Patient Navigator

• Jun 2018 - Present

Chart Documentation Improvement

• Jun 2018 - Jul 2022

♦ Review of the primary record to verify the accuracy of patient medical information and obtaining missing information.♦ Applying knowledge of medical terminology and procedures to evaluate clinical documents.♦ Review of the primary record to determine adequate source documentation is available to support all reported testing data♦ Clinically evaluate how the health record translates into coded data, including review of provider and other clinician documentation, lab results, diagnostic information, and treatment plans♦ Works collaboratively with the healthcare team to facilitate documentation within the medical record.♦ Communicate with providers either through discussion or in writing regarding missing, unclear, or conflicting health record documentation, and clarify the information as warranted♦ When contacted by Coders concerning opportunities for improved documentation, will review medical records and follow-up with office staff and physician as appropriate.♦ Serves as a resource for physicians and educates physicians on ways to improve their documentation so it more accurately reflects intensity of services/severity of illness.♦ Ensure documentation complies with all relevant governmental regulations♦ Identify patterns, trends, variances, and opportunities to improve documentation review processes.♦ Ensured patient confidentiality within the working environment Show less

Practice Manager

• Sep 2017 - Jun 2018

Contract hire to start a practce from the ground up. From furniture,to phones, to software, employee hires, and everything in between. Contract hire to start a practce from the ground up. From furniture,to phones, to software, employee hires, and everything in between.

Credentialing and Billing Manager, Genetic Testing,

• Sep 2015 - Sep 2017

Serves as the authorized point of contact for 7 laboratories, 7 physicians and staff, providing information or assistance in regards to fee schedules, contracts and carrier issues. • Establishes and maintains an effective working relationship with each center. • Overall Physician, Laboratory, and Billing Credentialing and Billing • Manages centralized provider contract administration, adherence, processes, and database management. • Uploads/reviews completed contracts and updates to/from billing system. • Notifies internal stakeholders of changes to payor contracts as needed. • Ensures all contracted rates are loaded accurately. • Develops methods of testing, auditing and tracking for each payor. • Coordinates with the Collections team to research and resolve claims issues, identifies trends affecting reimbursement and escalates issues to the Operations Manager. • Works with external parties in the resolution of payer issues due to credentialing and other contract problems • Performs all processes necessary for provider credentialing and re-credentialing with payors. • Gather, initiate, and maintain provider credentials - licenses, certifications, memberships, renewals, malpractice insurance, CEUs, etc. • Completed EFT's, EDI, AND ERA • Effectively communicates and coordinate provider credentialing requirements with center management. • Maintains a record of credentialing application status and provide updates regularly to Revenue Cycle Leadership. • Oversees, updates,and maintains credentialing databases including CAQH, PECOS, NPPES Registry, Sharepoint and any other applicable regulatory agencies. • Carries out all duties and responsibilities in an exemplary manner in accordance with established standards of professionalism, ethics, and custom Show less

Executive Management

• Nov 2009 - Sep 2015

PRACTICE MANAGER OF A HOME HEALTH/ DME FACILITY. 6 Senior Reports 35 total reports • Adhere to and implement all of the company’s policies and procedures and compliance with all accreditation standards. • Takes all appropriate actions to ensure branch complies with all laws and applicable regulations • Meet monthly with owner to report on all success/failures. • Meet weekly with department heads-track goals-report success/failures. • Help develop marketing plans with sales force-track success/failure-revise as needed. • Approve payroll prior to submitting. • Ensure CMN’s and other documentation requirements are procured in a timely manner. • Medical billing on BCBS, AETNA, UHC, HUMANA, MEDICARE, & MEDICAID on web portals. • Supervise and conduct inventory as required- maintain adequate stock with our excess. • Interviews and hire staff as needed. • Coordinate in-service training annually to meet all licensure and accreditation. • Provide counseling and guidance to a staff of 35 as needed. • Review delivery route sheets to ensure they’re logistically accurate • In home patient care –phlebotomy, injections, vital signs, cpap set ups, and various in home clinical care. (Reason for departure: Company was not a Competitive Bid winner and we were unsustainable without Medicare) Show less

Executive Manager

• Mar 2007 - Jul 2008

Responsible for daily activities in support of a non-profit organization's development programs. · Maintains donor records, solicits and acknowledges donations, and prepares advertisements or correspondence regarding the organization and its programs. May arrange and attend meetings with donors and prospective donors • Day to day responsibilities such as answering phone, emails, vendor support, • Develops and implements policies and procedures for the relations between the media and the organization. Works to expand understanding of the organization's business, performance, and strategy. Prepares summaries of media activity • Assisted media relations, announcements, editorial placement, and speaking opportunities. Develops press releases, white papers and supporting materials • Develops and implements the organization's programs. Assesses needs and ensures that program objectives are met. Coordinates activities of program committees and/or other groups to plan procedures • Grants/Proposal Writer Develops resources, researches funding sources, and writes proposals to a variety of organizations. Prepares contract proposals and may administer major contracts. Also may negotiate contractual provisions with potential partners. (Reason for departure: due to the poor economy, contributions that kept our association open desiccated and the Atlanta office was forced to close) Show less

