Overview:

• A highly motivated person thrives on challenges and able to manage both time and resource posses the ability to adapt quickly to new situations and highly experiences in the following areas:
• Reimbursement Methodologies Electronic Health Record EHR
• Maintain Confidentiality Data collection/management
• ICD-9/CPT/HCPC II Coding Writing/Communication Skills
• Supervising skills Plan/Organizational Skills
• Data Entry/Acct Receivable Practical Accounting skills
• Customer Service Oriented Privacy Security Laws
• Medical Record management Leadership/Team Player

Employment

Confidential

• Process attestation applications for State Incentive program ensure information is accurate/reliable for timely resolution.
• Researches/ identifies problem utilizing public eligibility programs system, Omnicaid, Aspen
• Respond to phone calls assisting provider with online web portal, maintain call log.
• Follow up on outstanding issues to ensure resolution, keeps the provider/customer informed on the status of application closes out case when complete.
• Communicates appropriately maintaining effective working relationship with internal external customer.
• Time management to resolve complex problems making recommendation to management to improve efficiency/effectiveness
• Prepare reports to track workload, time and quality input and audit work.
• Obtain/maintains knowledge of Federal, State local resources available to make sound decision

Employment

Confidential

• Credentialing providers for various facilities/hospitals
• Ability to interpret and compliance with Federal and State requirements
• Perform audits verifying current with licensure, certificate Malpractice
• Update/ maintain credentialing database
• Continuous communication among staff act as liaison assisting to help providers credentialing process.
• Maintain confidentiality foster a team environment strong time management skills

Employment

Confidential

• Supervisorial duties to a staff of 19 billers, account receivable voucher examiners .
• Conduct collection activities to reconcile/balance patient accounts to maintain account records
• Tracking monitoring 3rd party coverage information eligibility/patient data verified
• Knowledgeable of various health insurance plans/resource to assist patients
• Act as liaison consult with internal/external customers, patients hospital staff
• Direct/coordinate daily workload to comply with operating practices procedures.
• Delegate assignment to meet stringent deadlines and recommend solutions of problems.
• Interpret insurance benefits, policies and rule regulations to staff/patients providers
• Prepare/analyze operational/management reports reflecting collections, delinquent accounts etc,
• Assist with implementation a related billing software for claim submission via clearing house
• Keep self updated on policies/procedures/standards of insurance rules regulation effecting healthcare
• Recruit/on-going training, encourage teamwork and maintain confidentiality

Employment

Confidential

• Supervisorial duties to a staff of 11 for: denial management, billing, patient registration.
• Engage in planning monitoring day to day operational function
• Performing collection activities related to follow up and timely account resolution
• Act as liaison consult external/internal customers to support operational procedures, delinquent accounts, negotiate write offs etc.
• Conduct staff meetings leave authority, ensure adequate coverage in each section.
• Communication with people at all levels State, Federal local
• Detect resolve deficiencies within the revenue cycle
• Provide technical assistance to management, physicians, patients billing/denials/payments issues
• Identify/correct incorrect third party information posted to appropriate registration pages
• Develop analyze periodic collection/financial reports interpret to staff/colleagues.
• Promote team building and strives to improve business practices and workflow
• Maintain confidentiality interpret billing guidelines from Federal State.
• Ongoing training education to staff of ongoing changes
• Hire, discharge, transfer promote employees, resolve employees complaints and initiating a corrective action

Employment

Confidential

• Taught various Health Information Technology courses to diverse students.
• Use positive reinforcement in teaching emphasizing real work experience to effectively convey concepts to aid in learning.
• Communicate orally/written applying correct grammar, punctuation or spelling.
• Develop creative lesson plans to raise student awareness understanding for respective subject.
• Provide support, inspiration coaching to students for success and passing the course.
• Use interpersonal communication techniques to help students reach their full potential.
• Assessed evaluated students progress and meet with students of learning discrepancies
• Review assignment/lesson plans to modify or redesign
• Enter grades, retrieve students data, maintain confidentiality
• Consult professionally with students, faculty, staff and external customers

Employment

Confidential

• Billing Medical claims for outpatient hospital-base facility DME Medicare
• Prepare claims forms 1500/UB04 submitting claims electronic/paper filing.
• Data entry via the RPMS system capable of working in a hybrid environment.
• Strive for optimal payment strong ability to multitask, organize and detail oriented.
• Resolve any online edits, answers questions on unpaid claims denials
• Generate insurance verification and update RPMS system.
• Knowledge of various insurance billing regulations policies
• ICD-9/CPT/HCPCS II coding
• Review various billing, collections reports
• Follow up on pending claims/denials maintain record
• Back up Patient Registration updating demographic information
• Maintain confidentiality, knowledgeable of Medical Necessity/ POA
• Keep self updated through Newsletter, website CMS, trailblazer, AHIMA etc.

Employment

Confidential

• Provided leadership to 26 Patient Registration clerks/ 4 Medical Technicians.
• Distributes balances workload to support daily operational function.
• Knowledgeable of medical record police/procedures for processing medical/ legal documents
• Prepares charts, interact with patients, hospital staff, oversee equipment supplies
• Approve/Deny leaves, Assist supervisor and report all problems found.
• Monitor all denied verifications/updates returns to Patient Registration
• Maintain high standards towards internal/external customers, co-workers, etc.
• Develop, maintain and analyzes health information files
• Responsible for weekly/monthly work schedule and weekly station assignment.
• Review productivity, tardiness, absenteeism discrepancies with supervisor.
• Serve as a liaison between patient, subordinates hospital staff.
• Making regular spot check, recommend changes in position rotating assignments.
• Collecting, verify and insurance data/third party information into RPMS system
• Knowledgeable of Medicare, Medicaid Private insurance billing regulations eligibility guidelines.

Employment: Confidential

Billing Medical claims for outpatient/hospital facility Physical Therapy

Electronic paper filing on UB04 1500 claim forms

Data entry via the billing system, resolve online edits timely

Strive for optimal payment, resolve claim discrepancy/payment issues

Verifying eligibility/collecting updating demographic information.

Knowledge of various insurance billing regulations Medicare/Medicaid/Private etc.

Knowledgeable of ICD-9/CPT/HCPCS coding diagnostic/procedural

Reviews various reports to assure all billable claims have been billed

Follow up on pending claims/denials maintain a tickler file on billed claims.

Confidentiality/HIPPA

Employment: Confidential

Performing highly technical medico-legal functions

Medical Record analyzes/abstracting information.

Customer Service, working independently

Distributing Medical Correspondence with verified acknowledgement.

Knowledgeable of the Privacy, FOIA regulations.

Interviewing interpreting documents, forms etc.

Received/responding to written correspondence, telephone, fax, e-mail etc.,

Covering patient registration, collecting demographic information,

Submission of vital statistic, birth certificate, social security /paternity papers

Presentation on the privacy act, confidentiality, Health Records and Advance Directives.

Maintaining confidentiality and knowledgeable of HIPPA