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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLEWaunakee, WI Street Address
Authorized to work in the US for any employerPatient Reimbursement Coordinator (Enteral)UW Health Care DirectSummaryI performed the initial patient nancial and insurance verication and follow-up. I served as a communication liaison between team members, third party payers, patients, and billing for all nancial arrangements. I Worked closely with referral sources and patients regarding their nancial responsibilities. Also responsible for document management of patient information and ensuring that the claims produced for billing are accurate.Communicate eectively with referral sources regarding patient nancial responsibilities and insurance coverage for nutrition services.Communicate with patients regarding nancial responsibility both verbally and in writing.Performs price negotiations, when applicable, in the best interest of the patient with respect to UWHCD business (including self-pay arrangements), seeking management approval when applicable.Maintained knowledge of reimbursement principles and pricing parameters.An understanding of Wisconsin Medicaid and Medicare coverage principles and requirements for covered and non-covered therapies.Understands formula and related DME and supply pricing, as it relates to enteral therapy.Verbally communicate to patient information (including but not limited to insurance and authorization status) to team members in a timely manner.Promptly document all patient information including insurance and authorization information in accordance with company policy and procedures.Remain up to date on contract, network, and fee schedule information.Obtained authorization extensions on existing patients in a timely and accurate manner.Performs ongoing verication of patient insurance, as needed.Collaborated eectively with Reimbursement to troubleshoot patient specic A/R issues.Performed critical evaluation of vended patient cases and keept management apprised of any trends or issues, as applicable.Served as a back-up support to the enteral POC in managing supply orders and problem-solving delivery challenges.Managed over 25 Healthcare Insurance portals, via Brightree, Epicetc Independent Healthcare & Revenue Cycle Billing Consultant (Remote) The Charles Group LLC. - Waunakee, WI April 2019 to Present I work as a Healthcare Revenue Cycle consultant whom specialized inTurnaroundsInterim LeadershipCDM initialization, implementation, maintenance, compliance, reportingLeadership DevelopmentPerformance TransformationImplementation of Healthcare Software i.e.: (Epic)WorkowsFull Revenue Cycle TrainingConsultation and Strategic ExecutionRevenue Integrity Coordinator/ Chargemaster Analyst Unitypoint Health - Meriter Hospital/ Meriter Medical Group - Madison, WI 2015 to April 2019Acted as a business partner for operational leadership focusing on revenue cycle performance within assigned areas and responsible for overall business processes and standard operating procedures.Managed /Supervised Revenue Cycle team of 10 (FTE) hired, disciplined, audited, completed yearly personal reviews, lesson plans and training for suggested improvements.Revenue cycle team included following departments: Patient Access (Scheduling and Registration), Financial Clearance, Patient Financial Coordination, Accounts Receivable, Denials Management, Charge Description Master (CDM) Maintenance, Charge Capture, and Revenue Integrity, Payor Audits or other duties as assigned.Developed, tested, and programmed all functionalities for all versions of Epic for specic departments. Served as back up for each position in case of absence.Actively worked to align teams, processes and supporting technologies (e.g., Epic) to achieve optimal revenue cycle outcomes by identifying opportunities, analyzing options and providing recommendations to upper management. Responsible for strategically planning and implementing changes.Accountable for the overall process and policy documentation, including close coordination, communication with Department supervisors, and Revenue Cycle Coordinators in assigned areas.Supported supervisors and other departmental leadership to ensure that work queues are appropriately managed and any applicable Service Level Agreements (SLA) obligations are fullled. Monitor the eiciency and eectiveness of new processes and systems, as well as ensuring the timeliness and quality of projects.Identify any reporting needs for an assigned area and evaluated current reporting options. For identied gaps, responsible for the development and maintenance of standard reports, reporting templates or other toolsSupported leadership in the analysis of process improvement options and worked with counterparts to provide recommendations to operational upper leadership.Maintained process and policy documentation, appropriately coordinating with Specialty Department Directors and Senior Analysts in assigned areas. Supported workows and tools, including management of work queues and reports, basic system maintenance (or maintenance requests), documentation of workows, training and data analysis.Daily coordination with Informaticists or other appropriate teams to document and provide training of Epic or other system changes.Primary Epic trainer for end users within supporting business areasActed as an Ailiate Liaison and represented Meriter in dierent UPH / UW contexts and groups.Led special projects as primary Project Manager for any assigned performance improvement initiatives or work plans to include Epic Implementations.Acted as an escalation point for specic patient concerns or review of accounts.Solely responsible for reviewing and maintaining