Carol McGruder Page *

Carol McGruder ** Herrington Drive

Upper Marlboro Md 20774

240-***-**** (Cell)

Email : ad5anu@r.postjobfree.com

Patient Managed Care and Billing/Collections Professional Seasoned medical billing and patient care expert with over 20 years experience in managed care resolution, customer health, commercial and physician care . Successful track record of generating new business with managed care professionals, marketing medical account strategies and solutions to existing and potential clients in real-time and within individual budget constraints. Proven ability to recruit, retain, and motivate operational and medical personnel at all staff levels. Advanced patient account management and marketing communication skills in the private sector.

Areas of Expertise

Project Management Medical Billing Claims Management Collections Customer Service Account Management

Document Control Quality Assurance Client Relations Experience

Children’s National Medical Center, Washington, DC Credit Collections Representative (February 2005 – Present)

Provide advanced medical billing consulting and coordination to facilitate appropriate reimbursement for hospital and physician services.

Execute quality deliverables such as medical documentation, billing inquiries, and letters of appeal to professional carriers.

Serve as liaison with insurance carriers in addition to Medicaid/Medicare representatives, and other official representatives to ensure timely payments and billing.

Track and report payment trends and responsible to manage managed care contractor payment requirements.

Administer and maintain company financial documentation and generate correspondence concerning claims appeal processes.

Apply company-wide branding and implement operational procedures, forecasting, and other reporting mechanisms.

Investigate, collect, and resolve non and late payment issues and disseminate information to customers and health care providers.

Organize and facilitate regularly scheduled billing meetings and data reviews to ensure the integrity of data used in the preparation of monthly and quarterly reporting and forecasting efforts.

Identify, recommend, and document pertinent information into health care information system. Health Care Management Group, Silver Spring, MD

Patient Account Representative (January 1999 to February 2005)

Managed and administered over 100 accounts to include HMO’s, Workman’s Compensation, Auto Accidents, Commercial Insurance, in and out-of-state Medicaid and Medicare provisions as required.

Collected on accounts ranging from 75k to 1mil and consistently met monthly collection goals.

Led initiatives to meet revenue collection infrastructures relevant to meet company requirements.

Established relationships with insurance carriers and ensured assigned accounts were no more than 180 days past due.

Ensured insurance carriers paid reasonable and customary fees in accordance with their specific plans.

Documented preliminary medical referrals for claims reimbursement from insurance carriers.

Standardized and developed new requirements and appeals processes with appropriate documentation and proper coding during the appeals processes.

Scoped specifications for client mandated denials and mitigated appropriate claims to finalization. Carol McGruder Page 2

Metro Washington Orthopedic Association, Oxon Hill, MD Patient Account Coordinator (November 1997 to January 1999)

Gathered, assessed, and analyzed various delinquent accounts, maintained follow-up and collected delinquent balances to support and defend the customer requirements and physician budget constraints.

Oversaw the development of reports and statements of billing and ensured Workers Compensation, disability, and other legal matters were handled in an efficient manner.

Managed and established account cases and was responsible for scheduling patients for services rendered in compliance with Association guidelines.

Wrote policy and procedures in accordance with operations within the patient care unit and provided guidance on patient accounts and potential new carriers. Physiotherapy Associates, Bowie, MD

Accounts Manager (February 1995 to November 1997)

Trained and developed new personnel and responsible to manage the work insurance claims payments.

Reported to management on customer satisfaction through customer surveys, suggestions, and complaints.

Modified patient account operations based on customer feedback and ensured quality assurance through leadership and staff oversight.

Verified insurance eligibility and benefits coverage and liaised with customers to ensure deductibles were met and paid in a timely manner.

Managed new business accounts for insurance company offerings and made recommendations to management on way forward.

Led special projects and patient account initiatives to help enhance business operations. Drs. Viemer and Zell, Laurel, MD

Administrative Assistant (June 1993 – February 1995)

Conducted assessments & analysis to identify and improve upon customer specific requirements.

Scheduled appointments and managed the front office and patient files.

Posted charges and prepared monthly and quarterly reports as required.

Supported physicians with special projects on an as needed basis and oversaw other administrative personnel.

George Washington University Medical Center, Washington, DC Appointment Desk Supervisor (November 1990 – June 1993)

Directed the daily activities of appointment schedulers and provided feedback on work performance enhancements.

Managed the health care information scheduling system to ensure appointments were scheduled appropriately and timely.

Scheduled and posted surgeries and kept physicians informed of changes and other requirements.

Oversaw the dispatch system and provided recommendations on improvements as necessary. Training

Medix Medical School Training Certification Project Management Customer Account Management Patient Account Marketing Medical Billing and Coding Training Medicaid Billing and Enrollment Training Patient Care Compliance Training Professional References

Provided upon request

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