MONA BOUBERT

**** **** ****** *****, **

Pompano Beach FL, 33064

954-***-****

Email: ad42v9@r.postjobfree.com

Over 25 years of health care experience from registration, billing, revenue cycle, financial counseling and insurance collections/follow up/ payer trends issues. Very strong organizational skills. Worked on productivity and quality standards. Promote team development, excellent communication skills, strong background in medical billing reimbursement, ICD-9 coding, insurance and cash posting. Handles hospital patient accounts, post insurance and payments. Demonstrate leadership and identify operational issues.

Skills: Software: Microsoft Office Professional Suite 2003 and higher, MS Word, MS PowerPoint, MS Excel, MS Access, MS Outlook, Lotus Notes, Calyx Points, Source net, Blackberry and PDA, Right Fax, E-Fax, Navinet, Availity, Cerner, HPF, PBAR, On Demand Web.

Billing Software and Hospital Systems: Meditech, Medisoft, Micro MD, Optics, SMS, IDX, Star, Epremis, Caremedics, EFR/ISUITE, PAMS, Facts, WebMD, Webmats, Medisoft, Medical manager. Yazi, TMS, NRX, QS1, Emedeon, Eclypsis, As400, Hardware: All Dell, Compaq, IBM and laptops computers. All printers. O/S: Mainframe, Unix, Internet applications, Citrix, Windows XP, Windows 2000, Windows NT

CORE COMPETENCIES: Health Care Reimbursement/Revenue Cycle/Hospital collections experience. Knowledge of insurance (HMO, PPO), Commercial, Self-pay, Medicare, Medicaid, Workman’s’ Compensation and third party liability.) Familiar with ICD9/Coding Medicare RAC( Recovery Audit Program Guidelines). Knowledge all Florida Statutes for insurance reimbursement and familiar with state federal guidelines.

PROFESSIONAL EXPERIENCE:

Conifer Health Solutions Boca Raton, FL

Revenue Cycle Specialist Conifer Health Solutions June 2018 to present

Review and research payments, claims adjudication, billing results and dispute claim patterns for assigned payers. Review and validate claim issues and prepares documents to support/present in payer meetings. Work closely with internal and external stakeholders to ensure the expected reimbursement (Med-Assets), Billing, and Dispute Claims systems supporting assigned payer processes are working properly to efficiently adjudicate claims. Assist stakeholders in all necessary functions for analyzing payer performance and providing reports to quantify bulk issues. Lead and participate in meetings, as needed. Provides concise documentation and reports to all stakeholders. Assist in special projects to drive desired payer results.

Denials Specialist/ Appeals Writer January 2013 –June 2018

Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims. Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary. Manage several desks to include bulk appeals, log sheet and IRO desk and follow-up process for reimbursement. Interact with the provider representative on issues pertaining to contract and underpayment. Reviewed and being able to read contracts via Med Assets. Follow up on accounts with payer on appeal determination status. Request balance adjustment and referred accounts to legal for resolution when necessary.

Health Business Solutions Cooper City, FL

Sr. Denial Recovery Specialist-Trainer March 2008-January 2013

Responsible to recover payments owed to hospitals, facilities, clinics, physicians by Medicare, Medicaid and commercial payers for services rendered. Responsible for re-bill and request all adjustments. Follow up with carrier on claim status and resolve outstanding balances. Submit all bills via electronic in Caremedics Billing System. Implement all billing conversion to 5010 to be in compliance with CMS. Documenting all follow up actions in client systems. Trained employees, assigning and directing work; demonstrates leadership skills by reporting trends. Adhere to HIPPA guideline policy and procedure for patient rights billing and collections.

McKesson/Relay health Atlanta, GA

Sr. Reimbursement Specialist June 2007-March 2008

Provide operational assistance to revenue cycle supervisor and patient account manager. Produce standard reports supporting A/R strategy. Monitor progress through standard reports weekly and report status. Manage denial, adjustment request reports, identify trends in data, quantify, and report findings. Report all major negative trends. Assist all A/R correspondence staff in training, review work to ensure guidelines and productivity standards are being met. Responsible for reviewing accounts for collections and interaction with collection agency.

RPM/Caremedics Atlanta, GA

Reimbursement Specialist /Financial services January 2005-June 2007

Responsible to initiate billing follow up and/collections to resolve accounts. Responsible to analyze previous account documentation in client systems and other available sources. Communicate with patients, insurance carriers and handle all incoming calls. Train new staff on project specific information and maintain professionalism to ensure the highest quality of client satisfaction. Meet daily productivity and quality standards.

Serono Inc./Merck Medco Boston, MA

Reimbursement Specialist/Sales January 2001-July 2004

Responsible to secure reimbursement for injectable drugs. Provide customers with the best coverage and reimbursement for self-injectable drug to the Central West Region. Screen patient for financial assistance including Medicaid and other State programs to cover and pay for their medications. Work directly to support the needs of the manufacture’s sales force and the physicians. Coordinate nursing schedule and pharmacy delivery to patients. Travel to different states to attend seminars with neurologist and educate patients in payer policies and ensure their access to care.

EDUCATION

2015- Present Ashford University BS Health Care Administration

2009 – (CDRS ) Certified Denial Recovery Specialist

2007- Georgia HFMA (CPAR ) Certified Patient Account