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

St. Louis, MO

618-***-****

ad2tqy@r.postjobfree.com

Demetrice Fuller

CAREER SUMMARY

Many years of patient accounts regulatory and quality compliance (CMS) experience specifically relating to account billing, AR, coding, manage care, third party, attorney’s request, posting, customer service, reimbursement, and medical terminology, medical coding, UB04, 1500(HCFA), Medicaid Medicare billing, commercial billing, Posting payments remits, EOB, precertification, referral, autherzation

PROFESSIONAL EXPERIENCE

Financial Customer Service, BJC Health Care

10/10/2011 04/21/2022

Provide proficient hospital incoming calls multiple computer system compliance effectively manage incoming calls and out bound calls

Compliance (HIPAA), Identify fraud and notify compliance related issues due fraud issues

Review daily reports resolve patient issues written or verbal patient concerns and problems

Responsible for out bound calls to Physician office to resolve patient coding discrepancies

Send out UB’S 04 and Itemize Statements and Attorney’s request

Enhances the overall patient safety and HIPAA regulations by performing quality checks on Affidavits

Process subpoena requests, and certifications

Enhances the overall financial performance of the department through coordination and timely release of information for all regulatory agencies (RAC, MAC,

Quality Assurance Compliance Manager Guidance Health Service

12/1/2015-01/02/24

Perform review of (CMS), HIPAA.

Supervision and coordination of charge master and charge capture processes in researching coding and billing guidelines, researching insurance contracts, and updating hospital and professional charge master and charge capture processes

Works diligently with department heads, supervisors, staff, coders, and patient accounting personnel to continuously improve the goals of enhancing reimbursement, speeding up cash flow, and maximizing fiscal compliance

Works with the revenue producing departments to ensure ongoing coordinated and consistency with the charge master and charge capture processes, including accurate descriptions, coding, additions, deletions, pricing, revenue code, and any other changes

Maintains a working knowledge of revenue cycle processes to aid in the implementation of regulatory standards that assists the health system in cash collection while accurately complying with billing guidelines

Works with Finance, Revenue Integrity and Decision Support to perform applicable analyses to understand budget, net revenue change, and labor impact of proposed charge master changes

Performs analysis, identifies trends, validates compliance as related to fiscal activities generating additional revenue, reducing bad debt expense and charity write-offs, and overall expense reductions

Plan and perform operational, financial, compliance, and investigative audits

Manage, audit, and monitor both internal and external vendors against CMS, contractual, Federal, State, and NCQA standards

Provide development guidance and assists in the identification, implementation, and maintenance of compliance policies, procedures and work instructions.

Knowledge of medical terminology and procedures

Written and verbal communication skills

Supervisory skills

Customer Service skills

Negotiating skills

Mentoring skills

Interpersonal/human relations skills

Ability to manage multiple tasks simultaneously

Ability to operate a personal computer and various software packages

Ability to maintain confidentiality

Coding, CPT, HCFCS, UB04, HCFA

Supervisor Patient Accounts National Hospice Management

11/2/2009-04/01/2010

Supervise over (15) employee’s manages individual(s) including to hires, train new employee’s, assigns work, evaluates performance, conducts

Ensured that the productivity and actions of that group meet/support the overall operational goals of the department

May participated many in the development of departmental staffing, revenue and/or expense budgets and having direct responsibility for adhering to those goals.

Supervised the day to day operations of the department, ensuring timely billing of all product or service line accounts.

Reviewed and makes proposal for adjustments to accounts receivable balances

Audited accounts with outstanding balances and approves accounts for referral to a collection agency

EDUCATION

Certification in (HIPAA) Compliance

Currently enrolled in Medical Coding Program (St. Louis Community College- Gradate 12-2018 in process taking the Certification CCS (AHIMA) with BJC

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