PROFESSIONAL SUMMARY:

• Extensive experience in the area of Revenue Cycle and Analytical Processes. Comprehensive knowledge in methodologies for reduction of total days 30 - 180. Analytical systematic practice utilized to resolve age to balance ratio goals. Production goals of 10% and lower for days out within the follow up process. Increase of Cash Flow by 100% utilization of Collections and Recovery Practices. Vast experience with internal system support in relation to Cerner and Epic super user end support for Physician and Facility practices.

TECHNICAL SKILLS:

Systems: Ability, Accuro, Allscripts, Artiva, Confidential Oscar System, Care Medic, CARS, Centrincity, Cerner, Cerner Community, Cerner Sorian, Cerner Works, Citrix, CMS, C-Snap, DDE, EFR7, EHMR, EPIC, Eprimis, Excel, HMS, IBM, IDX, Invision, Mainframe, Market Place System, Maximus Federal Systems, Med Works, Medical Manager, Meditech, Medix, MS Access, MS Word, MS4, Navinet, Next Gen, One Source, Open Vista EMR, Outlook, Paragon, Passport, Power Point, Rubixis, SAP, Share Point, SIMED, SMS, Sorian Financial System, SSI, XAPPS, Zirmed,ASL, Predict DX

Expertise Skills: Clinical Support, Billing Edit Review, Procedure, Drug, Item Facility Charge Review, Analytical Investigative Problem Solving, Revenue Cycle Process, Charge Master systematic analysis Supervisory Support, Moderate Meetings, Support, Multitask Goal Oriented Cerner Implementation, Cerner Builds, Clinician Support, Support, Super User guidance, End User Guidance. Physician Billing, Facility Billing, Behavioral Billing, DME Billing, IN/PT Coding, OUT/PT Coding, Physician Coding, Revenue Cycle Management, Medicare/Medicaid Claims, Medicaid Managed Care Claims, Process Enhancement Healthcare Delivery Management, Interim Revenue Cycle Billing Specialist ER Central Registration, Front End Registration Processing Medical Records Requests copying, scanning, Bookkeeping, Pre - collections/Collections Calls (soft and hard), Self-Pay Collector Confidential t Access, Health Management Information, Charge Master Reviews and Maintenance Semi-Fluent in Spanish, Customer Service, Multi-line Phone Systems, Typing (100 wpm), 10-Key (250 kpm), Knowledge on Windows, MS Excel Spreadsheets, Outlook

PROFESSIONAL EXPERIENCE:

Confidential, Miami, FL

Healthcare Data Analyst

Responsibilities:

• Clinical Data Analysis
• Predict DX Data Analysis
• Underwriting Analysis
• DX, Prognosis Data analyzed for correct yearly underwriting cost
• Special Projects as assigned
• Daily data management analyzed and prepared via Excel, Pivots, Control V

Confidential, Cooper City, FL

Revenue Cycle Analyst

Responsibilities:

• Provided Analytical Support to acting director overseeing project for Loyola Hospital
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.)
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintain monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Provided FTE’s with daily workflow patterns, dispersed Productivity Reports daily
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Compiled and Dispersed inventory to be completed by a team of 20 FTE’s
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.

Confidential, Casper, WY

Meditech Clinical Auditor Consultant

Responsibilities:

• Clinical Auditing Analysis
• Facility Charge Review and Analysis
• Billing Audit Process and Analysis
• Billing Edit Process for Facility charges utilizing Meditech
• Super User
• End User
• End User readiness assessments
• Confidential t Financial Services Support
• Global Insight Staffing, Vacuolar Access Centers Present Philadelphia, PA Account Manager (Next Gen)
• Providing Revenue Cycle assessments by reviewing current operations and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.)
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintain monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.

Confidential, Greenbay, WI

Revenue Cycle Management Consultant (Meditech, Zirmed)

Responsibilities:

• Providing Revenue Cycle assessments by reviewing current operations and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.) for management team
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintain monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business. Reviewed claims for specific billing requirements and issues to management & staff.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.

Confidential, Lancaster, OH

Cerner Revenue Cycle Management Consultant

Responsibilities:

• Material Development
• Scheduling
• Device/hardware Assessment
• Practice Go-Live
• Full-fledged Go-Live Support
• Super User
• Insurance Coverage Verification Process
• Emergency Department Registration
• Confidential t Triage, Squad Registration
• End User
• End User readiness assessments
• Registration Coverage Elbow support

Confidential, Sacramento, CA

EOS Remote Executive Revenue Cycle Management Consultant

Responsibilities:

• Providing Revenue Cycle assessments by reviewing current operations and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.) for management team
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintain monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business. Reviewed claims for specific billing requirements and issues to management & staff.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.

Confidential, Casper, WY

Cerner Revenue Cycle Management Consultant

Responsibilities:

• Material Development
• Scheduling
• Device/hardware Assessment
• Practice Go-Live
• Full-fledged Go-Live Support
• Super User
• End User
• New process design and implementation
• Present and Future state analysis
• System configuration and design
• End user design work sessions
• program design and execution
• Support planning application and transition
• End User readiness assessments
• Integration Services
• Meaningful use assistance
• Providing Revenue Cycle assessments by reviewing current operations and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.) for management team
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintain monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business. Reviewed claims for specific billing requirements and issues to management & staff.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.

Confidential

Revenue Cycle Consultant

Responsibilities:

• Material Development
• Scheduling
• Device/hardware Assessment
• Practice Go-Live
• Full-fledged Go-Live Support
• Super User
• End User
• New process design and implementation
• Providing Revenue Cycle assessments by reviewing current operations and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business. Reviewed claims for specific billing requirements and issues to management & staff.

Confidential, Phoenix, AZ

Medicare Reimbursement Specialist Consultant

Responsibilities:

• Medicare Denial Research
• Medicare Contractual Adjustment
• Medicare Medical Necessity Denial Appeals
• Medicare Denial Coding Research
• Utilized all Medicare systems required to ensure client reimbursement via IVR, DDE
• Providing Revenue Cycle assessments by reviewing current operations, and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.
• Material Development
• Scheduling
• Device/hardware Assessment
• Practice Go-Live
• Full-fledged Go-Live Support
• Super User
• End User
• New process design and implementation

Confidential

A/R Specialist

Responsibilities:

• Providing Revenue Cycle assessments by reviewing current operations, and reviewing the age trial balance to identify high value opportunities for improvement.
• Post payment and contractual adjustment in accordance to EOB and Hospital guidelines. Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues, submit ARF for any corrections required, submit review requests on coding issues to HIM
• Research and compiled multiple reporting
• Receivable from +120 to under +40. Increase net collection on revenue per month: claims resolutions, resolve insurance discrepancies.
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintained monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.

Confidential, Chicago, IL

Expeditive Billing Consultant

Responsibilities:

• Providing Revenue Cycle assessments by reviewing current operations, and reviewing the age trial balance to identify high value opportunities for improvement.
• Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.) for management team
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintain monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business. Reviewed claims for specific billing requirements and issues to management & staff.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission.
• Medical Claim submissions, Confidential t Financial Statements.
• Providing Revenue Cycle assessments by reviewing current operations, and reviewing the age trial balance to identify high value opportunities for improvement.
• Post payment and contractual adjustment in accordance to EOB and Hospital guidelines. Research of contractual underpayments, payment denials, payment discrepancies and zero payments of clients.
• Billing medical claims out, verify and correct any coding issues, submit ARF for any corrections required, submit review requests on coding issues to HIM
• Research and compiled multiple reporting (create spreadsheets of errors, trends, productivity, etc.) for management team
• Helped to resolve cash flow issues: improved Cash Collections (110%) and decrease Accounts Receivable from +120 to under +40. Increase net collection on revenue per month: claims resolutions, resolve insurance discrepancies.
• Responsible for reviewing and obtaining owed revenue from assigned Confidential t accounts by re-filing claims to insurance carriers for additional payments, working denials (Insurances and SSI) and/or submitting collection notices to Confidential ts with outstanding financial accounts.
• Maintained monthly assigned Confidential t accounts by reviewing and resolving Confidential t data on outstanding accounts utilizing data and billing systems provided.
• Resolved Confidential t and provider inquires, processing accounts and correcting managed care issues. Follow-up on billing, appeals, problem accounts and re-files of insurance claims.
• Processed all claim rejections based on summary of remittance advice and insurance correspondence. Generated above industry benchmark revenue capture for outstanding Confidential t accounts.
• Organized and reconciled Confidential t claims for electronic billing or hard copy mailing of various lines of business. Reviewed claims for specific billing requirements and issues to management & staff.
• Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission. Maintain outstanding total A/R of less than 35 days for all Insurance carriers.
• Ensuring internal audit processes and requirements are met prior to billing releases which include: Medical Claim submissions, Confidential t Financial Statements.

