Patient Financial Services

Resume posted by sharonpollard in Health.
Desired salary: $98,000.00
Desired position type: Full-Time.
Location: Richmond Virginia, United States

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Summary

Highly analytical, performance-driven, and multifaceted professional, with extensive experience in denials management, patient financial services, insurance authorization and pre-registration, as well as patient access optimization. Armed with expertise in project management, aging AR analysis and review, and cash reconciliation. Concept-to-execution driver, able to develop and implement innovative solutions and programs to drive systems and process improvement, while increasing operational efficiency and customer satisfaction. Adept at identifying key initiatives and efforts to achieve company advancement and bottom-line results. Articulate communicator, able to establish and maintain collaborative and long-term relationships with diverse individuals.

Skills

  • Report and Document Preparation ~ Real Time Eligibility (RTE) ~ Call Center Operations
  • Staff Development and Training ~ Denials Management and Authorization requirements Compliance
  • Cash Reporting ~ Strategic Planning and Implementation ~ Claim Status Management

Education

BACHELOR OF SCIENCE IN MANAGEMENT SCIENCE
Kean University | Union, NJ

EPIC, HOSPITAL BILLING CERTIFICATION RESOLUTE, Feb 2011

PROFESSIONAL CODER CERTIFICATION, DEC 2008 | Instructor, PROFESSIONAL CODER CERTIFICATION, Oct 2011
American Academy of Professional Coders | Salt Lake City, UT

PATIENT ACCOUNT MANAGER CERTIFICATION, Apr 2009
American Association of Healthcare Administrative Management

TRAINING AND DEVELOPMENT CERTIFICATION
Kean University | Union, NJ

Experience

CONFIDENTIAL | RICHMOND, VA
Manager, Insurance Authorization and Pre-Registration Jan 2013–Present
> Direct overall facility operations for 14 acute care multistate hospitals involving financial clearance functions, pre-registration, insurance verification, preauthorization, and point of service collections in strict conformance with service level agreements.
> Expertly manage inbound and outbound call center on surgical and outpatient diagnostic scheduled procedures.
> Serve as a liaison between facility and physician’s office regarding pre-service correct authorization in accordance with scheduled patient status including inpatient, observation, and outpatient.
> Employ keen attention to detail in performing daily monitoring and analysis of the following initiatives:
– Financial clearance center insurance verification performance, to meet FCC service level agreements through timeliness, accuracy, and compliance standards; and
– Financial clearance center pre-registration performance call center, point of service collections, hold time, abandon rate, and quality assurance.
– Insurance master file, to render technical assistance to the Financial Clearance staff in developing appropriate plan selection.
> Work collaboratively with the following professionals in accomplishing key tasks:
– Utilization Review Department, in ensuring compliance of payer requirements and physicians order compliance with appropriate length of stay (LOS) observation (OBS) and inpatient only procedures;
– Coding and HIM Department, in determining Dx and Px codes potential that would deny based on payor contract specifics;
– Patient access and surgical local market leaders, in addressing authorization related issues which may potentially cause authorization denials.
> Proactively communicate with staff regarding changes and developments in payer authorization requirements.
> Supervise 42 FCC personnel in charge of recommending promotion, salary adjustment, and appropriate personnel action implementation.
> Take charge of establishing specific objectives, budgets, and performance standards for each area of responsibility; conducting staff reviews; and generating performance documents for direct reports.
> Drive efforts in enhancing local markets and patient services through the implementation of process improvements relating to insurance verification and pre-registration.
> Fulfill wide range of responsibilities which include financial reporting and preparation, planning, forecasting, and payroll administration.
> Executed surgical re-certification project, which involved surgical procedure changes prior to billing, thus reducing surgical denials due and increasing cash percentages monthly through pre-service point of service collection initiatives.
> Decreased patients’ wait time at check by implementing online pre-registration through the use of My-chart for scheduled surgical and outpatient procedures.

