Experience

NextGen Healthcare

• United States
• Software Development
• 700 & Above Employee

• Representative III, AR Management

  • Mar 2017 - Jul 2020

  • Review and/or audit accounts to determine status and appropriate action required from workflow generated from practice management system. • Document follow-up appropriately in practice management systems. • Research and follow-up on denials and requests for additional information utilizing denial management reports and correspondence. • Receive, research and respond to correspondence from insurance companies, attorneys and patients. • Use facility correspondence websites, phone… Show more • Review and/or audit accounts to determine status and appropriate action required from workflow generated from practice management system. • Document follow-up appropriately in practice management systems. • Research and follow-up on denials and requests for additional information utilizing denial management reports and correspondence. • Receive, research and respond to correspondence from insurance companies, attorneys and patients. • Use facility correspondence websites, phone and/or correspondence to contact payers regarding reimbursement for unpaid accounts. • Contact patients as needed to collect appropriate information or to collect and/or resolve patient balances. • Collaborate with management to identify payer trends and non-payment issues. • Identify, verify and document account adjustments according to established policy and procedure. • Ensure service level and productivity requirements are met as it relates to reimbursement of accounts, resolution of tasks and response to inquiries, etc. • Develop and maintain positive working relationships and partner with internal and external customers by providing superior customer service. • Work accounts containing higher degree of complexity in claims and/or client mix requiring higher degree of investigation, communication and customer service skills. Show less



True Health Diagnostics

• Interim Billing Manager

  • Feb 2016 - Jan 2017

  • Ensure the accurate and timely submission of all claims and timely collections occurs in accordance with all third-party contract terms including, Medicare, managed care, commercial insurance, and direct patient pay • Establish and maintain all billing and financial data, including medical billing code tables, rate schedules and payer information • Assure maximization of cash collections through organized, diligent and timely focused monitoring of all open accounts receivable… Show more • Ensure the accurate and timely submission of all claims and timely collections occurs in accordance with all third-party contract terms including, Medicare, managed care, commercial insurance, and direct patient pay • Establish and maintain all billing and financial data, including medical billing code tables, rate schedules and payer information • Assure maximization of cash collections through organized, diligent and timely focused monitoring of all open accounts receivable balances • Maintain and enhance billing policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies, procedures and due dates • Prepare detailed analyses and reports of billing and accounts receivable activity and results, including performance matrixes, bad debt expense and AR days outstanding • Analyze reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management. • Act as a resource to staff for billing and compliance processes, regulations or compliance issues. • Assist in the development of processes and internal guidelines. Collaborates with management to create process manuals and present education modules, either in classroom, meeting or one-on-one setting. Identifies training needs in collaboration with managers and audit findings. • Develop metrics to report out on programs and billing usage. Assists in the creation of reporting tools that capture critical data for program usage and identify risks, errors and potential compliance infractions. • Assist with the efforts to streamline the revenue cycle process. Partners with coding, billing and other staff to address issues and recommend alternative methods. Reviews current processes and offers effective, efficient and where feasible, timesaving measures. • Effectively interact with all laboratory departments including Sales, Operations and Technical Lab Show less



Essential Testing, LLC

• Hospitals and Health Care
• 1 - 100 Employee

• Billing Manager

  • Dec 2014 - Feb 2016

  Collinsville, IL • Responsible for processing insurance requisition data in the billing system accurately and completely • Review, analyze and delegate revenue order entry, error processing, posting, revenue reporting, collections and appeals • Investigate and resolve billing issues to ensure patients are billed within the appropriate time • Handle all patient questions pertaining to their account balance • Resolve patient complaints related to billing issues • Responsible for the overall… Show more • Responsible for processing insurance requisition data in the billing system accurately and completely • Review, analyze and delegate revenue order entry, error processing, posting, revenue reporting, collections and appeals • Investigate and resolve billing issues to ensure patients are billed within the appropriate time • Handle all patient questions pertaining to their account balance • Resolve patient complaints related to billing issues • Responsible for the overall direction, coordination, and evaluation of billing operations • Collaborate with department leads and Executive Management on common set of goals for process and system changes • Provide regular and ad hoc analytical reporting as required to Executive Management • Work with IT Department and XIFIN as needed to identify and fix technical issues • Oversee team in development of resolutions to billing related issues • Contribute to the strategic planning from an overall company prospective to achieve Company goals • Identify reoccurring issues and troubleshoot effective ways at long term resolution Show less



