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Click here or scroll down to respond to this candidate Candidate's Name , BS, CPC, CPB, CPPM, CPMA, CEMC, CEMA, CDEO, CPA-RAStreet Address Crossing DriveStockbridge, Georgia Street Address
PHONE NUMBER AVAILABLE (cell) EMAIL AVAILABLELINKEDIN LINK AVAILABLEEXPERIENCE: Over the span of my extensive career, which encompasses more than three decades, I have not only amassed a wealth of knowledge but also made significant contributions to various facets of the healthcare industry. My proficiency in practice management, coding, auditing, and billing has not just played a pivotal role but has been instrumental in enhancing operational efficiency and elevating patient care to new heights.03-2011 through 09-2024: Tanner Medical Group, Carrollton, Georgia (laid-off) Senior Manager Financial Operations: In this role, I am constantly updating my knowledge and skills to stay abreast of the latest developments in the healthcare industry. I work independently to achieve my goals. I work closely with the operations and finance departments regarding medical billing, coding, and audits. My responsibilities consist of the following: (08-2020 and present) Audit physicians and midlevel providers documentation according to the 2021 E/M Guidelines.
Review insurance audits and appeal when necessary. Also, I would review the audits with the affected physician or midlevel provider. Educate physicians and midlevel providers on documentation, medical necessity (2021 E&M Guidelines), coding/billing of E&M, surgical and medical procedures, and ancillary services.
Perform LEAN projects on operational and billing workflows.
Work with IT to improve EPIC provider, office, and billing workflows and edits. Coder and Auditor (PRN): I coded multi-specialty services/surgeries and audited E/M services with written feedback and education to physicians and midlevel providers, staff, and administration while working full-time in California. (01-2020 through 07-2020) Director of Central Business Office and Senior Auditor: I managed the central business office (CBO) operations and finance in this role. My responsibilities include the following: (2013-2019) Implemented strategies to improve billing functionality and streamlined operational processes. These efforts enhanced billing, collections, and coding. During my tenure, the CBO achieved the MGMA Best Performers in AR Days and AR over ninety days.
Conducted performance evaluations, compensations, and hiring to maintain appropriate staffing requirements. Provided strong leadership to enhance team productivity and morale. Director of Physician Practices: In this role, I managed fourteen medical practices operationally and financially family medicine, gastroenterology, cardiology, pulmonology, infectious disease, OBGYN, general/vascular/breast surgery, pain management, neurology, and psychiatry, which included the following responsibilities: (2011-2014) Managed and assisted nine on-site managers/office coordinators with operation duties, including but not limited to marketing, human resources, payroll, and quarterly financial meetings with providers and administration.
Educated physicians, midlevel providers, and staff on E/M coding, medical necessity, and documentation guidelines via classroom setting and on-site training. Performed live education by rounding with the physicians and midlevel providers. Served on ICD-10, EHR Implementation, Ambulatory Quality Council, Patient Wait Time, Lean Six Sigma, and Infectious Disease Prevention committees.
Prepared monthly financial reports for physicians, the Senior Vice President, the Chief Administrative Officer, and Accounting.
Conducted performance evaluations, compensations, and hiring to maintain appropriate staffing requirements.01-2020 through 03-2021: Cypress Healthcare Partners, Monterey, California Medical Coder and Auditor Remote Contractor: I audited physicians, midlevel providers, and medical coders and provided coding and documentation education remotely and on-site while working in Georgia. (08-2020 through 03-2021) Revenue Cycle Director: I supervised the revenue cycle department during the COVID-19 pandemic. (01-2020 through 07-2020) Managed the revenue cycle and coding departments to improve cash flow, coding and billing, and operational workflow. Assisted the coders in coding multi-specialty services and surgeries (e.g., general surgery, vascular surgery, cardiovascular, emergency medicine, urgent care, primary care, OBGYN, plastic surgery, neurosurgery)
Audited and educated providers on E/M coding and documentation.
Conducted performance evaluations, compensations, and hiring to maintain appropriate staffing requirements. Worked closely with the operational management team regarding workflow improvements to reduce denial volume.08-2007 thru 03-2011: Sherman Cardiovascular Care Associates, Sherman, TexasDirector of Operations: In this role, I managed a three-cardiologist practice by performing human resources, payroll, financial, marketing, and operational responsibilities, such as
Performed day-to-day finances, including posting deposits to the accounting software (Peachtree), paying invoices and payroll. Prepared monthly financial reports for the accountant and physicians. Established financial and operating budgets, providers' productivity (salary), and incentive models.
Created the organization's human resources, financial, billing, and operational policies and procedures.
Advertised the business through various sources of marketing (radio, print, and TV).
Conducted performance evaluations, compensations, and hiring to maintain appropriate staffing requirements. Assisted with internal IT-related issues.
Educated physicians, mid-level providers, and staff on coding, documentation, and billing principles. Established an extensive customer service program.