Director Patient Financial Services Nov 2011–Nov 2013
> Led the daily activities of departmental operations including cash collections.
> Worked closely with peers within the revenue cycle organization in supervising denials, reviewing trends, driving process improvements, and setting long-term revenue goals.
> Utilized Epic and SMS/Express Query in evaluating and preparing reports to observe payor contract compliance and timely follow-up.
> Discussed trends that affect cash collections and contract modifications through meetings with payor network provider representatives.
> Strictly adhered to the organization’s policies and applicable laws in accomplishing supervisory responsibilities.
> Carried out key tasks which include high-dollar claim analysis, month end reports compilation, aged receivables reviews, as well as write-offs preparations on bad debt and underpayments to Senior Management Team.
> Demonstrated competency in addressing problems affecting back/front end service, efficiency, and productivity.
> Maintained active communication with HIM, Case Management, and Coding departments in providing appropriate billing and patient status transfers related to payer denials.
> Offered recommendations to assigned payors and work queue in overseeing claim status and denial projects.
> Served as a driving force in increasing clean claims and decreasing claims holding for edits; while reducing aged receivable.
> Made major contributions in delivering excellent service by distributing workflow to appropriate staff, while meeting and surpassing department’s productivity and cash goals.
> Streamlined claims process and payment by facilitating insurance follow-up education to staff which involved payor contract specifics analysis.

Epic Connect Care Application Coordinator and Hospital Billing Trainer Dec 2010–Nov 2011
> Assisted in coordinating daily activities concerning the hospital billing application development and implementation.
> Rendered support in performing testing and ongoing CBO onsite support as well as issues resolution through heat tickets.
> Facilitated trainings to end-user regarding HB application at classroom and onsite facility/practice in local market; as well as to credentialed trainers and super users, responsible in conducting and coordinating new hires trainings for new software releases and updates.
> Promoted and ensured training environment and materials maintenance.

Insurance Follow-up Manager and Insurance Follow-up Supervisor Aug 2007–Dec 2010
> Maintained accuracy and on-time billing and collections on patient account balances for seven facilities by leading staff of 23.
> Coordinated weekly departmental meetings, as well as monthly provider representative meetings at third-party payers to promptly solve underpayment, contract, and billing issues.
> Evaluated and created seamless flow of information involving billing, transaction posting, and other patient financial services areas, while posting or applying insurance adjustments and payments.
> Generated day-to-day productivity employee records to meet performance standards and achieve departmental goals, while conducting cash computation balancing and distribution to vice presidents, directors, and managers.
> Collaborated with HIM, Case Management, and Coding departments in ensuring appropriate transfers of billing and patient status relating to payer denials.
> Assumed full accountability in handling the posting of payments and adjustments.

MEDICAL MANAGEMENT | RICHMOND, VA
Medical Accounts Receivable Manager Aug 2006–Aug 2007
> Keenly oversaw AR follow-up and correspondence performance for all payers.
> Performed and maintained month-end analysis and reports for 43 clients, which included aged AR statistics reporting in a weekly basis to ensure clients do not exceed 30 days.
> Guaranteed efficiency of aged AR statistics efficiency through the implementation of specified policies and procedures.
> Effectively handled multiple assignments through priority management to maintain days in AR.
> Held accountability in applying and recording insurance adjustments and procedure code entries.
> Presided over new employees training and hiring.
> Developed and provided staff goals recommendation for operational and AR aging productivity, while addressing procedural or deficient work productivity concerns through the execution of discipline procedures to employee.
> Increased cash flow by serving as a liaison between clients and the organization, in charge of evaluating billing and coding issues.

Earlier Career:

MCKESSON PROVIDER TECHNOLOGY| SOMERSET, NJ
Medical Accounts Receivable Manager 2005–2006
Medical Accounts Receivable Supervisor 2003–2005
Senior Medical Biller 2001–2005

QUALCARE PREFERRED PROVIDER ORGANIZATION | PISCATAWAY, NJ
Claims Examiner 1998-2000

ANTHEM HEALTH AND LIFE INSURANCE | PISCATAWAY, NJ
Client Service Specialist 1997-1998

Additional Experience

MEDICAL BILLING & CODING SOLUTION | RICHMOND, VA
Coding Instructor Feb 2011–Present
> Guided and mentored students regarding medical billing, medical terminologies, International Classification of Diseases 9 and 10 interpretation, and Current Procedural Terminology (CPT) book utilization.
> Provided hands-on assistance to various individuals in reading operative notes, preparing medical charts, and complying with several billing laws including Health Insurance Portability and Accountability Act (HIPAA).
> Prepared students for national certification through the American Academy of Professional Coders.