SUMMARY

• Seeking a position in healthcare, utilizing technical training and Revenue Cycle skills to support a growth oriented organization, with the opportunity for professional growth based on performance.
• Subject Matter Expert in assisting organizations optimizes their Electronic Medical Record (EMR) investments through Charge Description Master (CDM) integration and implementation of processes that will maximize integration, work flows, and metrics.
• Analyzing and resolving patient claims being held by billing edits on Bill 45, Bill 49, DET, CRT, Medical necessity, Correct Coding Initiative, Outpatient Code Editor(OCE), Inpatient Code Editor, Self - Administered and other claims requiring clinical expertise’s.
• Strong understanding of SDLC/Waterfall/Agile project management frameworks and Business Analysis practices.
• Skills in analysis, organization, prioritization, leadership, project management, and communication methods utilizing tools and techniques associated with products such as Word, Excel, PowerPoint, Project, etc.
• Good knowledge of PMI industry-standard and PMBOK.

TECHNICAL SKILLS

• MS Project, Clarity 7, MS Office 365/SharePoint, MS Visual Basic, MS Outlook, MS Office 2014
• MS Excel, MS Word, MS PowerPoint, MS SQL, HL7 - Iguana, Mirth, Quovadx/Cloverleaf Integration Engine
• Charge Description Master (CDM), Epic 2009, 2014 & 2016 - (ASAP, Prelude, Beacon, Resolute HB & PB
• OpTime, Anesthesia, Cadence & Crystal Report Writing), Allscripts, McKesson - (HEO, HED & HPF)
• MEDHOST, STAR Navigator, Cerner - (PowerChart & Cerner Works), HP Quality Center, Crystal Report Writer
• MD Audit, E & M CPT Coding Review and Audit Tool, PICIS, 3M Encoder, Patcom, Medassets, Xclaim, Zirmed
• Acculog, TMHP, Availity, Clearancepro, NextGen, PHIcure, HIPPA.

PROFESSIONAL EXPERIENCE

Confidential

Principle Application Specialist

Responsibilities:

• Oversee daily Epic revenue cycle functions and act as front line leader to answer staff questions and prioritize follow-up efforts.
• Responsible for overseeing the ADT (Admit, Discharge, and Transfer) processing of all third-party claims for inpatient and outpatient primary and secondary claims for professional billing.
• Responsible for monitoring and improving all Epic revenue cycle metrics and measures for their respective departments, including but not limited to the following: AR days, aged AR, cash collections, denials, avoidable write-offs, staff productivity and work quality, credit balances.
• Acts as user liaison between clinical or business departments and Information Systems; providing domain expertise and experience for multiple interacting healthcare departments.
• Lead pod meetings to help identify payor/department trends and facilitate cross-training between staff.
• Monitor representatives’ daily responsibilities, including oversight of revenue cycle representative work queue activity and duties to ensure timely processing of claims and follow-up on accounts for optimal resolution.
• Conducts analysis of necessary application modifications and work with the appropriate Vanderbilt IT associate or the vendor to coordinate the modification.
• Assist in obtaining information related to trends for PO CBO and practice leadership by working with team members to identify and analyze trends.
• Responsible for conducting quality review of revenue cycle follow up staff.
• Establish continuous interface training and learning opportunities for staff members.

Confidential

Project Manager

Responsibilities:

• Leads the revenue cycle departments (i.e Epic Registration, Revenue Integrity, Billing, Scheduling, Coding and Charge Description Master).
• Review compliance components in the VIRA process for all supplies requested by facility and provide documentation for SOX maintenance. (MD Audit)
• Provides overall direction, hiring and staffing, for the patient access department enhancing patient and provider satisfaction.
• Drives continuous improvement in operations of patient access pre-registration, benefit verification, pre-authorization, and admissions/registration. (Cerner)
• Ensures efficient operation and effective reimbursement of third party account receivables by researching accounts, refiling or appealing claims, submitting additional medical documentation and tracking account status by monitoring and analyzing assign unresolved third party accounts.
• Assist in account profitability to meet revenue and margin requirements set at the corporate level.
• Support the development of auditing, reporting and contract modeling tools as needed for identification and analysis of rate and/or fee schedule auditing, financial performance and contract performance as well as modeling and analysis of potential opportunities.
• Ensure efficient and accurate delivery of high quality, cost effective service by Room Management staff, as measured by bed control, transfer center and ADT performance statistics, variance analysis reports, payor mix analysis, strategic initiatives, and other pertinent data metrics.
• Maintain QA statistics (including patient wait times, Census, Collections, Revenue Cycle denials and Appeals logs) and report results to the Director.
• Directly oversee the daily activities of the registration areas to ensure department standards are met.
• Act as liaison between application teams and client management and end users to determine application needs and resolve problem situations.
• Secure all signatures necessary for treatments, release of medical information, and assignment of insurance benefits and payment of services from legally responsible patients.
• Work closely and professionally with nursing and ancillary departments in an effort to maintain a teamwork approach.
• Review daily billed, unbilled, rebill, pre-service accounts to ensure accounts have been activated.