08-2001 thru 04-2007: Texoma HealthCare System, Denison, TexasPractice Administrator: I managed five medical practices comprising internal medicine/family medicine, two OBGYN, and two pediatric practices. My responsibilities include the following but are not limited to: Achieved operational excellence by streamlining processes and implementing best practices. Reduced expenses by improving workflow processes, staff reduction, revenue production, and cost awareness.
Reduced the accounts receivable days by assigning staff to work the sixty and older aging diligently. Improved customer service by training and educating staff on proper etiquette in resolving issues and collecting money.
Conducted performance evaluations, compensations, and hiring to maintain appropriate staffing requirements.03-1999 thru 07-2001: LeBauer HealthCare, Greensboro, North CarolinaCoding and Compliance Manager: In this role, I worked in the central business office for 80 plus physicians and midlevel providers. My responsibilities included but are not limited to: Audited and coded physician and midlevel providers documentation. Educated physicians and midlevel providers on proper documentation and E/M coding. Audited and educated medical coders. Analyzed third-party reimbursement for improper payments and appealed inappropriate payments and audits.
Prepared and presented analytical audit reports to administration and physicians.
Coded cardiology, gastroenterology, pulmonary, pediatric, and internal medicine/family practice charges and posted them daily. Conducted performance evaluations, compensations, and hiring to maintain appropriate staffing requirements.09-1996 thru 03-1999: Integrated Provider Networks, LLC., Durham, North CarolinaReimbursement and Coding Analyst: In this role, I educated physicians, midlevel providers, and clinical and billing staff on coding and documentation, reimbursement issues, and denial management. I resolved billing and coding issues for various specialties (i.e., Family Practice, Urgent Care, Pediatrics, and OBGYN). Audited physician and midlevel providers medical documentation and coding/billing. Produced analytical reports on physician productivity, evaluation and management usage, and cost analysis of the department to the Senior Vice President. Supervised the Reimbursement Analyst Department.
06-1991 thru 09-1996: Physician Support Systems, Inc., Mount Joy, Pennsylvania Senior Account Analyst: I researched and solved billing and coding problems for ninety-six physician groups on the East Coast. Conducted internal audits on the billing system for improvements. Educated the internal departments on third-party billing changes and insurance carrier policy updates. Trained the billing department to take a proactive measure on the accounts receivable follow-up by calling insurance companies thirty to sixty days after the submission date and resolving denials. Supervised the Research Department. (1995-1996) Account Manager: I managed a hospital-based multi-specialty physician group (i.e., Cardiology, Neurology, Oncology, Emergency Medicine, OBGYN, Pulmonary, Physiatry, Clinical and Anatomical Pathology, Clinical Psychology, Radiology, Anesthesia/CRNA, Nuclear Medicine) by assisting the on-site Director with any practice-related issues and improving the profitability of the practices by improving data capture and billing processes. Monitored the quality of the coding and the accounts receivable, analyzed all operational and billing issues that impacted the monthly performance, and removed obstacles. I performed CPT, ICD-9, HCPCS coding seminars, Basic Anatomy and Physiology, and Third-Party Billing. Promoted to Senior Account Analyst. (1992-1996) Patient Communication Clerk: I managed patient and insurance inquiries regarding balances, billing, and coding. Promoted to Account Manager. (1991-1992)10-1990 thru 10-1999: U.S. Army National Guard in Pennsylvania and North Carolina Served during the Persian Gulf War stateside at Fort Bragg, Fayetteville, NC. Army Medic (92B) I served as an Army medic during the Persian Gulf War. I worked in a field hospital unit that was attached to the 82nd Airborne. I provided paramedic services to injured/sick soldiers and performed ancillary services, such as lab draws and medication administration via intramuscular, intravenous, and subcutaneous.
Patient Administration Specialist (71G) I served as an administration specialist at the field hospital. I performed administrative duties and assisted the CMO with administrative paperwork.EDUCATION:
Lancaster Bible College, Lancaster, PA: Graduated in July 2010 Bachelor of Science in Biblical Studies/Counseling
Certified Professional Auditor-Risk Adjustment (CPA-RA): NAMAS certified 10-20-23 Certified Documentation Improvement Expert Outpatient (CDEO): AAPC certified on 12-12-2020 Certified Evaluation and Management Coder (CEMC): AAPC certified on 08-11-2018 Certified E&M Auditor (CEMA): NAMAS certified on 03-07-2016 Certified Professional Medical Auditor (CPMA): AAPC certified on 11-22-2014 Certified Professional Practice Manager (CPPM): AAPC certified on 12-14-2013 Certified Professional Biller (CPB): AAPC certified on 08-24-2013 Certified Professional Coder Physician (CPC): AAPC certified on 11-02-1998
Army Medic and Patient Administration: United States Army served from 10-1990 through 12-1999
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