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Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Professional Summary

A driven and compassionate health care Manager with 20 years experience in  fast-paced Multi-million dollar Healthcare  Non-Profit and Profit Organization, including Patient account and Health insurance Revenue Cycle in insurance, /hospital environment. Accountable and responsible with a strong focus on  Revenue cycle reconciliation and ,patient collection.  Extensive experience recruiting, developing and managing  staff. Expert in planning and organizing activities consistent with agency goals and mission.

 
 
 
 
 Professional strengths:
  • Possess excellent verbal and written communication skills
  • Business development for team and work independently as well
  • Budget management, Product development and project management
  • Possess good management and organizational skills
  • Ability to train and Mentor teams 
  • Vendor management, Medicare/Medicaid compliance and strategic partnerships
  •  Insurance State &Member billing including Child Health plus, Quality Health plan, Essential plan, ADAPT, Manage Long term care, Medicaid & Medicare . Hospital billing include inpatient  & out Patient, Patient Account billing for  various specialist such as Behavioral/ Mental Health,  Nursing home, Home care, Ob/GYN, Orthopedics, Oncology, Cardiology, internal Medicine, Urology, Pharmacy, Laboratory, Radiology, DME Billing, 
  • specialize in Medicare, Medicaid, BCBS Manage care medicaid/ Medicare, commercial, Worker compensation, No Fault & Local
  • Excellent knowledge of ICD-9 ,CPT-4 revenue cycle  compliance & Audit
  • Expertise in electronic exchange of healthcare information transactions directly to a payer(s) or via a clearinghouse.  Ex: 837, 270/271


Education and Training
Strayer University Morrow, GA Expected in 2011 Master of Arts : Healthcare Management Human Resources, Health Services Management Policy, and Analysis Management - GPA :
Braircliff Bethpage Bethpage, NY Expected in 1991 Bachelor of Arts : Human Resources, Healthcare Management, Health Service Policy and Analysis Medical Billing/ Administrative - GPA :
Sunny Farmingdale University Farmingdale, NY Expected in 1993 Medical Assistant Administrative : Medical Billing - GPA :
New York School OF Medical and Dental Assisting Forest Hill, NY Expected in 1999 Certificate : Health Services - GPA :
Professional Experience
Acadia Healthcare - Revenue Cycle Manager
New Castle, DE, -
  • Directed the installation of improved work methods and procedures to achieve agency objectives. 
  • Created annual goals, objectives and budget and made recommendations to reduce costs. Served as liaison between management, clinical staff and the community.
  • Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
  • Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.
  • Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.
Northwestern Medicine - Patient Account Revenue Cycle Manager
Glen Ellyn, IL, 05/2006 - 08/2013
  • AS a Manager I carefully selected, developed and retained qualified staff, as well as trained new staff annually and keep them abreast with current changes..
  • Managed patient Billing/ Collection on Article 16, 31, 28; Health Home; PROS,OPWDD, DAY HAB, Respite and Residual.
  • Managed Nursing Home Transition, SEMP, Home Health and Mental Health Clinic /Make sure staff Follow-up called to insurance, research all denial and rejection code for all procedural and make the necessary changes for effectiveness.
  • Implement in the design and execution of programs that contributed to the new age change of regular Medicaid/Medicare to Managed care Medicaid/Medicare and APG billing of the organization in the 2010 fiscal year.
  • Served as liaison between Upper management, clinical staff and the community.
  • Implemented standards and methods to measure the effectiveness of agency activities.
  • Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
  • Regularly evaluated employee performance, provided feedback and assisted coached and disciplined staff as needed.
  • Reviewed electronic exchange of healthcare information transactions directly to a payer(s) or via a clearinghouse 270/271 Health care eligibility benefit inquiry & response; 837 healthcare claims denials & eligibility; TA1 & 999 interchange acknowledgement; 278 Admission notifications;835 healthcare claim payment/ Advicesuch as:
Metropolitan Diagnostic Imaging - Billing Office Supervisor
City, STATE, 12/2004 - 01/2006
  • Billed all Radiology Charges for Medicaid in Epaces/ follow to Medicare and commercial insurances.
  • Overseeing all aspects of the billing process.
  • Ensure all billing submissions are submitted on a timely basis.
  • Ensure all payments are posted accurately and on a timely basis.
  • Manage all billing audits.
  • Provide timely notation of action taken on patient accounts.
  • Responsible for the supervision, management, performance and development of all billing staff and for ensuring their understanding.
Medical Management Solution - Revenue Cycle/ Operation Manager
City, STATE, 05/2000 - 11/2004
DR. Hamil Willolobgy - Medical Assistant Manager
City, STATE, 04/1992 - 11/2000
Accomplishments
  • Deloitte 2014 Year End Audit
  • Child Health Plus A133 Earnest &Young  2014 Compliance Audit    
  • QHP Reconciliation Audit for 2014 to 2015
  • Department of Health  2015 audit For Senior Health Partner
  • The Billing Management project envisions replacing the current Structure/ systems, which were designed to automate the traditional billing teams transaction responsibilities of administering Macess , invoicing and check tracking, with a value-creating system that more fully enables the billing to participate in the strategic activities of the company. These value-creating opportunities consist of the following components
  • Workforce Analytic/Performance Management. Looking beyond standard reporting metrics, Workforce Analytic should enable management to track and evaluate performance across key, multi-disciplinary metrics such as Check posting margin, customer data, operational productivity, member check tracking coming from the offsite business office activity  training and educating the staffs
  • Project Objectives
  • The project objective was to replace an aging billing department and failing software system with a state-of-the-art Human billing Management System to meet current business needs and to allow for the achievement of future business strategies including growth.
Professional Affiliations

Member of the AAPC since 2012

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Resume Overview

School Attended

  • Strayer University
  • Braircliff Bethpage
  • Sunny Farmingdale University
  • New York School OF Medical and Dental Assisting

Job Titles Held:

  • Revenue Cycle Manager
  • Patient Account Revenue Cycle Manager
  • Billing Office Supervisor
  • Revenue Cycle/ Operation Manager
  • Medical Assistant Manager

Degrees

  • Master of Arts
  • Bachelor of Arts
  • Medical Assistant Administrative
  • Certificate

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