trends for potential risk and escalate payer trends.AR follow-up for all payersManaged all electronic billing submission (EDI)Prepare, review and submit for all audit documentationChild Guidance Resource Centers Havertown, PABilling Coordinator (Sept. 2013 to Dec 2013) (temporary assignment) Beacon Hill FinancialAR management, denial management, claims correction.Auditing claims before they are submitted to the clearing house to ensure proper billing.Complete and monitor all billing and authorizations utilization via the PA Promise system.Esperanza Health Center Inc. FQHC Philadelphia, PABilling Supervisor (May 2011 Sept. 2013)Supervised 6 member medical billing staff, reporting to the Assistant Financial Director.Audit preparation for UDS reporting for wrap payments from Medicaid and Medicare.Managed FQHCs account receivables of $2.5 millionAccount Reconciliations of hospital billing, behavioral healthcare (counseling) and home visits (sick calls, general healthcare, and HALOS for HIV patients).Analyzed payer trends ensuring accurate and timely reimbursement to prevent financial loss and depreciation.Established self pay sliding fee schedule management.Implemented account management of OBGYN self pay schedules.Trained staff members on payment posting and charge entry.Corresponded with providers on all billing related issues in accordance with Medicaid and Medicare Standards.Training billing staff on Medicare follow-up on IVANS/ Lime Portal software, including but not limited to payer requirements, correct ICD-9 linkage and CPT coding, generating statements, identification and explanation of benefits analysis, and successful collections of the self pay population.Managed staff paid time off accrualsAdvance America Bristol, PABranch Manager (November 2004 March 2006)Managed account receivables and account payables to meet established budget goals.Conducted monthly audits and weekly internal audits within a 1% of error margin for District Management audit preparation.Processed daily deposits.Setup and maintain staff member schedules.Worked with marketing to establish branch recognition in the community.Interviewed and hired potential candidates.Provided exceptional customer service for current and potential clients.Select Medical Corp. / NovaCare Inc., King of Prussia, PAAccounts Receivable Representative (May 2001 October 2004)Managed the accounts receivable of 5 physical therapy and 2 occupational therapy centers in central Pennsylvania.Responsible for direct online billing with Capital Blue Cross.Conducted insurance verification and secondary billing.Handled credentialing issues for Orthopedic Specialty. Coordinated massive payer specific resubmissions.Specialized in workers compensation and motor vehicle claims, Handled managed care and third party administrators and Medicare and Medicaid claims.McKee, Shepherd and Griska Medical Associates at the University of Pennsylvania, Philadelphia, PAAccounts Receivables Representative (July 2000 May 2001)Accounts receivable follow-up for two medical practices.Traveled frequently between locations and as needed.Charged entry in IDX billing and account receivables system.Processed direct patient cash payments on site.Provided patients with financial consulting to determine payment plans.LANGUAGE SKILLSSpanish fluentWriting fluentTECHNICAL SKILLSGoogle Platform, MS Suites, Next Gen, AVATAR, Navinet, Promise, McKesson Practice Partner Electronic Health Records, IDX BAR & PCS WCC, Emdeon, EPIC, Relay Health, Pronet, PCC, CAMS2000, AS400, OHS1, Medix, ANASAZI, ACHIEVE, Windows XP/7, Windows Remote Desktop, Microsoft Office Suite 2010, Outlook.EDUCATIONBachelor of Science in Healthcare Administration (in progress)University of Phoenix, Axia College of Natural Sciences, Philadelphia, PACertificate of Approval Advanced Billing Manager, 2016Medicare FQHC Training, Updated 2016 |
