area business office manager nc medicaid specialist resume example with 20+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary
Professional with large corporation, multi facility experience seeking full time employment with an establishment needing reliable, accurate and innovative financial management abilities.
  • Budgeting proficiency
  • Accomplished leader
  • Knowledge of Medicaid statutes and regulations
  • Analytical thinker
  • Supervisory training
  • Independent judgment and decision making
Work History
11/2008 to Current Area Business Office Manager/NC Medicaid Specialist Kindred Healthcare, Inc. | City, STATE,
  • Support Business Office in A/R, A/P, Payroll, Ancillary Control.
  • Review accounts for timely billing and collections.
  • Monitor Insurance and Managed Care policies for accurate billing.
  • Provide information to operations manager and set goals for collections.
  • Review, log and maintain Medicare RFAI's.
  • Work with pharmacy on denied meds being billed to facility, appeal where necessary.
  • Monitor Medicaid Pending Accounts for 12 Facilities.
  • Liaison between facility, county and state.
  • Monitoring appeals when needed.
  • Provide Collection and Bad Debt Matrix through out the month for projections.
  • Maintain Policy and Procedures for internal audit.
  • Perform monthly audits, Patient Trust, Cash and Adjustments.
  • Quarterly, Payroll audits.
  • Maintain goal of 10% <60 days.
  • Received satisfactory in 2012 Internal Audit.
  • Manage Facility BOM and staff, work performance, vacation and annual reviews.
11/2008 to Current Area Business Office Manager Kindred Healthcare, Inc | City, STATE,
  • Recruited, hired, trained and coached on average of 5 new employees per year.
  • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
  • Educated staff on state and federal statutes, rules and regulations governing home care services.
  • Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
  • Organized the department in accordance with administrative guidelines in order to provide specified nursing services to meet the legal, organizational and medical staff guidelines.
  • Interpreted and communicated new or revised policies to staff.
  • Oversaw private and MCR billing, payroll, AP, and AR and verified that proper procedures were followed.
  • Developed and achieved financial and growth goals.
  • Strategically planned methods to achieve operational goals and targets.
  • Reviewed customer survey information to prioritize areas of improvement.
  • Reviewed customer survey information to prioritize areas of improvement.
  • Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating a proactive work environment.
  • Routinely collaborated with department managers to correct problems and improve services.
05/1996 to 02/2008 NC Medicaid Specialist Sava Senior Care | City, STATE,
  • Liaison between facility and State or County.
  • Supported 32 NC facilities.
  • Reduced Medicaid Pending accounts.
  • Trained and Retrained Medicaid Pending Policy Wrote Medicaid Pending Policy.
05/1996 to 02/2008 Regional Collection Manager/Regional Financial Analyst Sava Senior Care | City, STATE,
  • Provided support for 14 facilities.
  • Trained and Retrained FC fundamentals.
  • Remain up to date of state/federal regulations.
  • Audit Accounts.
  • Audit Patient Trust.
  • Monitor the compliance with policy/regulations of Facility Bookkeepers Implemented new Facility Accounts Receivable software systems Conduct monthly Facility AR reviews to improve collections Problem solve -Research causes and develop action plan/solutions Liaison with Medicare Intermediaries (Palmetto, Mutual of Omaha, BCBS of NC) to improve facility Medicare receivables Worked directly with NC Medicaid (EDS), & SC Medicaid to resolve issues.
  • Worked with Insurance/Managed Care Companies to insure timely payment and resolve any issues Analyze monthly Profit & Loss Statements.
  • Attend Management meeting with all Regional Staff.
  • Train Business Office personnel (ongoing and new staff) on Insurance Verification, Certifications for Medicare A and B and Pre-certification for HMO/Managed Care companies.
  • Back up Facility Business office staff as necessary.
Expected in 1 1988 to to AA | Business Administration and Management Gaston College, Dallas, NC GPA:
    Business Administration and Management
  • Coursework in Business Management
  • Coursework in Health Services Administration
  • Coursework in Human Resources Management and Accounting
Expected in 1986 to to High School Diploma | West Lincoln High School, Lincolnton, NC GPA:
  • Account reconciliation
  • Invoice coding familiarity
  • Analytical reasoning
  • Advanced computer proficiency (both PC and Mac)
  • Strong in MS Access and Excel
  • Billing and collections expert
  • Accounts payable specialist
  • Invoice and payment transactions
  • Exceptional organization
  • Flexible thinker
  • Complex problem solving
  • Results-oriented

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Resume Overview

School Attended

  • Gaston College
  • West Lincoln High School

Job Titles Held:

  • Area Business Office Manager/NC Medicaid Specialist
  • Area Business Office Manager
  • NC Medicaid Specialist
  • Regional Collection Manager/Regional Financial Analyst


  • AA
  • High School Diploma

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