Results-oriented manager with strong leadership skills and a proven history of increasing revenue, streamlining operations, and improving employee performance.
*Possesses 10 years of government and private sector experience in healthcare billing, managing billing collections and contract negotiations in Managed Care and a variety of healthcare settings.
*Strengths include auditing and ensuring regulatory compliance, Project Management, New business development, and educating employees to effectively perform a comprehensive range of billing activities and claims.
Froedtert Memorial Lutheran Hospital - Billing Compliance Analyst New Berlin, WI, 09/2013 - 11/2015
Responsible for monitoring risk management strategies to ensure regulatory compliance with timely and detailed reports.
Assists director, manager, and coordinator of billing compliance in organizing and implementing compliance initiatives related to hospital & physician billing in accordance with rules, regulations, laws and payer contractual requirements.
Researches coding, coverage, medical necessity and other compliance issues for all payers related to new charges added to the charge master.
Accept/reject clinical coding recommendations based on provider documentation, administrative policies, regulatory codes, legislative directives, precedent or other guidelines to perform analysis of provider billing against Current Procedural Terminology (CPT) coding logic and rules.
Finalize reimbursements based upon audit findings.
Assist with research of health plan coding questions and fraud investigation.
Maintain appropriate records, files, documentation and general administration.
Responsible for leading and directing customer service, admissions and registration and all revenue cycle activities related to billing; facilitated timely patient follow up with third parties and ensured standards are maintained.
Key accomplishments to date: Utilize ATB report to identify over $1 million in written-off and unbilled claims and offered a time-sensitive strategy to secure payment for such claims.
Employed information technology to improve work processes to electronic submission of claims.
Understand and manage denial process Implement standard processes and quality monitoring to compliment technology Oversee department training and individual development Drive the resolution of unpaid or underpaid claims Monitor, track, and evaluate staff productivity and performance and provide summary report to executive management on a monthly basis.
Branch Metrics - Lead Adjunct Instructor Chicago, IL, 10/2009 - 11/2012
Develops learner-centered curriculum, instructs students, and employs various methods of assessments for the following classes: Business Management, Organizational Management, Operational Management, Health Information Data Management, Human Biological Systems, Ethics & Regulatory Compliance, Medical Billing & Coding, and ICD-9 Coding and ICD-10 Coding.
Reliant Care Management Company, L.L.C - Billing & Account Receivables Supervisor City, STATE, 01/2004 - 01/2010
Directed billing department operations for four facilities Managed, coached and motivated staff; achieved high levels of team performance which met budgeted goals and demonstrated consistency in current accounts receivables.
Reliant Care Management Company LLC - Billing Manager City, STATE, -
Utilized exceptional attention to detail to audit records, policies, and procedures; compiled findings; created and implemented system and procedure improvements resulting in compliance with state and federal guidelines.
Leveraged strong communication skills and technical expertise to set up new facility operations; trained staff in account receivables and admissions; supervised billing in three new nursing homes.
Oversaw and analyzed financial reports and trends; monitored 30-60 days collection history; ensured appropriate billing of ancillary therapy, Medicare, Medicaid, room and board, pharmacy, lab, and X-rays resulting in consistent revenue generation.
Skillfully managed operations; achieved a 30% increase in operating budget profit for three consecutive years.
The Shurn Group - Account Executive City, STATE, 2003 - 2004
Engaged in new business development; performed sales and marketing; utilized excellent interpersonal skills to recruit hospital clients and employment candidates to place staff.
Negotiated service fees, manage client interviews and placement; consistently met monthly sales goals.
Increased sales by 17% within a one year period.
Professional Affiliations
Skills
accounts receivables, administrative, attention to detail, Billing, budget, Business Management, excellent interpersonal skills, strong communication skills, CPT) coding, Client 6.6, client, clients, customer service, Data Management, Delivery, Dental Assistance, directing, documentation, executive management, financial reports, ICD-10, ICD-9, information technology, Leadership, Regulatory Compliance, Logic, director, marketing, Medical Billing, Medical Management, Meditech, Microsoft Excel, Microsoft Power Point, Microsoft Word, new business development, nursing, organizing, Organizational, Performance Management, policies, processes, profit, Coding, quality, research, risk management, sales, SSI, strategy, therapy, Transmission, written, X-rays
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
How this resume score could be improved?
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