Confidential

Program Director

Responsibilities:

• Manages a Department of five managers and 50 full and part-time employees.
• Oversee Admitting, Registration, QA, Insurance Verification, Pre-Registration, Denials, Compliance, Employee Productivity and Upfront collections.
• Reviews all BHL, Mutual, FCSO, PAS Billing Compliance correspondence and adheres to all guidelines.
• Optimize utilization of newly installed Epic electronic Health Record software by leading the department to become an Epic Single Billing Office (SOB) operational organization.
• Ensures the Charge Description Master (CDM) structure supports effective entry of all chargeable services/items. Maintain changes and updates of hospital charge entry process and interfaces.
• Manage all levels of Revenue Cycle (hospital and physician), PFS, Clinical and Financial department staff to resolve complex issues on accounts and patient records.
• Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolved issues and notify appropriate leadership.
• Support Corporate with compilation of information needed for organization profit and loss statements required by financial accounting.
• Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improved flow of claim and enters all corrections into the systems.
• Support Regulatory compliances and auditing solution for reporting.
• Managed all stages of enterprise application life-cycle management: application strategy, software selection, development, deployment, maintenance, upgrades, operation and support within a multi-platform computing environment.
• Coordinate with other technical support teams that provide middleware, data administration, system administration, production control, operations, and security services in a matrix environment.
• Accurately develop project plans, resource requirements and project cost estimates; ability to deliver projects within budget, using resources efficiently and effectively.
• Develop Metrics and KPI’s designed to monitor the performance of management and staff in achieving SLA’s adhering to process and the timely recording of pertinent data.
• Supports multiple concurrent projects and/ or application modules, upgrades, educates and coaches other team members and manages user expectations. (Allscript, Epic & Cerner)

Confidential

Patient Access Liaison/Manager

Responsibilities:

• Participate in planning, upgrades, implementation, management and evaluation of Epic EMR software for the Information Services Department.
• Under general supervision gathers and analyzes user needs for developing and modifying clinical or business applications in the healthcare environment.
• Servers as the charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard Charge Description Master (CDM) error report and communicating with Ancillary Departments to resolve issues, member of facility FECC Committee; reports charging issues, etc. (E & M CPT Coding Review and Audit Tool)
• Documented interface specifications, fact-finding and analyzes complex results and proposes solutions or recommendations.
• Responsible for and oversees day to day tracking, Epic Work Queue and follow-up on issues and questions of daily operations.
• Provides advanced application support and guidance to end users and provides technical guidance to less experienced personnel.
• Develops testing scripts and participates in ADT inbound & outbound testing.
• Makes recommendations with some guidance and provide alternatives with regards to various development and support initiatives.
• Work with the Director of Information Technology to set project timeframes and deadlines. Work with the Epic Analyst staff to ensure projects and tickets are done in accordance with timeframes established.
• Coordinated implementation of new releases including testing, enhancement decisions and training.
• Participated in work flow design, using change control procedures.
• Establish well-formed relations with facility operators related to revenue.
• Communicate effectively the results or finding in data in an organized, solution based, summarized and meaningful format for the respective audience(s).
• Assist with projects including new initiatives involving various stakeholders within and outside the revenue area.

Confidential

Admission Counselor

Responsibilities:

• Assist in providing access to services provided at the hospital.
• Performed in the various Verification/Pre-certification areas is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement.
• Verification of eligibility/benefits information for the patient's visit obtaining Pre-cert/Authorization/Notifying Third Party payers within compliance of contractual agreements with a high degree of accuracy.
• Responsible for maintaining knowledge of HMO's PPO's Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers.
• Maintaining knowledge and adhering to third party payer contractual agreements minimizing the Hospital's financial risk for claim denials thus maximizing reimbursement for services rendered.
• Responsible for maintaining knowledge of the Financial Policy and deployment of practices used with Patient Access to resolve the patients' accounts.