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Click here or scroll down to respond to this candidateCandidate's Name
tenfraz@gmailPHONE NUMBER AVAILABLESUMMARY OF QUALIFICATIONSMulti-disciplined, solutions-focused revenue cycle professional with successful experience in healthcare management. Savvy leader, skilled in building cooperative working relationships, driving productivity, supporting change management initiatives, and motivating others to continuously deliver superior performance results.Advanced computer skills in MS Office Suite IDX, Allscripts, HMS, SSI, Meditech, EPIC, RealMed, Medassets and Nextgen,CORE COMPETENCIESTeam Building / SupervisionStaff Development / TrainingPayroll /Records ManagementAudits/IQCProject LeadershipMedicare/Medicaid/Managed CarePhysician Group/Hospital/LTACInsurance Follow-Up and CollectionsPayment Variance AnalysisDenial ManagementGo Live Elbow SupportPROFESSIONAL EXPERIENCEVA Trainer Specialist- (Contract) Kansas City, Mo. 02/03/2022- 07/01/2023Deliver instruction and manage diverse classes of adult learners in a single classroom or simultaneously via satellite or other virtual delivery methods to multiple sites. Conduct individual, small group, and full classroom exercises, including simulations and end-to-end process activities. Develop relationships with learners, understand the range of learning styles in the classroom and tailor instructional guidance to accommodate for these preferences. When instructing within a certified educational institution, responsible for determining the organization, communication and delivery of the course content and materials, and for developing learning activities and demonstrations. May collaborate with internal organization to develop, enhance, and/or evaluate new or existing learning objectives and course content, such as lecture, lab exercises, field training, computer-based training (CBT). May be responsible for testing and qualitative evaluation of participant's attainment of learning objectives. At more senior levels, may evaluate and/or oversee contractors or vendors to develop and/or administer instructor-lead training programs. (It should be understood that this is not intended to be a detailed nor comprehensive description of any individual employee's job content.nThrive/MedAssets Plano, TXPatient Account Rep (Contract) February 2017 May 2017Follow up on all claims from billing through final resolution.Review and prepare claims for manual and/or electronic billing submission.Identify billing errors for correction and resubmit claims to insurance carriers.Follow up on payment errors, low reimbursement, denials, etc.Review Insurance EOBs and initiates appeals as necessary.Print and mail UB04s or HCFA 1500s as necessary for account resolution.Act cooperatively and responsibly with patients, visitors, co-workers, management and clients.Keep current with all commercial and managed care pricing models, rules and regulationsMaintain a professional attitude.Maintain confidentiality at all timesProfessional Medical Services - Ft. Worth, TXMedicare Claims Specialist November 2015 - April 2016Investigated, and resolved and patient issues by analyzing the facts and circumstances to develop timely, effective, logical yet creative solutions.Performed collection procedures on both inpatient and outpatient claims.Reviewed EOBs for contractual discount payment and patient responsibility.Reviewed payor contracts to determine payment variance analysis.Responsible for written and verbal appeals with insurance companies for under paymentsEnsured that daily, weekly, and monthly billing functions were accurate.Updated/ adjusted accounts with secondary billing informationAdjusted, corrected, and billed claims from DDECorrected and rebilled claims from Xclaim systemCymetrix- Lewisville, TXProject Supervisor September 2013 August 2015Responsible for developing, implementing, managing and meeting or exceeding the Operational goals of our clients and Company.Responsible for overseeing the daily operations of a project(s) and the management of the project staff inclusive of onsite Team Members when applicable.Coordinated and conducted interviewing of potential new hires and bringing recommendations to Operations Manager.Trained new Team Members.On-going training and mentoring of Team Members.Completed monthly account reviews for each patient account representative on the project.Ensured Team Member and project compliance with HIPAA standards.Received and reviewed client project reports generated from supervised team members.Monitored and ensured all staff members compliance with company/client standards.Conducted disciplinary counseling including performance improvement plans as required.Reviewed and approved monthly client invoices for accuracy.Responsible for Billing and Collection of assigned high dollar accounts.Identified and communicated trends and issues to Operations Manager & Client.Worked with management in developing policies and procedures.Specialized in Managed Care, Medicare, Medicaid, Commercial and Workers Compensation.Dell- Addison, TX January 2012 - September 2013Claims Specialist Team Lead (Contract)Served as Team Lead to the Manager of Reimbursement, responsible for billing and collection staff of 15+ FTE.Investigated, and resolved staff and patient issues by analyzing the facts and circumstances to develop timely, effective, logical yet creative solutions.Performed collection procedures on both inpatient and outpatient claims.Reviewed EOBs for contractual discount payment and patient responsibility.Reviewed payor contracts to determine payment variance analysis.Responsible for written and verbal appeals with insurance companies for under payments.Ensured that daily, weekly, and monthly billing functions were accurate.Monitored and provided status of delinquent accounts.Cymetrix- Lewisville, TX February 2007 - August 2011Patient Account Team LeadResponsible for implementing policy and procedures to ensure the department runs efficiently. I was instrumental in setting and achieving monthly goals.Responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances.Completed all business related requests and correspondence from patients and insurance companies.Researched and responded to all patient inquiries received by telephone and mail.Updated patient demographic information and initiated account adjustments.Resolved account balances to zero prior to accounts being forwarded to an outside agency for collections.Reviewed EOBs for contractual discount payment and patient responsibility.Completed written and verbal appeals with insurance companies for under payments per the facility's contract.Responsible for weekly client conference calls to discuss ongoing project issues and concerns.Eligibility Representative November 2008 - April 2009Responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments.Conducted health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing.Provided enrollment assistance and HIPP/Premium Assistance program information over the phone to Medicaid eligible recipients and their family members.Verified, documented and investigated the presence of health care coverage for Medicaid recipients and their families.Assisted in the identification of members that may qualify for the HIPP/Premium Assistance program.Followed-up with patients and agencies to ensure eligibility for dates of servicesWorked closely with hospital based staff and third party agenciesFresenius Medical Center- Richardson, TX November 2003 - November 2005Commercial Collection RepresentativeInvestigated and called insurance companies to collect on primary and secondary claims.Billed claims and sent patient collection letters.Updated/ adjusted accounts with secondary billing informationEDUCATIONUniversity Of Arkansas at Pine Bluff - Pine Bluff, ARClasses toward Business Administration GPA: 2.5Brown Mackie College Bedford, TX.Obtaining a bachelors degree in Healthcare Management- March 2014- May 2016 |
