Experience

Flagler Health+

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Revenue Integrity Manager

  • Jan 2009 - Present

• Revenue Integrity Manager, Chargemaster Coordinator, PFS Assistant.

  • Jan 2009 - Present

  • Working proficiency of Medicare Reimbursement methodologies including OPPS, DRG• Competent in Billing, Coding, Modifier usage, NCCI Edits, MUE, CMS Claims Guidelines• Denial management – analyze, track, forecast all denials and track appeals• Contract payment accuracy to optimize full payment from commercial and medicare• Created 10 new charge audit programs; both front end and back end• Meditech professional including Item Master, Chargemaster, OR Module, BAR Edit, PCI• Member of FHA, AAPC and various discussion forums• Medicare and Commercial payor remit educator for employees of Business Office• Member of Clinical Resource Committee and Advisory Council for new supplies and services• Compliance team member in acknowledgement of cost reporting instructions• Implemented new Implant P&P resulting in revenue capture of greater than $100,000 for FY09• Pharmacy billing expert maximizing reimbursement by coding specifically according to Medicare. Medicaid, and Commercial requirements and contractual obligations. Netting an additional >$50k/yr• Insurance professional supporting Insurance audits resulting in saved revenue of $250,000• Created E&M level criteria for 4 areas of Hospital, including OB, Oncology, and ER capturing $250,000 additional revenue• P&P committee member for new hospital owned clinic; Billing, Charging, CMS enrollment • RAC coordinator including MR tracking, financial analyzer and Appeal implementation phase• Implemented new process of time capture in OBS to remain in compliance with Medicare guidelines• Educated and implemented new IV infusion time capture process resulting in > $150,000/revenue• Improved communication between PFS, HIM, Quality Improvement Team and Utilization Review by creating weekly roundtable discussions• Intensive charge review in order to maintain consistency in markups/revenue• Initiated high cost drug project, charging appropriately resulting in $50,000 addl. revenue for FY09



Humana Inc

• National Audit

  • Jan 1997 - Jan 2009

  Coordinated audit programs for 10 Clients managing P&P, monitoring workflow and post-audit reporting.Headed a team of 4 auditors to effectively create new audit programs and increase net revenue. Analysis of data from claim extracts of approximately 15,000+ lines each, resulting in the launch of 14 projectsOversee special project plans for insurance specialties, contributing to new 3 new audit programs.Post-implementation performance measures tracking inventory, savings, production and cycle timePerformed cost/benefit analysis for year-end budget reports and forecasting.Audited Financial Transactions related to client commission payments, invoicing over $600,000.00Financial Recovery analyst performing payment reviews related to provider contracts and member benefits.Client AR representative collecting $130,846.00 in payments negotiating with healthcare providers. 12 years experience with DRG, CPT, ICD9, HCPC coding practices and the working knowledge of CMS pricers.Client communication of audit process; monitoring expectations, barriers, and reporting performance and financials. Adjudicated healthcare claims which includes payment, provider contract interpretation, and member benefits.Responsible for payment intent of provider contracts for 41 hospitals within the Florida market.Query report creator in Microsoft Access and SQL - Collectible audit dollars; $1,486,000 in a six-month timeframe.P&P documentation creator of the web based claims payment system, and audit tracking.



Healthcare Ins

• Contractor

  • Feb 2005 - Dec 2008



National Auditing Services

• Utilities
• 1 - 100 Employee

• Project Manager

  • Jan 2005 - Dec 2008