Livecareer-Resume
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 9XXX5
:
Summary

Driven Senior Production Unit Manager professional offering over 20 years' experience in many facets of professional-fee billing. Proven strengths at building and fostering exceptional working relationships and maintaining optimal billing efficiency. Strong emphasis on team work and finding and developing each team members skill set. Excellent organizational skills and problem-solving abilities with superior client service skills.

Skills
  • Credit and collections
  • Billing dispute resolution
  • Bill processing
  • Adjustment posting
  • Payment management
  • Audit procedures
  • Department oversight
  • Accounts receivable expertise
  • Coding proficiency
  • Accounts receivable
  • Cross-functional team collaboration
  • Fiscal reporting
  • Team leadership
  • Policy development
Education and Training
Community College of Baltimore County, Essex, MD Baltimore, MD Expected in 05/2010 Associate of Arts : - GPA :
Experience
Agility Health - Senior Production Unit Manager
Auburn, ME, 01/2017 - Current

Working in the deaprtment of Gynecology & Obstetrics, I provide analysis, consultation, and reports to the Department Administrator, and the Senior Director or Revenue Operations for Physicians Billing Service/Clinical Practice Association (CPA). Review provider income data with department administration, CPA, and Professional Billing management. Manage a staff of 21 employees that include accounts receivable, coding and documentation, as well as financial counselors to ensure timely and consistent reimbursement for services. Regular interaction with physicians and APP's and their divisional managers to answer related questions and to clarify various billing concerns. Research and resolve compliance issues. Maintain strict confidentiality of staff and patient information. Promote team work and identify areas of improvement and recommend coordinated actions to bring about changes.

Provide this support/direction for providers and staff at Johns Hopkins East Baltimore Campus, Bayview Campus, Johns Hopkins at White Marsh, Greenspring Station, Odenton, Sibley Maternal Fetal Medicine ad Gynecologic Oncology, Howard County Maternal Fetal Medicine and Laborists groups, and Signature Gyn/Ob in Columbia and Eldersberg as of 2/1/2020.

Provide clarification and detail on monthly variance reports for the sub-specialties within Gyn/Ob. Interaction with Third Party and Provider Enrollments departments for all payer related issues/concerns. Direct the development of billing policies and procedures for the departments professional fee billing offices consistent with, and complementary to, those already in place with the CPA.

Development and presentation of monthly divisional reports for the sub-specialties within Gyn/Ob, to provide an in-depth financial analysis at the divisional level. Routine interaction with physician divisional directors to review sub-specialty billing information used in development of future business strategies.

Effective delegation of responsibilities to leads and supervisor in order to foster a culture of independence and accountability.

Johns Hopkins University School Of Medicine - Assistant Production Unit Manager
City, STATE, 01/2014 - 01/2017

In the Department of Pediatrics, responsibilities included the daily supervision of billing staff including time and attendance, authorization of paid time off and monitoring compliance with personnel policies and procedures. Worked directly with Third Party Department to resolve payer issues. Assisted in developing office policies and procedures, served as a lead for troubleshooting, problem solving, and expected to exercise independent judgement. Responsible for completing key tasks as needed and defined by the department management.

Required a thorough understanding of medical billing and experience using the appropriate billing system. Possess excellent communication and customer service skills with the ability to work well under pressure. maintain strict confidentiality of staff and patient information. Promote team work and identify areas of improvement and recommend coordinated actions to bring about changes. Perform all management tasks such as distribution of work priorities and goals, recommendation in hiring and termination decisions, discipline and performance reviews. Monitor staff productivity and take actions to maximize. Monitor billing budget versus actual, pinpointing areas of concern and initiate corrective action. Monitor productivity of insurance follow-up staff; adjusting workflow to meet departmental targets. Research and resolve problems as needed to ensure adherence with departmental policies and procedures. Assist in development of billing policies and procedures consistent and complementary to those already developed by the Physicians Billing Service. Monitor and resolve patient inquiry list. Work monthly reconciliation to ensure all outstanding items are resolved prior to month-end book close. Proactively follow up on rejection trends. Provide assistance over specific functional areas as identified by the Production Unit Manager.