CDM, assigning new charge codes (ICD10), HCPCS codes, supply codes.Ensuring all data elements are accurate and comply with all payor requirementsMaintained both Hospital and Clinic master fee schedules for CDM, constant monitoring for changes in Medicare and Medicaid regulations to assure the appropriateness and the impact in hospital reimbursementSolely made fee recommendations for both the Hospital and Clinics based on comparison of a relative value system, national benchmarks, and community standards. Ensure fee that covered our costs, are consistent, defendable and are within community standardsBi-weekly meetings with specialty departments in Hospital, free standing clinics, and Health-Psych departments to assure changes are appropriately communicated to aected departments and modications made in related ancillary systems throughoutResearch and resolution of missing charges, undercharges, and erroneous charges. This included corrections and re-billing of charges, feedback and education to the medical unit sta, process and procedure review to prevent repetition of the problems.Completed price analysis of all ICD10 codes relating to both Hospital and professional charges via Medicare fee schedule, entered and published into chargemaster, uploaded into Epic and daily management of new and ever changing proceduresWorked solely as the Liaison between physicians and administration in communications regarding new medical procedures, providing physician's resources and being their conduit to administration to strengthen the relationships throughout the hospital and medical group.Maintained an open line of communication with clinic physicians, in hopes to maintain and grow their patient referral base.Prepare invoices for all outside vendors to include all air and ground ambulance charges, specic to payor contracts; Medicare /MedicaidPriced, entered and billed all DME third party contracts. Financial Coordinator / Certied Application Counselor Unitypoint Health - Meriter Hospital / Merifter Medical Group- Madison, WI2009 to 2015Trained in calculating Hospital in-patient estimates, FINA assistance; collecting monies, posting all payments, keeping and reconciling cash drawers, making deposits- writing workows for all mentioned and sole trainerImplemented Epic billing-collection processes self-pay and insurance follow-up for Meriter Medical GroupReviewed 30-50 accounts daily for accurate billing. Updated correct insurance information via patient call, calling insurance companies, reviewing online software. Updating account information, resubmitting claims to Insurance company, clearing houseProcient knowledge in claims, benet, enrollment, and providerOversaw processes and work distribution via work queues to ensure adequate staing numbers for productionCreated workows and made adjustments as necessaryMonthly collections reconciliation for three respective agencies, nancial analysis of departments.Promoted to Supervisor of MMG, managed 8 FTE's. Hired, red, trained, performed yearly reviews, identied and resolved sta concerns, taught and implemented new strategies in order to bring successes to sta.Hiring of Billing department via interviews. Trained Epic workows to Billers and Customer service departments in order to learn and fulll a high level service agreement to MeriterReviewed and audited phone sessions for customer service representatives, made informative suggestions and teaching and training weeklyDaily- weekly audits and phone monitoring follow up plans MMG; Outbound- Inbound phone calls to patients/billing questions. Resource for all outlying clinics self-pay policy and procedures, referrals.Procient in claims, benet, enrollment, provider knowledge and understandingPrepared, analyzed and interpreted quality and quantitative Epic clarity reports for review and shared with fellow management in order to document and improve Meriter's overall performanceDaily Dashboard review of work queues for company matrix, productivity standards and operating budget requirementsImplemented Epic billing-collection processes self-pay and insurance follow-up for Meriter Medical GroupDeveloped Bankruptcy, Probate workows, implemented policies into Epic.Prepare Epic lesson plans; training material as per Epic updates; teach classes to all applicable end user Meriter sta. Work closely with IT sta to continually measure work ow standards.Created Meriter (HCFA)Financial Assistance for Health Care Program for Meriter Medical Group.Created and developed statement system for MMG with third party vendors/ IT department.Serve as MMG's collections Liaison; Serve as attorney's witness and appear for court dates for all suit authorizations in suing patient's.Versed in Medicare/ Medicaid managed care and all contracted insurances.Set up Epic reporting for clinical analysis, process improvement for entire Medical Group Practices; member of the Meriter Medical Group Revenue Cycle Team.Understanding of CPT codes and unique billing standards to include charge master to set fees as per AMA coding standards. Versed and trained in Cadence- registration, scheduling.Implementation team member for pre-authorization-referral process for self-pay patientsState and Federal training, obtained Certied Application Counselor Status Help to Implement POS Up Front collections for Medical Group clinics. Created and set up new policies and determined new procedures, created and implemented and trained new work-ows as per analysis and metrics, successful go-live.Assessing patients' nancial and insurance information in order to determine Medicaid, Marketplace, or other community programs as per Federal mandates. Member of Meriter implementation /Project Management team; Certied Resolute Professional Billing and self-pay, insurance