Patient Financial Services Teamlead (Medicare) Resume Example
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PATIENT FINANCIAL SERVICES TEAMLEAD (MEDICARE)
Professional Summary
Flexible MBA graduate with long background in healthcare. Current PFS teamlead with in-depth revenue cycle and medical billing knowledge. Also experienced in planning and production of company-wide events.
Education and Training
Master of Science: Health Systems Management2012Texas Woman's UniversityCity, State
3.5 GPA
MBA: Business2012Texas Woman's UniversityCity, State
4.0 GPA
Bachelor of Science: Recreation and Leisure Services2010University of North TexasCity, State
3.6 GPA
Skill Highlights
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Professional Experience
Patient Financial Services Teamlead (Medicare)01/2013 to CurrentCommon SpiritOmaha , NE
- Responsible for performing billing, collections and reimbursement services of claims and duties to 40 regional hospitals.
- Analyze and report RTP'd (Returned to Provider) claims from Medicare.
- Completion of redeterminations and reopening for claims requiring appeal.
- Assist/lead in training of new and current associates.
- Leading monthly CMS compliance meetings with billers.
- Experience in Six Sigma practices, Meditech (McKesson/3M), SSI, Connance, and CollectLogix.
- Use Medicare's DDE Remote system (MyAbility) to review rejections, account status, and make online adjustments.
- Maintain collector queue to with daily goal of 98% penetration.
- Analyze compliance rebill logs from facilities and resubmit claims for corrected payments.
Provider Relations Representative10/2012 to 01/2013PwcLithia Springs , GA
- Work on behalf of State Medicaid agencies to recover payments from the provider(s) who should have billed Medicare for the service instead of Medicaid.
- Make outgoing calls to customers (providers/pharmacies/patients/carriers etc.) to confirm receipt of mailings and request action.
- Review and analyze documentation and claim data to determine validity and proper action.
- Updates accounts receivable system with denial and group information.
- Respond to incoming phone calls, e-mails, and faxes from customers with regard to mailings, cycles, or other functions performed by the service center.
- Review and analyze documentation and claim data to determine validity and proper action.
- Updates accounts receivable system with denial and group information.
- Assist with high priority special projects that directly affect client relationships.
Eligibility Operations Advisor07/2012 to 09/2012Heritage Green Assisted LivingMechanicsville , VA
- Responsible for verifying, documenting and coordinating information needed to process applications.
- Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing.
- Provide enrollment assistance and HIPP/Premium Assistance (HIPPA) program information over the phone to Medicaid eligible recipients and their family members.
- Verify, document and investigate the presence of health care coverage.
- Identification of members that may qualify for HIPPA.
- Customer including high volume of phone work answering questions and other inquiries regarding HIPPA.
- Obtain and/or verify all items related to eligibility and enrollment into HIPPA.
Pharmacy Benefits Manager02/2012 to 06/2012City Of Lakewood, CoLakewood , CO
- Responsible for determining the root cause for a carrier/group combination to yield an unsatisfactory pay rate.
- Correct the root cause and rebill claims when appropriate.
- Determine the reason a carrier/group combination is not yielding the desired results.
- Verify eligibility, claim status, and other pertinent data elements to deny or rebill a set of pharmacy claims.
- Identify potential data or pharmacy billing platform issues and escalate with supporting documentation.
- Call carriers for claims follow up.
Business Office Associate02/2007 to 02/2012CarMax Auto Superstores, IncCity , STATE
- Responsible for all operations of the business office including the opening and closing, face to face customer service, handling accounts payable functions, tendering cash transactions, preparing bank deposits, answering multi-line phone system.
- Systems used include Microsoft, Oracle, Peoplesoft, Kronos, and Order Entry.
- Manning the store's front desk.
- Reviewing and processing documents associated with customer's vehicle purchases and complete and processing all registration (in and out of state).
- Planning and preparation of all major store events and parties from 2008-2012.
- Assisting purchasing team with appraisal purchases and in-store auctions,.
Therapeutic Recreation Intern01/2010 to 05/2010Texas Scottish Rite HospitalCity , STATE
- Educated community about TR which involves assessment of patient leisure related needs, development of leisure related goals, provision of leisure activities to address goals.
- Assist in planning and maintaining a balanced budget for therapeutic recreation programs.
- Assist in the delivery of therapeutic recreation services which involves assessment of patient leisure related needs, development of leisure related goals, provision of leisure activities to address goals, documentation of progress toward goals, and evaluation of patient progress and programs.
- Participate in TR community outreach programs as assigned.
- Monitor use and condition of recreational equipment and assist in ordering recreation and leisure supplies as needed.
- Participates in quality improvement activities pertinent to TR scope of services.
Recreational Therapy Intern01/2005 to 05/2005V.A. HospitalCity , STATE
- Interacted with patients and assisted in the delivery of therapeutic recreation services
- Participated in recreation activities, directed daily activities, transported patients.
- Made program flyers.
- Assisted with aquatic programs
Skills
Medical billing, Medicare and Medicaid, customer service, data entry, Kronos, Meditech, Microsoft Office Suite, Order Entry, Peoplesoft, event planning, policy analysis, quality improvement, Six Sigma, SSI,payment validation
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Resume Overview
School Attended
- Texas Woman's University
- University of North Texas
Job Titles Held:
- Patient Financial Services Teamlead (Medicare)
- Provider Relations Representative
- Eligibility Operations Advisor
- Pharmacy Benefits Manager
- Business Office Associate
- Therapeutic Recreation Intern
- Recreational Therapy Intern
Degrees
- Master of Science : Health Systems Management 2012
MBA : Business 2012
Bachelor of Science : Recreation and Leisure Services 2010
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