Johns Hopkins University School Of Medicine - Auditor and Recovery Audit Contract Specialist
City, STATE, 02/2011 - 01/2014

Provided audit and research support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements for the Department of Anesthesia and Critical Care Medicine. Used established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the Sr. Auditor/Trainers, Leads, Manager and Director to provide input and assist in the development of any applicable training and education content. Assisted in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. The documentation audits are conducted as part of the School of Medicine’s Billing Quality Assurance Compliance Program.

Conducted independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders. Researched and answered billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures. Verified and corrected as necessary, the audit work completed by the Auditors. Reviewed documentation or coding patterns by a provider, division or department that poses a compliance risk and provided input on recommended solutions. Assisted with the development of training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis. Participated in provider feedback sessions along with the Sr. Auditors/Trainers on the results of their medical record documentation reviews and provides input and support as needed. Supported the management team in the preparation and revision of a Compliance Training Manual for routine and special training programs. Assisted in the research and development of medical record documentation standards and requirements related to clinical services billing. Kept current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9/10-CM Coding, and professional fee billing. Performs other compliance related activities as necessary.

Scope of Responsibility
Knowledge of the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division. Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.

Decision Making
On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area. Routinely handled confidential patient information and sensitive financial information.

Authority
Billing Compliance Auditors may be asked to assist with training new staff or correcting the work of others. Identifies and suggests process and operational improvements.

Communications
Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

Johns Hopkins University School Of Medicine - Accounts Receivable Specialist
City, STATE, 01/1998 - 02/2011

While working in the Department Of Pediatrics as a Collection Specialist, responsibilities included follow-up with insurance companies to collect outstanding accounts for which payment has not been received in response to the claims submission process, either electronically or by paper. Assigned payer groups of outstanding patient accounts. Various methods of follow-up were used. Expertise in insurance follow-up processing and be knowledge of CPT and ICD-9/10-CM coding as well as an understanding of the JHOC registration process and be able to recognize and resolve incorrect demographic and insurance registration. Maintained an understanding of claims submission requirements for all payers to expedite payments as well as knowledge of appeals and rejections processing. Excellent communication skills coupled with patience and fortitude.

Specific Duties/Responsibilities:
Identified problem issues on outstanding patient accounts. Worked to resolve issues so that invoice will be processed by payer or balance moved to patient responsibility.
Identified insurance issues of primary vs secondary insurance, coordination of benefits, Eligibility and any other issue causing non-payment of claims. Contacted the payer or Patient as appropriate for corrective action to resolve the issue and receive payment of Claims.
Handled patient account inquiries and assists patients with filing or re-filing of claims including secondary insurance.
Communication with patients, physicians and insurance companies to resolve accounts. This includes resolving issues identified through incoming correspondence.
Print and mail/fax claim forms and statements as requested by patients, insurance companies or other authorized third parties.
Confirm credit balances and gather necessary documentation for processing refund.
Printed medical notes from the Meditech/EPIC system when needed for the processing of claims.
Working knowledge of EPIC billing and registration systems.
Communicate trends and A/R issues to management
Assist with charge corrections and other minor coding issues
Maintained personal productivity goals
Stay abreast of insurance guidelines (attending webinars and providing updates from websites)

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Disclaimer

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:

87Good

resume Strength

  • Length
  • Measurable Results
  • Personalization
  • Strong Summary
  • Target Job

Resume Overview

School Attended

  • Community College of Baltimore County, Essex, MD

Job Titles Held:

  • Senior Production Unit Manager
  • Assistant Production Unit Manager
  • Auditor and Recovery Audit Contract Specialist
  • Accounts Receivable Specialist

Degrees

  • Associate of Arts

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in: