Bruce, J. Mosley, MBA, E.d.S, Consultant

**** **** *********** *****

Lakeland, Florida 33813

863-***-****

acc9e7@r.postjobfree.com

OBJECTIVE

Healthcare Hospital Reimbursement Contractor seeking a permanent position

that would utilize my diverse hospitals electronic billing/hospitals

rebilling, hospitals collections, hospitals underpayments, and backlog

experience. Specializing in rebilling claims using billing software such as

Zirmed while responding to electronic denials. Strong background in

analyzing payer contracts, payer denial management, analysis, claims

management, and appeals/denials management.

BILLING EXPERIENCE

Health Management Associates (HMA)

12/2012-Present

Revenue Recovery Variance Specialist (Hospital Billing)

Responsible for identifying hospital underpayment variances, denial trends,

and root problems

V Successfully acted as liaison with hospitals l CFO's, Hospital

Managers, Patient Registration Directors, Directors of Reimbursement

and various hospital reimbursement staff-Revenue leakage

V Provided on-site support for hospital reimbursement issues, monthly

reports/status meetings, collections reports and scheduled Process

Improvement meetings

V Implemented and developed internal hospitals Intranet with links to

all payers reimbursement manuals, denial policies and procedures,

denial patterns, Provider rep listing and electronic appeals

guidelines

V Maintained, analyzed and negotiated all hospitals contract language

for review leakage that improve hospital future contract negotiations

with payers

V Assigned to Hospital in the following states, FL, GA, NY, TX, WA, KY,TN

V Successfully, rebilled using SSI found 50 million incorrect denials

and collected over 25 million dollars.

V Audited a HMO Medicare payer finding a contract discrepancy with fee

schedule. Successfully negotiated an underpayment of $137,000

underpayment WITHOUT using appeal process

Trilogy Health (Hospital Contract)

Billing Manager

07/12 to 11//12

Responsible for improving hospitals collections, billing, reimbursement and

operations overall improvement

V Duties including monthly client meetings for hospitals CFO and

Director Reimbursement

V Successfully used Change Management strategies to motivate employees

that lead to increase in collections efforts by 30 percent and an

overall positive change to business environment

V Responsible for managing 100 employees, 5 remote hospitals nurses

and 8 attorneys

V Successfully improved billing from 800k to 1.2 million per month using

a collection system that was similar to the functions of Zirmed.

V Developed innovative ways to improved the business climate and

resolved hospitals A/R denials by 30% that led to the profitable sale

of Trilogi to Recondo Technology

V Successfully managed over 30 different hospitals acting as Central

Billing Office (CBO) while reviewing contract language versus payer

fee schedules to ensure claims paid at correct reimbursement rate

Amerigroup Inc., Tampa, FL

09/10 to 07/11

Billing Analyst (State of Tennessee Contract)

Responsible for adjudicating Medicare hospitals claims and LTC Medicaid

claims edits for State of Tennessee

V Conducted and participated in monthly conference calls and on-site

meetings with State of Tennessee concerning implementing procedures to

reduce errors and improve production rate

V Successfully found hospitals claims system error (Facets) that led to

a $70k savings based on fee schedule miscalculations for Long Term

Care(LTC)

V Implemented hospitals claims policy and procedure that lead to

improving team error by 2%

V Recognized by reimbursement department for maintaining an 0.0 quality

error rate

V Utilized Facets system for rebilling and solving over 300 hospitals

claims denial edits per week.

V Using Zirmed billing software increase monthly billing from 1.2

million to 2.1 million.

V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes

Mosley Group Services-Lakeland, Fl.

08/06 to 08/10

Healthcare Hospital Billing Consultant

Mosley Group Services (MGS) is a full-service hospitals reimbursement

consulting company

V Successful developed innovative reimbursement method using

Reimbursement Pro to dispute and validate

V Inpatient and hospitals Medicare payments that lead to over $150,000

in underpayments

V Implemented and designed reimbursement strategies with hospital claims

lines denied for missing NDC number, this strategy led to over

$750,000 in hospitals underpayments

V Implemented hospitals reimbursement strategies without APPEALS that

lead to a $150,000 underpayment for hospital reviewing the contract

that had specific diagnosis that would pay for cosmetics procedures

V Implemented coding change for a new hospital sleep apnea home product

that lead to over $200,000 in reimbursement for hospitals and

physician groups

Wellcare - Tampa, Florida

10/05 to 07/06

Hospitals Billing Supervisor - (Medicare/Medicaid State of Georgia

Contract)

V Successfully lead calibration meetings/onsite with State of Georgia

CFO, auditors, and Directors based contract performance, quality,

contract deliverables, and specific hospitals contractual amendments

V Primary duties included supervising a reimbursement team of 35

Hospitals /Physician employees while processing hospitals claims using

the Diamond Paradigm billing adjudication system.

V Secondary duties included supporting two Director of Claims with RFP

responses to State of Georgia,

V Subject Mater Expert (SME) concerning Georgia hospitals claims.

Specialized in claims backlog, PowerPoint presentations, Visio,

IntelliClaims, UB92, HCFA-1500, HCPCS, ICD-9, CCI edits, and CPT-4

codes. Diamond Paradigm billing system.

