Dedicated to cutting company costs and reducing employee turnover and continuous process improvement in the face of rapidly evolving and changing markets. Extremely results-oriented and proactive in finding cost-effective solutions to company-wide problems.
High-energy Manager successful in building and motivating dynamic teams. Cultivates a company culture in which staff members feel comfortable voicing questions and concerns, as well as contributing new ideas that drive company growth.
Budgeting and finance
Recruitment and talent development
Accounts payable and receivable
05/2007 to Current
Operation AnalystMedical University Hospital Authority – Charleston, South Carolina
Review / Analyze managed care contracts for best reimbursement option Collects and analyzes operational data -Request for information(RFI), Insurance, Medicare cost report (MCR) Assists in the design, development, and implementation of data gathering and reporting methods and procedures within Operations Review sampling of facility and physician charges for accuracy Produce monthly reports to identify any potential risks/opportunities in charge capture Ensured clinical protocols are utilized to account for cost and evaluation for recipients and donors for reporting on MCR Procurement, tracking and allocation of credit card purchases Collaborate with the Purchasing department in obtaining transplant projects Maintain office supplies and hotel Dbase for tracking and reporting purposes Compile and track financial data to be used for UNOS reporting, annual insurance RFI and Transplant Annual report Prepare/trend/track/ consolidate time summaries and time summary report for MCR Improve and Develop Productivity/Resource models.
Work with leaders on identifying and implementing productivity improvements.
Collaborate with Business Manage and Medical University of South Carolina manage care to ensure contracts are optimal Report trends and variances to Business Manager Collaborate with Billing Team, Financial Coordinators, Customer Service, Scheduling, Nurse Coordinators, Statistical Research and Transplant Program Assistance in resolving specific patient financial and volume trends specific to regulatory agencies Maintain liaison with Physician group and Medical University of South Carolina Actively participates in Transplant community events Meet with Lead coordinators about changes within each transplant program Trend and track SAC fee per organ Develop and implement data analysis report relative to the hotel utilization for all transplant programs Liaison with transplant contracted hotel and Medical University of Hospital Authority Create and maintain utilization report for accurate collection and payment of hotel invoice Invoice Medicaid broker for reimbursement of recipient hotel occupancy Prepare and distribute monthly, volume, organ procurement, Medicaid report Recommend procedural changes to improve efficiency of operations Adheres to HIPAA privacy and confidentiality regulations and guidelines Ad-Hoc Requests as necessary.
07/2006 to 05/2007
Fiscal Technician IIMedical University Hospital Authority – Charleston, South Carolina
Processes all third party claims in timely and accurately Manage and resolve third party denials and charge allocation Initiate claim adjustments and resubmission of claims to insurances Maintains a thorough knowledge of third party billing, authorization, precertification and collection requirements Reviews all claims in accounts receivable/payable and take necessary action to resolve issues (i.e.
credits, denials, incomplete or no authorization/ pre-certification, request for additional information) Review and adjustment of claims within the claims transactional system, according to insurance plan benefits and contractual reimbursement terms Review and resolve account credit balances, bi-week by submitting requests for refunds or adjustment to the account Review, investigate and release low to high complexity claims - reducing the days in A/R Ensuring accurate payment for services provided Resolve account patient data integrity error reports Determine if correct billing/coding requirements have been met Process claims subject to COB (Co-ordination of Benefits) according to plan benefits, COB rules and contractual reimbursement terms Processing employee claims Retroactive adjustment projects, as assigned Daily analysis of workflow to meet targets, including distribution of workflow Complete daily activity logs as required Assist in training other claims staff Identify, communicate and advises supervisor and manager of any changes in claims processing, denials, or rejects Develops relationships and works professionally with insurance carriers and clients Utilizes all resources available, including electronic inquires to verify eligibility, benefits, and claims status Updates patient and insurance demographic and financial information in computer system as needed Adheres to HIPAA privacy and confidentiality regulations and guidelines Ad-Hoc Requests as necessary.
10/2000 to 07/2006
Compliance Manager Data CoordinatorUniversity Medical Associates – Charleston, South Carolina
Mentor and manage data entry, coders, outreach specialist and IT personnel Managed day to day billing, coding and registration procedures Coordinate billing, compliance education and training of new and existing staff Analyzes/QA's of charges submitted, charges entered, DOS and C&C reports Analyze/QA's of compliance audit and customer satisfaction report Maintain liaison with UMA/MUSC/CMH Adheres to HIPAA privacy and confidentiality regulations and guidelines Design, development, and implement data gathering and reporting methods and procedures within Operations Determine effectiveness of current operational activities and determine problem areas and develop solutions Serves as primary site liaison for staff managed and other internal departments as required Conducted audits on providers, coders, data entry and registration staff Updated databases, resource materials, publications, coding materials, CCI Input data into a Web based system for processing to health insurance carriers Manage strategic initiatives that drive down cost through cost structures, benchmarks Ad-Hoc Requests as necessary.
09/1993 to 09/2000
Supervisor, Financial CounselorUniversity Medical Associates – Charleston, South Carolina
Mentor and manage daily processes of onsite and outlying healthcare staff Trained staff on systems: SMS, Keane/PHS, Data bases, Oversite, andClaim manager Design, development, and implement data gathering and reporting methodologies and procedures within the Physician office group Evaluation processes to determine effectiveness of current operational activities and determine problem areas and develop solutions Serves as primary site liaison for financial counselor, couriers and other internal departments as required Submitted annual department cost projection report Prepare and process employees payroll Perform annual employees review Maintained Liaison with UMA/MUSC/CMH Monitor production and ensured maximum utilization of all active systems Developed and implemented procedures to improve staff task workflow efficiency, Developed and implemented procedures designed to control cost Determine percentage of charitable discount applied to patient's accounts Reviewed rejected input, output and updated hospital computer systems with accurate reimbursement records Edited financial accounting classification on patient accounts for UMA/MUSC/CMH Audited accounts for accurate payment and make appropriate adjustments Prepare financial, point of service and statistical reports Adheres to HIPAA privacy and confidentiality regulations and guidelines Ad-Hoc Requests as necessary Developed manuals and flyers regarding operating systems for financial counselors Assisted in budget preparation and best practice plan initiative Assisted in the development of the financial counselor start up -policy and procedures pertaining to day to day functionality Participated in YES Campaign Trained new hired financial, coders, billers, data entry and IT staff Arranged multiple continuing education programs for financial counselor, coders and billing staff Coordinated efforts between various staff/unit at MUSC of policy and procedures for billing and collection.
Bachelor of Science: Limestone College -
Certified Revenue Cycle Associate, South Carolina Healthcare Financial Management Association:
McKesson JBoss Portal Horizon Enterprise Materials Management (HEMM) Universal Management System (UMS 3D Accounting) Manager Today's Workforce Certificate Supervisor Today's Workforce Certificate Medical Terminology Certificate Coding Certificate Surgical and Primary Care Billing Certificate Medical Coding Certificate Reimbursement Certificate Cardiology Billing Certificate High Impact Communication Certificate Team Builders Certificate Collecting the money people owe your practice Certificate