Experience

Primecare Community Health Inc

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Senior Revenue Cycle Manager

  • May 2020 - Present

  - Manages Billing department; continuously trains, and supervises a team of six people. Reports to the CFO.- Effectively problem solves and manages processes.- Establishes, implements, and manages billing standards, policies and procedures that are effective; supports patient and referral-based access and achieves financial goals for the organization.- Maintains compliance with State and Federal programs. - Provides ongoing guidance, feedback, and forecasts key indicator trends and performance measures.- Researches, analyzes, and responds to inquiries regarding compliance, medical coding, billing denials, and billable services.- Supports the retrieval, review, and delivery of medical records needed for internal or external audits or payer requirements.

• Revenue Cycle Manager

  • May 2019 - May 2020

  - Directed associated revenue cycle activities to maximize accounts receivable results.- Ensured appropriate staff training and cross training, evaluated staff performance, and recommended hiring, terminations, promotions, and salary action.- Communicated the status of billing and cash related activities and escalated issues to payers and organization’s leadership as necessary to help drive timely and accurate final resolution.- Oversaw and streamlined billing and collections processes and improved the data integrity among all business lines.- Maintained strong relationships with payer representatives to address issues and needs.

• Accounts Receivable (A/R) Specialist, Team Lead

  • Sep 2018 - May 2019

  - Met with billing Manager to discuss workflows and resolve reimbursement issues and billing obstacles.- Attended webinars, conference calls, and insurance rep meetings.- Responsible for Inpatient Billing and transition to AlertMD application.- Oversaw updates on missing slips and productivity of all team members.- Able to submit about 150 - 200 missing slips daily and performed special projects as needed.

• Accounts Receivable Specialist

  • Jan 2018 - Sep 2018

  - Reviewed physician charges and codes and submitted claims to insurance for reimbursement.- Submitted inpatient charges in Athena, clarified issues with providers, and verified missing information in Epic.- Recorded and tracked all deliveries to include in monthly and yearly reports. - Reviewed and analyzed patient accounts, verified balances, applied FA, and initiated refund requests for overpayments.- Processed, followed up on, and resolved requests for medical records and itemized bills.- Handled reports and coding issues for outsourcing company and participated in weekly conference calls.- Performed collection calls and offered payment plans to patients with outstanding balances.

• Referral Coordinator

  • Jan 2017 - Dec 2017

  - Submitted referral information to insurance companies for prior authorization.- Prepared referral forms and transmitted required information to specialists and imaging centers.- Communicated with patients and providers to obtain any needed information for referral completion and to inform of any anticipated delays.- Identified in-network providers for appropriate specialty and arranged appointments as necessary.- Followed up on referrals and determined if patient had completed appointments; if yes, routed referral to Medical Records to request progress notes; if not, routed referral to ordering provider.- Conformed with, and abided by, all regulations, policies, work practices and instructions.

• Registration Clerk

  • May 2016 - Dec 2016

  - Greeted and registered patients in a timely manner and ensured all information was accurate and complete.- Verified insurance benefits and eligibility prior to patient’s appointment.- Answered inbound calls, returned voicemails, and made reminder calls about appointments.- Assisted with scheduling appointments and filed any necessary department paperwork according to department guidelines.