follow-up. Business Development / Marketing / Public Relations Americollect, Inc Manitowoc, WI Work From Home 2007-2009Worked extensively with the sales and marketing team to grow company from 40-100+ employees through new business development within a two-year time line.Solicited Health care; Utility; Government; Cellular; and Cable industries via cold calling, face to face walk-ins.Answering, preparing, delivering R.F.P's (request for proposals) to perspective clients, scheduled follow up meetings.Member of Collections process team, identied and researched company vision mission and values into a successful workow and company slogan of Win-Win collections.obtained ACA certicationSolely added over one million dollars of revenue to company.Associate Marketing Team member, developed marketing strategies/products for immediate growth in industry.Public Relations duties. Wrote monthly company press releases published in local chambers; Corporate Report Wisconsin; Health care magazines (The Voice), along with writing nomination letters, (Corporate Report Wisconsin Magazine, INC.500 fastest growing companies 2009. Nomination letter won "Small Business of the year award" for company in 2008. Co-wrote, published, and distributed company newsletters on a quarterly basis.Attended all pertinent industry related organizational conferences throughout the state of Wisconsin. Member of Toast masters.Attained continuing education credits for future growth.Planned, promoted, marketed, and sponsored organizational conferences in excess of 100 plus attendees relating to industry.Collection Agency Liaison / Physician LiaisonDean Health System March 2002-2007Extensive training in medical insurance, payment posting, accounts payable, accounts receivable, and bankruptcy.Responsible for auditing patient accounts for updated insurance information. Claim denials, denial research to include correct CPT codes, obtaining new information and resubmitting claims.Obtaining correct demographic information via patient phone calls outbound-inbound (25-40 Dailey) Made collection attempt, set up payment arrangements, no pay- send account to collections.Dynamic customer service skills.Promoted to Collections LiaisonMember of Dean /Epic implementation Team for Professional Billing Epic version 2002Daily walk-ins, incoming and outgoing phone calls with patients, physicians, and lawyers.Listening, obtaining specics, researching, and providing solutions to their immediate concerns, providing timely answers.Testing /programming/ preparing workows/ billing processes/ setting fees as per Medicare fee schedule/ statement process'sWorking hand in hand with agencies to reconcile accounts daily for balancing at month end.Review accounts concerning settlement oers in direct relation with the respective collecting agency.Preparing supporting documentation and attending monthly trials as a witness concerning accounts in direct relation to suit authorizations with attorneys.Solely in charge of nance programs for Dean Health System to include LASIK, Bariatric, Plastic and Dynamic Orthotic Cranioplasty.Writing, proposing, and completing nance contracts.Recruited from Administration to role of Physician Liaison because of my dynamic customer service level and understanding of patient satisfactionI was the conduit between the Clinic Physicians and the Administration staResponsible for forming, growing and maintaining long-term partnerships with physicians, urgent care facilities, medical specialty groups and other clinical groups to increase referrals and gain market share.Daily Physician meetings, weekly administrative reporting for comparative analysis in seeking new and eective strategiesAcoustical Consultant Project EstimatorSullivan Brothers Inc June 1999- January 2002Performed varying duties in sales and accounting to include accounts payable /receivable, collections, nance.Collections ManagerDaily reconciliation of company accountsDailey collection calls, payment plans, payment posting, weekly reconciliationInside and outside sales, preparing picking tickets for supply pick-up.Project estimator Sullivan Brothers Supply Inc.Inventory control management.Project estimating, providing and answering bids. Providing excellent customer service.Human Resources assistant to the president & CFO for Sullivan Supply Store ManagerMusicland- On Cue Inc 1994-1999Recruited, hired, retained eective associatesCoach and train team to achieve maximum resultsIdentied and focused on development for future growthCreated eective schedules and manage payroll dailySupervised daily operations of the storeConducted weekly-monthly employee meetings on new product: new artists, books, movies, instrument productsCompleted ninety-day employee probation reviewsConducted yearly reviews; ensure that all team members understood and accepted their roles and responsibilitiesEnsured the store achieved all store sales goals and comp plansConducted sales pull-downsTracked and reported key project metrics to include daily productivityAttended yearly Management Corporate trainingCompleted accounts payable-receivables, managed daily cash ow, bank depositsReviewed customer complaints, found immediate resolutionTrained and promoted sta to management positions throughout the companyParticipated in new stores openings in the United States to enable turn-key customer service Computer Skills;Microsoft WordMicrosoft ExcelMicrosoft Power PointMicrosoft Works,Microsoft OutlookLotus NotesHealth Industry SoftwareEPIC *Certied* Resolute Professional Billing & Self-Pay Follow-up. Version Spring 2008Medtech, BloodhoundTRACSCranewareBrightreeEducation2 years in Marketing / EconomicsNicolet College & Technical Institute - Rhinelander, WI August 1989 to June 1992 |