Qualink Inc. /NCO- Lakeland, FL

05/04 to 08/05

Hospitals Billing Supervisor - (Hospital Contracts)

V Primary duties included supervising 15-18 employees serving as Central

Billing Office (CBO) reimbursement team for 12 different hospitals.

V Created rebilling appeals strategy which produced a 1.6 million

dollar reimbursement for Bronx Lebanon Hospitals and 3.2 million over

the next 8 months

V Provided insurance verification support, resolution, and appeals,

claims phone support, re-billing support, denial, and researching

denied claims to identify root causes.

V Responsible for reviewing SSI denial reports to review bills against

billing policies and procedures.

V Successfully reviewed Bronx Lebanon Hospitals SSI billing system that

resulted in a 1.6 million reimbursement in 6 months. Specialize in

Medicare/Medicaid, claims backlog, HCFA-1500, COB, CPT-9, and UB92

forms.

ACS Inc. Medicaid Fiscal Agent - Alpharetta, GA

04/03 to 04/04

Claims QA Supervisor/-ACS (State Contract)

V Primary duties included providing call center reimbursement/claims

audits for 200 employees at the ACS Inc. office in Atlanta, GA Ravina

Perimeter Mall location.

V Primary duties include auditing call center employees to improve

hospitals claims processing quality and production using the Avaya

auditing system.

V Duties included providing written policy and procedure updates for the

Georgia Department of Community Health (DCH) for physician and

hospitals claims.

Claims Billing Supervisor/ Trainer - ACS Inc. (State Contract)

Provide on-site training to 400 hospitals and physician groups rolling out

HIPAA reimbursement and EDI

V Successful training over 400 Medicaid hospitals s and Physicians in

Washington, DC and Maryland groups covering HIPAA privacy, security,

standard transaction, and standardized code sets.

V Supervised and lead a team of five consultants providing onsite

PowerPoint training and workshops to the Medicaid provider community

V Resolving billing issues, EDI issues, HCPCS, CPT-4 codes, ICD-9,

claims backlog barriers, denied claims, reoccurring billing issues,

and addressing any claims that need adjustments.

Ross Perot Companies - BCBS of New Jersey - Rutherford, NJ

04/02 to 04/03

NASCO BCBS Claims Reimbursement Billing Lead-(Ross Perot Contract)

V Responsible for COB Claims reimbursement adjustments in accordance

with BCBS claims policies and procedures. Duties included analysis

claims system edits make correction action reports for management.

V Duties included senior level knowledge of benefits contracts, ICD-9,

CPT-4, HCPCS, adjudication edits, coordination of benefits (COB) and

healthcare terminology.

V Supervised and lead a team of 10 employees while being held

accountable for hospitals claims resolution and production.

V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes

(Claims Backlog)

IBA - Frederick, MD

09/01 to 04/02

(SME) Claims Billing Contractor (Health & Human Services Contract)

V Responsible for creating reimbursement-coding crosswalk that would

indentify 911 supplies and claims that would match the standardized

HIPAA coding structure.

V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes

V Responsible for gathering Medicare/Medicaid crosswalks creating new

codes for procedures not present in the Medicare coding system, in the

event of another 911 incident.

V Responsible for subject matter expertise and updating of RFP as each

phase of the project was completed. Claims coding assignment and

claims workflows. The system would duplicate Medicare/Medicaid

hospitals policies and procedures

Ross Perot Systems - Magellan Behavioral - Columbia, MD

01/01 to 06/01

Claims Billing Analyst Contractor (Ross Perot Contract)

V Duties include analyzing Ad-Hoc reports for improve processes and

reporting for mental health and substance abuse claims.

V Duties included training on CPT-4 and ICD-9 proper claims combinations

preventing appeals and denials. Responsible for providing claims

management for Behavioral and EAP accounts.

V Accountable for processing coding of mental health claims and

substance abuse claims, while ensuring proper claims adjudication in

Claim Operations while improving workflow processes.

V Responsible for maintaining a 95 percent claims resolutions production

standards. Also responsible for claims resolutions of any claims over

90 days backlog.

V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes

EDUCATION

Webster University of Business and Technology - Jacksonville, Florida - MBA-

Masters in Business Administration graduated (1999)

Liberty University-Lynchburg, Virginia-Ed.S-Educational Specialist

graduated 06/2010

SOFTWARE

Microsoft Professional Office 2000: Word, PowerPoint, Excel, Access,

Outlook, Lotus 1-2-3, Lotus SmartSuite, Works, WordPerfect, Visio, Adobe

PageMaker, CorelDraw, Photoshop

CLAIMS SYSTEMS & E-COMMERCE Hospital HPF, Hospital EDI Tracker, Hospital

Revenue Cycle Pro, Webstrat, iSynergy, SSI Billing System, CMS Inpatient

Pricer,IntelliClaim, Diamond Paradigm, OmniTrack, SIR, Mercy Hospital

Patient Registration System, Illinois Hospital Billing System, SSI Hospital

Billing System, Passport, Availity, Medi-Tech, Amisys claims system,

Cerner NEBO Patient Registration, Humana Claims Imaging processing, BCBS

electronic Processing system.

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