OBJECTIVE:

• To obtain a challenging position in a stable and secure company where I can maximize my Revenue Cycle medical billing collections, client service, and management skills.

TECHNICAL SKILLS

• Microsoft Office Suite/Access/ Word / Excel Pivot Table Revenue Cycle Billing /Collection Claims
• MS4/Artiva/Cerner/SSI/CMS.GOV /HIM/CA/Availity Med - Cal/Medicaid/Medicare Billing
• Oracle software/Visio/PowerPoint / MS Scheduling Commercial Insurance Billing/ IPA's & UM's Admissions
• Epic Billing software /eFR/ Savvion/Legacy -Artiva Workers Compensation Billing Claims
• Facets/SQL/CISCO / Medical Billing Review /IDX Appeals and Grievances on Commercial and Government Claims
• Project Server 2007-2010 Account Receivables/Payable
• SharePoint Administrator/Cerner/Noridian Front office Operations
• Medicaid/ Medi-Cal/ Cal Win/Medicare/DDE Financial Services/ Accounting/Bookkeeping
• ICD10 /CPT Coding / UB04/ HCFA 1500 Quality Assurance
• CIWRS System/CATS System Facilitate Training
• Project Management Book of Knowledge Insurance Underwriting
• Lotus Notes/ Outlook Typing/10 Keying/ Data Entr y

PROFESSIONAL EXPERIENCE

Confidential

Research and Financial Supervisor

Responsibilities:

• Responsible for oversight of Medi-Cal Research and Financial staffs and operations information for the Department of Health Care Services organization.
• Motivating and leading staffs that services provider’s, billing groups, State departments or agencies, the legislature, and other external entities.
• Monitors the creation of weekly and monthly reports.
• Supervision of research and finance professionals staff coaching, training and development.
• Oversees the provider research and financial analysis quarterly, and annual reports and ensures financial information has been recorded accurately.
• Setting goals for performance and deadlines in ways that comply with company's plans and vision.
• Organize workflow and ensuring that employees understand their duties or delegated tasks.
• Monitoring employee productivity and providing constructive feedback and coaching.
• Analyzes data, identifies trends and uses statistics ensuring their responsible areas meet the company business and customer needs. Promotes understanding of the processes required for fulfillment of customer satisfaction and contractual commitments (including Service Level Agreements (SLAs).
• Uses improvement methodologies to provide leadership to support and/or optimize business performance.
• Supervise a team primarily comprised of non-exempt employees or contingent workforce with well-defined, limited scope, including directing daily work activities/priorities, time tracking, people recruitment and development, cost management and workforce planning.
• Provide general supervision and guidance within one functional area (Research and Financial for providers).
• Work with multiple functional areas (e. g. Education & Outreach, Provider and Member Customer Service Call Centers) to ensure overall Service Level Agreements are met.
• Act as a resource to staff related to benefit and salary administration.
• Assists with hiring tasks and feedback for the employee performance review process.
• Manage team and individual performance. Monitors team members progress on goals.
• Ensure processes and procedures, are documented and reviewed/updated on a regular basis.
• Resolves and monitors routine customer escalations as appropriate and solves routine issues within established guidelines.
• Escalate issues for which there is not a document procedure or precedent set and reviews production reporting and workforce management as required to support processes.
• Lead my team toward operational excellence by monitoring key metrics, ensuring team goals and contractual commitments are met.
• Produce goals to include process improvements and provides production data to upper management.
• Creates a working environment that is conducive to individual growth, high performance, challenging and rewarding.
• I have experience with Customer Relationship Management (CRM) applications.
• Strong verbal and written communication skills, with excellent customer service and problem resolution skills.
• Detailed and team oriented.

Confidential

Medicare Revenue Cycle Business Analyst

Responsibilities:

• Within healthcare organization in this capacity, the handling of hospital patient billing/collection data and executing key tasks within the revenue cycle. Utilizing workflow Management such as Artiva, eFR, CA, EDM, HIE, MS4, SSI, Cerner, HIM, MRT, DDE/ Noridian, ( UAT) -application and end user testing, and Health logic.
• This includes initial billing and invoicing, arranging for payment and payment processes, overseeing collections and accounts receivable, and ensuring a smooth financial system that properly accounts for all services rendered.
• Works collaboratively with accountants, Compliance, financial analysts, to properly oversee every aspect of payment and collections and Billing.
• Analyze gap analyst of a hospital or clinic’s financial operation. Special projects with in Commercial billing, Veterans Administration, and Medicare.
• Make sure that every aspect of billing and budgeting runs smoothly, whether it’s accounting for patient treatments, calculating the cost of patient intake, issuing bills for payment by the patient and their insurance company, or collecting on past-due obligations.
• Provide hospitals and clinics collections of outstanding balances to fund their operations.
• Oversee the smooth operations of the HARP program and associated departments to promote absolute essential survival long-term facility AR.

Confidential

Worker’s Compensation/Clinical Supervisor

Responsibilities:

• Supported a group of 20-25 worker’s comp representative’s, managed timecards and reviewed audit reports. Foster and promote a team culture of enquiry and learning that enables individuals to openly question, reflect and learn from their practic e.
• Provide effective leadership in ensuring that worker compensations practices comply with policies and procedures. Facilitated training on the process of claims by utilizing the state reference guides and Billing grids for calculations of a claim. QA all claims for proper completion. Coached and developed the team to reach our team goals while maintaining and staying in compliance.
• EDI 835 and 834 healthcare claim data exchange within or outside the company in ensuring clinical audit becomes part of everyday practice with user acceptance testing ( UAT) application testing, and end user testing.
• Ensure patient records are up to date and are an accurate reflection of the WC claims. Compiled M&P"s documents as a SharePoint administrator MS Scheduling.
• Ensure staff records of sickness and annual leave are accurately recorded and relevant policies and procedures are followed and meeting all guidelines.
• Actively participate in the recruitment and interview process of staff.
• Respond to requests for employment references for team members as necessary.
• Coordinate the daily productivity of billing claim cases, Data Analysis, CPT Coding NCCI, ME, MUE, ICD9, HCPCS, EOB’s, UB92’s, HCFA 1500 and Excel.
• Submit Appeals and request archived bills, Accounts Receivables and Account credit. Billed private insurance, verify eligibility, referrals and authorizations. Correspond with adjusters for billing purposes and Authorizations for treatment.
• Implemented Cal/OSHA health/safety rules and regulations, liaison for company policy questions, and facilitated training.