Software/Practice Management Proficiencies

IDX, Mysis, Meditech, Sage, A4 Nterprise , e Clinical Works, Allscripts PM, Allscripts Professional EHR, Microsoft, Excel, Word, Outlook, PowerPoint

Professional Experience

Confidential

• Abide by Federal and State guidelines as it pertains to billing, coding and auditing.
• Actively participate in change management fixes and enhancements in order to assist staff in adopting new functionality and workflows.
• Assesses, analyzes and recommends process changes to support a strong corporate compliance program and communicate audit findings and activities effectively to appropriate parties.
• Assist in new practice development and/or transitioning practice management and development.
• Assists departments in understanding regulatory requirements and in developing self-monitoring protocols. Responsible for conducting internal audits as well as oversight audits of external delegated entities related to delegated activities such as utilization and case management, credentialing, claims and customer service.
• Audit physician documentation for trends and inaccuracies for the purpose of potential greater reimbursement or potential refund
• Clinical Customization Module usage
• Comply and maintain timely updates based on operational demands and compliance with federal, state, and local guidelines.
• Create coding manual developing implementing policies and procedures per specialty.
• Ensures that operations within the policies, procedures, and regulations set forth by state and federal laws, including Medicare and Medicaid.
• Extensive experience and knowledge of Allscripts Professional EHR and PM for 109 multi-specialty providers. Duties include implementation, training, and audits of new and established providers, managers and staff.
• Implementation preparedness of Billing interface, MPV, E M Calculator.
• Maintain abreast of current industry related topics/policies for physician practices, billing policies, changes to Medicare, Medicaid, and third party payers.
• Perform training using appropriate tools and methods, assisting users in effectively utilizing systems to meet business needs.
• Performs follow up audits to determine whether recommendations have been implemented.
• Plan implementation, develop, administer, and document basic skills assessments and competency exams.
• Respond to specific coding inquiries and provide brief updates regarding coding, billing, and proper documentation.
• Responsible for developing, implementing and maintaining an effective system for monitoring, auditing and identification of compliance risks for all lines of business, including Medicare, Medicaid and Commercial.
• Responsible for documenting auditing and monitoring results and making recommendations as to what must be done to become complainant.

Specialty auditing/coding includes:

• Surgical Oncology
• Reference Lab Billing
• Radiology
• Pulmonology
• Psychiatry
• Podiatry
• Physical Therapy
• Physical and Rehabilitative Medicine
• Pediatrics
• Orthopedics
• Ophthalmology
• Obstetrics and Gynecology
• Neurology
• Nephrology
• Internal Medicine
• Gastroenterology
• Family Practice
• Evaluation and Management Coding
• Cardiology
• Ability to apply compliance rules to practical daily operations
• Ability to understand and interpret government health insurance laws and regulations familiarity with Medicare, and Medicaid rules
• Demonstrated critical thinking, analytical and problem solving skills
• Understanding of HMO business practices and government health insurance products
• Ability to manage multiple projects, prioritize assignments, and be flexible
• Highly effective research, writing, and communication skills
• Demonstrated intermediate-level computer skills in MS Outlook, Word, Power Point, and Excel
• Ability to present an unpopular opinion
• Ability to work well independently or with others
• Ability to work well with both internal and external customers
• Ability to lead teams as necessary
• Highly organized
• Strong attention to detail

Confidential

• Responsible for the initiation, development and completion of operational policy and procedure manual for front office and back office processes.
• Ensures the proper billing protocol is met with regards to written policies and procedures.
• Ensures timely updates based on operational demands and compliance with federal, state and local guidelines.
• Works with practice administration and central business office director to ensure accountability at the team member level for adherence to operational standards as defined by policy and procedure.
• Provides data needed to support recommendations and aid in decision-making.
• Responsible for initiation, coordination, and completion of operational training related to registration, insurance verification, charge entry, daily balancing and claims scrubbing exception reports to include materials and classes.
• Performs analysis and validation testing on front and back office workflow.
• Initiate best practices with regards to quality, productivity and federal, state and local guidelines across all front office, registration and charge entry functions in physician practice locations and central billing office.
• Develops and recommends new and/or revised policies and procedures to maintain compliance with federal, state and local guidelines.
• Ensures the proper billing protocol is met with regards to written policies and procedures by all team members.
• Partners with Corporate Ethics and Compliance to ensure all audits are completed to resolution based on findings.
• Stays current on trends with Hospital, Physician practice billing policies and procedures including, but not limited to, changes in Medicare, Medicaid, third party payers, CPT, ICD-9 and modifiers.
• Maintains current knowledge of all regulations and standards to ensure compliance of all processes and policies regarding claim submission, financial policies, including all local, state and federal guidelines pertaining to claim process.

Confidential

• Managed a staff of five coders ensures staff adhered to coding compliance.
• Adhered to Medicare/Medicaid compliance policy reviewed and trained.
• Posting of charges and payments, code hospital charges.
• Audit for accurate CPT, ICD-9 and HCPCS coding compliance.
• A/R support leader to ensure proper documentation.
• Audit, verify, and approve employee time sheets for payroll as well as approve time off requests.
• Patient Check In patient Check Out scheduled appointments collected co-pays and balances.

Specialty coding/auditing includes:

• Cardiology
• Evaluation and Management Coding
• Family Practice
• Gastroenterology
• Internal Medicine
• Nephrology
• Neurology
• Obstetrics and Gynecology
• Ophthalmology
• Orthopedics
• Pediatrics
• Physical and Rehabilitative Medicine
• Physical Therapy
• Podiatry
• Psychiatry
• Pulmonology
• Radiology
• Reference Lab Billing
• Surgical Oncology