Patient Representative III (Lead) Resume Example

• Work with clinic specialties to enhance revenue performance within charge capture and accounts receivable.
• Analyze and compose effective reports daily to streamline workflows.
• Performs qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
• Meticulously identify and rectify inconsistencies, deficiencies and discrepancies in medical documentation.
• Research CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
• Facilitate successful internal and external audits through sound and thorough documentation.
• Collaborate with the Medical Staff to ensure compliance with the health system contracts in place with all managed care payers.
• Demonstrate fiscal responsibility and contributes to departmental achievement of financial goals.
• Collaborate with various stakeholder on process automation to encourage continuous improvement.
• Effectively collaborate with appropriate physicians, management, and staff to obtain, document and validate information related to assigned projects.                                                                                                                  

Position: Patient Account Representative II                

• Assisted with multiple projects aimed to increase revenue generation and improve process efficiencies. Helped develop KPIs and dashboard to track project's progress.
• Developed and helped implement TAVR correct coding and claim resolution processes to decrease payment lag. 
• Identified revenue opportunities within Clinical billing processes and developed SOPs to ensure timely charge capture and provide the opportunity for charge reconciliation.
• Identified $350,000 in critical care denials and worked with the Clinical management to develop a plan to correct the coding errors and appeal for reimbursement. Implemented edits to decrease errors.
• Analyzed Internal Medicine's accounts receivables and identified $400,000 in potential reimbursement and developed project plans to resolve each project with implementation led by section leaders.