SUMMARY:

• Versatile Professional with over 20 years of extensive Accounting and Healthcare administration experience.
• Proficient in billing and collections - ED, TED, ASC, MOB, IP, OP and NP Medicaid and Medicare claims
• Hands on experience in resolving pricing issues on all products for Dealerships, Finance, Regional and Insurance Managers.
• Well versed in processing purchases, payments, receipts and journals of existing accounts in Oracle Financials.
• Implemented detailed patient financial services processes.
• Results-oriented and solution-focused. Accounting professional skilled in problem solving and maintaining accuracy.
• Experience with 835 and 837 layout for healthcare claim loop and segments

SKILLS:

Accounting/Finance Software (Advanced): People Soft 8.0-9.9, NetSuite, Crystal Reports, Great Plains(Dynamics), Compass Accountant, SQL Reporting Server, Oracle11i (financials, Collector/AR work bench, super User access), IPP, CCIS (invoicing), Lawson, Care Zone 1.0 and 2.0, Salesforce, Zuora, Oscar, DPS, Quickens, Tesla, Metra Net, Aladdin,Via Blix (Credit Card - payment system), Cybersource (Credit Card-payment system), Contract Management ( Confidential ) System and Dun & Bradstreet (D&B) and Microsoft Office Suite.

Medical Software (Advanced): Cerner/NThrive, EPIC, HMS, (McKesson) STAR, Medifax (FL Medicaid), Compass RCC, PreBill Edit (PBE) module, Allscript, Epremis, Medisoft, Medical Manager, Meditech, Cerner/Soarian (Financials) Facets, Ensure, IDX, Mosaic, SSI, FACS, MHN (Multi-Health Network), Florida Shares (DDE-web base), Boost, Prism, Event Tracker, GUI (web-base), Claims Net, CRT 4.0,QVT Term, Art2000,PCAT,Batch Tracker, Clientele (CA& ATL),Dan soft HCFA Mapper, MS SQL, Specbuilder 5.5, IRCS, MHC (Claims), Maccas, Healthland/Dairyland, Envision(MS-Medicaid ), GHP(GA-Medicaid), BCBS and UHC, Navinet, Passport, EMDS, Invision (SMS), Healthware, On Demand, Emdean,.

PROFESSIONAL EXPERIENCE:

Confidential, Atlanta, GA

Revenue Cycle Analyst

Responsibilities:

• Training staff on working specific edits to satisfy a clean claim
• Quality assurance on accounts for accuracy and productivity
• Working bill edits for clean claim submission
• Billing corrected claims for Inpatient and Outpatient charges
• Billing combination claims for all payers including Medicare/Medicaid
• Working Observation claims and adding OBS hours as required; dropping OBS claims for billing
• Follow up on Medicaid Confidential claims 60+days

Confidential

Healthcare Consultant

Responsibilities:

• Obtained prior authorization and referrals from IDX, Navinet and Passport system
• Obtained patient eligibility from multiple systems; followed up with patient to update insurance
• Reviewed patient referrals and charts for follow up appointments in EPIC system
• Reviewed patients chart for procedure and specialist corrections
• Phoned patient to ensure medical records were updated
• Phoned patients as a courtesy of their upcoming scheduled appointment(s) per the referral
• Phoned patients to confirm that they are visiting the correct facility as referred
• Scheduled appointments accordingly
• Documented accordingly

Confidential

Senior Revenue Cycle Consultant

Responsibilities:

• Billed ED, TED, ASC, MOB, IP, OP and NP Medicaid and Medicare claims
• Billed and followed up on Blue Cross and Managed care accounts
• Worked special projects which consist of preparing refunds on straddled accounts
• Managed the Pre-Bill edit report for various departments
• Complete write offs for straddle accounts and small balance write offs
• Work pre-bill edits and failed claim reports
• Complete billing holds and error claims from various edits and submit clean claims
• Bill corrected claims for primary and secondary payers as requested from the Collections department

Confidential, Arlington, TX

Senior Revenue Cycle Consultant

Responsibilities:

• Trained employees on SSI (Click ON/Linux) billing system on Medicare and Managed Care claims
• Hospital billing for all payer’s including Medicare and Medicaid on the SSI system
• Worked with various access codes and completing all claims for billing once worked
• Worked various Medicare billing projects on UB04 and Confidential 1500 claims over 60 days
• Billed BCBS, Medicare and Medicaid claims 15> days daily and validated over 200 claims daily
• Researched late charges in Envision (SMS) and rebilled as corrected claims
• Out-patient and Pharmacy claim processing on a Confidential -1500. Processed 100-300 claims daily
• Entered correct Revenue and Confidential codes in SSI table for 837 HIPAA compliance and correct billing
• Created pivot tables for the collection’s department AR and over all AR for the company

Confidential, Bethlehem, PA

Revenue Cycle Consultant

Responsibilities:

• Completed special projects on billing and AR issues
• Primary billing and collections for commercial and BC/BS carriers; add late charges for billing
• Worked all error reports in SSI for commercial, Medicaid and Worker Compensation claims
• Worked claims in SSI that were on hold for various edits for billing
• Data entry on claims with missing NPI and physician names and revalidate those claim for billing
• Linked remittance in SSI for proper secondary billing and corrected claims
• Worked ticket request from the collection department from the ARF system in 24- hour work around time
• Processed over a 1000 Medicaid crossover claims in SSI by a deadline
• Completed Worker’s Compensation packets for billing and billed claims by a deadline
• Updated insurance information in SSI and HMS for billing
• Batching and balancing of electronic and paper claims
• Documented and recorded all processes in HMS system