CTG

• United States
• IT Services and IT Consulting
• 700 & Above Employee

• Senior Support Analyst/Application Management

  • Jul 2014 - Oct 2014

  Dallas, TX • Resolve open help desk tickets through communication with department staff to identify the issues involved and determining the best possible solution available • Create, modify, schedule and monitor application extracts for downstream systems and outside vendors • Provide second level determination and resolution of assigned applications • Advance the operational efficiency of the use of assigned applications • Educate customers as to the solution of software problems by… Show more • Resolve open help desk tickets through communication with department staff to identify the issues involved and determining the best possible solution available • Create, modify, schedule and monitor application extracts for downstream systems and outside vendors • Provide second level determination and resolution of assigned applications • Advance the operational efficiency of the use of assigned applications • Educate customers as to the solution of software problems by answering questions, interpreting operation instructions, and providing references to the administration of end- user applications systems • Respond promptly to helpdesk notifications, customer complaints and concerns Monitored the in-use help desk application software • Assist with finalizing forms, procedures, and documentation needed for maintenance of application programs • Gather, review, and summarize information needed to determine solutions for client application software problems and determined when, where, and how to reroute problems to other technical areas Show less



GroupOne Healthsource

• Billing Liaison/Account Manager

  • Aug 2012 - Jul 2014

  Ballwin, MO • Manage and maintain data files for 10-12 physician practices with various specialties in various states • Identify reimbursement and coding issues • Train physicians and the office staff on software • Research and resolve technical and configuration issues with software or escalated them to the necessary level • Perform monthly AR analysis for clients and reviewed them and made recommendations to reduce AR • Educate clients on medical documentation and billing… Show more • Manage and maintain data files for 10-12 physician practices with various specialties in various states • Identify reimbursement and coding issues • Train physicians and the office staff on software • Research and resolve technical and configuration issues with software or escalated them to the necessary level • Perform monthly AR analysis for clients and reviewed them and made recommendations to reduce AR • Educate clients on medical documentation and billing guidelines • Manage overseas reimbursement teams Show less



US Center for Sports Medicine

• United States
• Medical Practices
• 1 - 100 Employee

• Billing Manager

  • Jul 2011 - Aug 2012

  Kirkwood, MO • Manage the transition from an outside billing service to in house billing • Manage the implementation and maintenance of the software • Create charge entry, payment posting, denial management, collection, payment arrangement and refund workflow processes • Create balancing reports to assure accurate posting • Examine CPT and ICD-9 codes for accuracy, completeness, specificity and appropriateness • Identify and rectify inconsistencies, deficiencies and discrepancies according to… Show more • Manage the transition from an outside billing service to in house billing • Manage the implementation and maintenance of the software • Create charge entry, payment posting, denial management, collection, payment arrangement and refund workflow processes • Create balancing reports to assure accurate posting • Examine CPT and ICD-9 codes for accuracy, completeness, specificity and appropriateness • Identify and rectify inconsistencies, deficiencies and discrepancies according to services rendered • Educate providers regarding billing and documentation policies, procedures and regulations • Identify and resolve patient billing and payment issues • Evaluate patients’ financial status and establish appropriate payment plans Show less



Stockell Healthcare Systems

• Patient Accounting & Training Specialist

  • Jan 2010 - Jul 2011

  Chesterfield, MO • Provide training during and after the implementation of the Patient Accounting module of the software • Create and implement a work flow process for the collection department to improve the number of AR days and to increase the incoming revenue • Create and implement a work flow process for the billing department to increase the number of clean claims that were submitted to the clearinghouse • Provide assistance in trouble shooting claim errors and then correct the system… Show more • Provide training during and after the implementation of the Patient Accounting module of the software • Create and implement a work flow process for the collection department to improve the number of AR days and to increase the incoming revenue • Create and implement a work flow process for the billing department to increase the number of clean claims that were submitted to the clearinghouse • Provide assistance in trouble shooting claim errors and then correct the system configuration issues that caused the errors • Manage the extended business office services for clients that needed assistance in collections Show less



Comp One

• Claims Specialist

  • Jul 2009 - Jan 2010

  St. Louis, MO • Respond to correspondence from insurance companies • File appeals on denied claims



Office Team

• United States
• Individual and Family Services
• 1 - 100 Employee

• Medical Billing & AR Specialist

  • Apr 2009 - Jul 2009

  St. Louis, MO • Work temporary assignments and special projects for medical billing



Physician Management Services

• United States
• Medical Practices

• Medical Billing & AR Specialist

  • Nov 2006 - Apr 2009

  Arnold, MO • Verify eligibility and benefits • Verify CPT and ICD-9 codes were accurate • Post charges and submit electronic and paper claims • Identify errors and re-file or appeal denied/rejected claims • Post payments and adjustments and track and resolve underpayments • Prepare and review patient statements



Northwest Anesthesia

• United States
• Mobile Gaming Apps
• 1 - 100 Employee

• Medical Billing & AR Specialist

  • Jul 2006 - Apr 2007

  Bridgeton, MO • Post charges • Work monthly aging reports