HEALTH SERIVCES COORDINATOR

• Sep 2004 - Jan 2007

• Co-ordinates all Health Services Functions. Ran a clinic that allowed employees to be medically treated without having to leave the corporation • Responsible for Workers Compensation billing & payroll, maintaining OSHA Log, monthly reports, and all purchasing. • Extensive creation and use of Excel spreadsheets, PowerPoint, Word, and Microsoft Office documents. • Created and designed Health Services communications that were distributed throughout CIBA Vision. • Continually built web pages for the CIBA Intranet, as well as the CIBA View that is seen company wide. • Worked hand in hand with Benefit Department, HRIS, Compensation, and Human Resources with several companywide projects. Show less

Office Manager/Practice Administrator

• Jan 2004 - Sep 2004

• Supervised all office personnel. Established and implemented protocols for all office procedures. • Opened new medical facility from the ground up-including Credentialing, CLIA certification, OSHA & HIPPA Compliancy, Commercial Billing, Medicaid and Medicare Billing,. • Restructured the billing process for higher revenue and efficiency and recovered lost revenue from backdated claims. • Employee Payroll, Employees bonuses and commissions, Benefits administration, Human Resource issues, Employee evaluations, Workers Comp, PeopleSoft 7.5 & 8.0, Kronos. • Strategic business partner with management teams targeting staffing needs and hiring process. • Source nationally and internationally to present qualified candidates for a medical environment to work with Patients, Hardware, Software, Project Management, and other various positions. • Partner with all levels of management to develop and implement staffing plans, conduct interviews, assist managers with candidate selection, source candidates at open houses, career fairs, through the internet and networking, responsible for proposals, making job offers and negotiating salary. • All clinical duties preformed in the back office setting. (Reason for departure: I was offered a better growth potential and learning experience) Show less

Director

• Jul 2003 - Jul 2004

Managed a team of patient care coordinators that enter referrals into our database system and follow an order through completion - working closely with the account managers to ensure accuracy and completeness of an order. Sourcing and ordering all of our "Non-Pharmacy" products for our patients. These products include: DME - Durable Medical Equipment and Supplies (i.e. Wheelchairs, crutches, bandages, braces, pads, beds, walkers, etc.). TENS Units, MRI's, Physical Therapy and Home Health. As part of my job I have the ability to negotiate pricing and contracts with vendors, identify appropriate vendors, deal with injured workers, as well as build our network of "Non-Pharmacy" providers. Working one on one with Workers Comp Adjusters. Billing Commercial, Government, and Workers Comp for all DME, TENS, MRI and Home Health. I work with Billing/AR closely on ANY billing problems. Collecting money on past due accounts. Power Point presentations, Microsoft Excel, Oracle, ICD 9 coding and HCPCS, commercial and workers compensation guidelines, HIPPA, JCAHO, and OSHA compliant, and Netledger Show less

Durable Medical Equipment Coordinator

• Dec 1998 - Jun 2003

Assisted in monitoring the standards required from The Health Insurance Portability and Accountability Act (HIPPA) of 1996. Taking DME orders from physicians or hospital. Verify insurance and benefits, pre-cert/authorize any specialty DME with insurance companies. "Farm out" any DME or supplies to appropriate vendors, negotiate prices with outside vendors, scheduling time for delivery of equipment, troubleshooting any problems, delivery and setup of equipment. Responsible for auditing for Management. Handled all DME Billing questions and assisted on the A/R clean up team. Performed various home health care duties such as CPAP machines, tracheotomy care, wound and dressing changes. (Reason for departure: Family of a patient was so impressed by my nursing skills and home health knowledge, the family was determined they would open their own Home Health Care Company and I was invited to help construct their company) Show less

Office Manager/RN

• Jan 1998 - Dec 1998

Responsible for Accounts Receivable, Account Payable, and generating all daily financial reports. Coordinated credentialing contracts and fee schedules for top payers. Managed patient collections and created financial payment plans. Assisted in monitoring the standards required from The Health Insurance Portability and Accountability Act (HIPPA) of 1996. Insurance coding and billing. EKG's, minor surgical assisting, ultrasound therapy, PFT's, phlebotomy, injections, complete physicals-male and female, x-ray positioning and techniques, CBC's, Reflotron, Sed rates, and pregnancy, mono, strep and hemocult using kits. (Reason for departure: the physician's wife became ill with cancer and for health reasons they closed the practice and moved to a different state) Show less

Office Manager & Registered Nurse

• Apr 1994 - Jan 1998

Complete triage, spirometry, minor and major surgical assisting, injections, blood collection, suture and staple removing, CBC's, Sed rates, pregnancy, mono, strep, and hemocult using kits, drug screens. Ultrasound therapy, whirlpool wound treatment, physical therapy assisting, X-ray techniques positioning and developing, casting limbs and casting removal. Workers Comp-emergency care, drug screens, physicals, and follow up care, and emergency care of all kinds Responsible for all aspects of Insurance, A/R, daily reports, month-end-reports, and all financial statements. Assisted in monitoring the standards required from The Health Insurance Portability and Accountability Act (HIPPA) of 1996. (Reason for departure: Company was sold to a Sports Medicine facility and the new physicians brought in its previous medical team) Show less