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.
Â
Â
Â
Â
 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 teamsÂ
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,Â
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. Â Ex: 837, 270/271
Education and Training
Strayer UniversityMorrow, GAExpected in 2011 – –Master of Arts:Healthcare Management Human Resources, Health Services Management Policy, and Analysis Management - GPA:
Braircliff BethpageBethpage, NYExpected in 1991 – –Bachelor of Arts:Human Resources, Healthcare Management, Health Service Policy and Analysis Medical Billing/ Administrative - GPA:
New York School OF Medical and Dental AssistingForest Hill, NYExpected 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.Â
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:
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  Â
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.
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:
