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Click here or scroll down to respond to this candidateCandidate's Name
Middletown, NJPhone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLESummary of Qualifications:Several years of experience in the healthcare industry as well as in the Human Resources Profession have furnished me with the knowledge to which I can provide support and direction as an asset on many levels. Employment Experience:Minding Miracles Learning Center Atlantic Highlands, NJ 2016-Present Medical Billing Consultant/H.R Establish and monitor projects/reports for aging, provider productivity, error/rejection, CPT, providers/locations, etc. for productivity as well as internal audits. Monitor A/R for refunds, underpayments, non-payment, etc. Negotiate contracted rates for providers with carriers. Research and educate staff as well as providers on HIPAA, state & national regulations, coding, documentation, etc. Update employee records Point of contact for staff as well as benefit administrators/vendors. See newly hired employees through the process of paperwork, state requirements and signing up for all employer digital apps. Process termination of staff as well as resignations. Assist with bi-weekly payroll and bonuses. Guide management to ensure an equal work environment for all staff and provide an open door policy for all employees' concerns.J & S Stark Billing and Consulting Agency Shrewsbury, NJ 2008-2017 Accounts Receivable Specialist/Denial Management/Lead/Trainer Research out of network provider issues for credentialing to be updated appropriately. Research new coding and billing guidelines to educate staff and physicians. Training of all new employees for three different departments. Review of reports including but not limited to: Aging, Emdeon Rejection/Error, EDI daily submission and provider productivity as well as conduct individual projects. Constructed a training manual for all new staff as well as interoffice templates for a more productive workflow. Devised spreadsheets to track production of the Accounts Receivable department and track new issues through to resolution as well as an interoffice reference for employees to assist with common issues Assisted in preparation and transition of new Physician Group accounts to the company. Conducted internal audits on staff as well providers. Review and finalize necessary refunds to either patients or insurance carriers. Register and update online web access for several insurance carriers. Central Florida Hand Specialists Orlando, FL 2003-2008 Office Manager/Human Resources Negotiate fees with workers compensation carriers and attorneys. Coordinate with Nurse Case managers, Claims Adjusters, as well as Attorneys for patient care, patient MMI and necessary IMEs. Conduct interviews with applicants for potential employment. Initiated a testing system for applicants to determine the extent of their skills. Produce write ups to current employees when necessary. Assisted with Network/Server and Remote access connections as well as nightly server backup. Administer conversion into a new EMR system and the creation of the details of patient charts. Produced templates within the EMR system for quick reference and physician medical records. Monitor surgery schedule, coding, authorization for surgeries, patient eligibility and responsibility Medical Health Center Middletown, NJ 1998-2003Receptionist/Medical Biller Receptionist duties, answer phones for all physicians, schedule appoints for exams, testing, and outpatient surgery. Follow up with patients via telephone in assistance with monitoring care. Billing data entryPrudential Healthcare Cranbury, NJ 1996-1998Customer Service RepresentativeHMO/PPO/Indemnity & Employee Plans Answered incoming calls from members and providers. Provided accurate eligibility and HRA/HSA information at time of service Reviewed claims in question from providers or members and requested reprocess of claims when necessary. Explain patient coverage and responsibility Selected to regularly provide assistance for Prudential Employee Plans Professional Skills: Ability to identify issues, solve problems and develop new procedures to help office grow Possess strong interpersonal skills with employees, management, clientele, etc. Able to communicate clearly, both written and orally, with employees, in group presentations and meetings. Capability to effectively establish projects, analyze data and present findings to provide a resolution. Able to prioritize and plan work activities as to use time efficiently Organized, accurate, thorough and able to monitor work for quality Dependable, able to follow instructions, respond to management direction and able to improve performance through management feedback Manage audits to completion. Knowledge of laws and processes for workers compensation, disability, FMLA, etc. Comprehension of medical terminology, pharmaceuticals, claims, EOBs, ICD9/ICD10 and CPT coding. Extensive experience with insurance on both the provider and patient aspects:Workers Compensation, Automotive/PIP, TPA, Commercial Insurances as well as Medicare and Medicaid. Computer skills:Microsoft Products,Teams, Outlook, Google Suite, GPS, Profs, Medic, Lotus, IDX, Misys, Medical Manager, Cerner, Kareo/Tebra, QuickBooks and ADP. Education:Middletown High School Middletown, NJBrookdale Community College Lincroft, NJMajor: BusinessAAPC CEU certificate for the Podiatry Foot-Ankle ICD-10 AAPC CEU certificate for E/M Modifiers & the Latest CMS Guidance on -59 |