Confidential, Wilkes-Barre, PA

Claims Analyst

Responsibilities:

• Analyze claims: Product Review; for providers and members: verify eligibility and benefits
• Research and Process Rejected Claims Appropriately within Confidential Claim Guidelines
• Adjustment Review for Provider, Hospital, Ancillary, and Member based claims
• Compensation Claim Management, Analysis of data to identify inappropriate claims or fraud in relation to ancillary claims
• Workflow Production Requirements, Quality/Quantity Daily Requirements, Medical Records Review/Request for Claims Adjudication (letters, phones)
• Special Projects Upon Request

Confidential, Winston Salem, NC

Interim Account Receivable-Billing Specialist

Responsibilities:

• Medical Billing, Insurance Follow-Up, Review registration and charge entry, providing feedback on quality to practice. Post payment and contractual adjustment in accordance to EOB and client guidelines. Process credit card payment online via Passport web, Insurance Verification.
• Corrected and submitted rejected claims in Real-Med, corrected invalid ICD9 codes.
• Followed- up on claim status, worked claim denials until payment received. Helped to resolve cash flow issues: improved Cash Collections (110%) and decrease Accounts Receivable from +120 to under +40.
• Increase net collection on revenue per month: claims resolutions, resolve insurance discrepancies.
• Entering and updating Confidential t’s demographics in NextGen. Initiate check tracers, verify coding errors on Encoder, create spread sheet to monitor trends and issues.
• Review and verify refunds to Confidential t and insurance reverse incorrect adjustments.
• CPT/ICD9 coding correction and Research corrected front end edits and reviewed EHR.
• Corrected and rebill Medicaid claims on promise web. Analyzed Confidential t accounts for payments or specific billing denials as well as working account edits for resubmission. Maintain outstanding total A/R of less than 35 days for all Insurance carriers.
• Ensuring internal audit processes and requirements are met prior to billing releases which include: Medical Claim submissions, Confidential t Financial Statements.

Confidential, Bethlehem, PA

Interim Billing Clerk

Responsibilities:

• Medical Billing, Handle A/R Payment posting from all Confidential t and Insurance carriers. Used spreadsheet for keeping records of Confidential ts payment information
• Process Insurance and Confidential t over payments and offsets. Processed claim for HMO, Medicaid, Commercial and Medicare. Reconciled cash payments, and completed special projects as needed
• Responsible for incoming correspondence and handling A/R collection from Various Insurance carriers

Confidential, Bethlehem, PA

Interim Billing Clerk

Responsibilities:

• Medical Billing, Handle A/R Payment posting from all Confidential t and Insurance carriers. Used spreadsheet for keeping records of Confidential ts payment information
• Process Insurance and Confidential t over payments and offsets. Processed claim for HMO, Medicaid, Commercial and Medicare. Reconciled cash payments, and completed special projects as needed Responsible for incoming correspondence and handling A/R collection from Various Insurance carriers

Confidential, Swiftwater, PA

Data Entry Clerk

Responsibilities:

• Process all Imovax/Imogam customer order, provided customer support thru call center. Expedited emergency delivery for Confidential ts expose to rabies
• Obtained and updated customer account information to CAM system. Provided maintenance to CAM marketing projects inbox

Confidential, West Paterson, NJ

Payment-Poster/Collections-Biller

Responsibilities:

• Medical Billing-Billed Commercial, HMO, Medicaid and Medicare plans for Office Visits. Posted all Insurance Payments, reconciled Cash Payments. Process Daily Bank Deposits, responsible for processing reports for impending A/R.
• Accountable for all correspondence and submitting appeal Letters for payment. Processed valid Confidential t/Insurance refunds, Confidential t Relation Representative.
• Provided to new and established employees. Followed- up on claim status, worked claim denials until payment received.
• Corrected and submitted rejected claims, corrected invalid ICD9 codes. Responsible for account aging and increase the monthly goal by100%.

Confidential, Totowa, NJ

Cash Representative

Responsibilities:

• Posted Commercial, HMO, Medicaid and Medicare payments. Process valid insurance refunds, process Confidential t credit card payments. Coordinate Confidential t payment for Home Infusion Therapy. Responsible for all in/outbound correspondence, handle daily customer service.

Confidential, Albany, NY

Collection-Payment Poster

Responsibilities:

• Insurance Follow-Up, Handle AR Payment posting from all Confidential ts and insurance carriers. Process Insurance/ Confidential ts overpayment and offsets. Handle Insurance follow up for all carriers. Accountable for various projects such as NYS Medicaid/NYS Medicare. Handle customer service and charge entry, provided for New/Established employees. Process claims for HMO’s, Medicaid, Medicare and Commercial.