Confidential, Atlanta, GA

Account Receivable/Account Payable Specialist

Responsibilities:

• Resolved pricing issues on all products for Dealerships, Finance, Regional and Insurance Managers
• Corporate collections and billing on over 800 high dollar accounts
• Created credit, debit memos and invoices for negative commission: locate payment for claims in GP
• Reviewed invoices for accuracy and coding errors; sent invoices and statements monthly
• Reconciled and canceled contracts in Confidential system where applicable
• Completed write offs and adjustments on aged, rejected and pro-rated reinstated invoices
• Managed invoice processing, billing, purchase orders and payments
• Cash application and created daily and weekly cash reports for accounting management
• Balanced monthly general ledger accounts to accurately record cost and month end accruals
• Reconciled discrepancies between general ledger accounts and accounts receivable trial balance's
• Monitored payments due from clients and promptly contact clients with past due payments
• Researched missing and unapplied checks; posted payments in Great Plains AP module

Confidential, Meridian, MS

Healthcare Consultant (Independent Contractor)

Responsibilities:

• Provided interim managed care reimbursement assessments/recovery
• Managed a portfolio of MS- Medicaid accounts; followed up on MS Medicaid claims on the Envision
• Hospital and Physician Billing on all commercial claims electronically in SSI and collections in Meditec
• Billed BC/BS and UHA corrected claims within timely filing guidelines on SSI (ClickON) system
• Worked denial 1500 claims and correct time and units on ambulatory claims for billing
• Identified Medicaid error on 90% of denied claims; implemented resolution for payment
• Manual physician billing on Confidential 1500 claims
• Worked all correspondence requests from the insurance company and healthcare providers
• Monitored and worked all secondary claims including cross over claims

Confidential, Duluth, GA

Account Receivable Specialist

Responsibilities:

• Collected on over 1000 accounts for (BuyerZone, Net 30, ACH/Credit card and Lexis/Nexis)
• Generated Receipt Reports in Oracle and import in Excel
• Posted checks, ACH/EFT and Wire payments to the current general ledger
• Processed credit card payments via accounting web portal
• Worked strategies, post payments and adjusted on accounts in Oracle 11i AR work bench
• Completed zero receipts in Oracle
• Created and reformatted revised/reinstated invoices
• Explained products, services and contracts to the consumer
• Generated 'Final Demand' letters for customers prior to forward to unmanageable debt collections
• V-look up on accounts, created pivot tables for Net 30, Net 45 and Net 60 accounts
• Created cases in Sales force for Renewal team and Sales team
• Applied cash and credits to complete month end AR

Confidential, Colorado City, TX

Healthcare Consultant

Responsibilities:

• Collected on self-pay claims that were 90-180 days old.
• Improved charge capture, increased revenue (Net) on Cerner Soarian.
• Captured charges as they occurred on Cerner.
• Integrated financial and clinical information in Cerner financials.
• Filed MSP claims with correct documents; submitted cross-over claims hardcopy
• Resolved high dollar and 120+ Day Medicare Accounts
• Worked Medicare denied claims from the DDE for hospital and specialty provider claims
• Worked short paid claims and post payments in the Heathland system
• Completed accurate Medicare adjustments per the remittance
• Worked on-site with patients with their Deductibles, Co-Insurance and HIQA information
• Recorded production and documentation on each account in Excel and Heathland/Dairyland

Confidential, Alpharetta, GA

Account Receivable Specialist

Responsibilities:

• Managed various accounts which consist of credits, debits and unapplied payments
• Completed level ticket requests from the Net suite system
• Researched checks/unapplied payments from lock box and posted on applicable General Ledger
• Processed purchases, payments, receipts and journals of existing accounts in Oracle Financials
• Worked in the journals module (Oracle) to transfer payments from one account to another
• Performed SQL query and client look up in PeopleSoft 8.0/8.8
• Processed multi-site invoices and ensured proper coding and approval
• Granted autonomy to make final decisions on unmanageable debt accounts referred to TPA
• Reinstated invoices that were previous closed and resubmit to client for payment
• Granted exclusive rights using (Via Klix and Cybersource) to process credit card payments and refunds

Confidential, Atlanta, GA

Provider Field Representative/Escalation Specialist

Responsibilities:

• Performed on an escalation team, resolved escalated issues for the (Department of Community Health)
• Worked error reports and corrected edits for proper billing and payment of claims
• Audited and tested claims to validate claims for processing on the GHP web portal, WINASAP
• Worked cross over claims; MSP claims and validation on Confidential 1500 and UB04 on SSI system
• Promoted to Provider Field Representative-2003
• Assisted Medicaid providers with mass adjustments and advanced payments on their revenue
• Trained providers at various Medicaid workshops on billing and reimbursement of claims
• Traveled to provider facilities to assist providers and staff with billing, software issues and finances
• Traveled to various providers' office in the South region and trained providers on how to use the GHP portal and how to bill using WINASAP (Medicaid claims billing module)