Revenue Cycle Behavioral Health

James Longworth, CPC-A

Nashville, TN

Cell: 865-***-**** Email: ad5fv5@r.postjobfree.com

LinkedIn: www.linkedin.com/in/jascolongcpc

Practice/Revenue Cycle Manager & Certified Professional Coder Revenue Cycle Management Team Management

Staff Hiring & Training Professional Coding

Provider Payer Enrollment EMR Template Building

Certification: Certified Professional Coder, CPC-A, AAPC Technologies: Healthport PM, NextGen EMR

Industries: Healthcare, Orthopaedics, Behavioral Health, EMR/PM WORK HISTORY

Senior Specialist I, Implementation and Training, NextGen Healthcare, Atlanta, GA 2022-Present

First Tier resolution Manager for client escalations.

Main trainer for our RCM Support Team.

Liaison between training team and RCM account managers.

Assist training team with specialized training and support.

Create and Present Webinars

Research each Project, determine client needs and implement a training plan based on their workflows.

Train Providers and staff on the Electronic Health Record, customize each client’s EHR, and create custom forms to be used within the EHR.

Train Providers’ staff on patient registration, appointments, office management, billing workflows, claim follow up, and reporting.

Consult with clients that have large Accounts Receivable, identify the issues, devise training plans and workflows to improve their AR.

Senior Provider Enrollment Specialist, American Physician Partners, Brentwood, TN 2017-2022

Assisted in creating the Provider Enrollment Department and transferred responsibilities from a third-party vendor and brought it in-house.

Research payers' enrollment processes and requirements, create and maintain SOP's.

Proficient in PECOS, revalidations, and troubleshooting.

Responsible for enrolling large numbers of providers timely with specific and strict deadlines and start dates across 17 states.

Routinely meet with RVP's and Medical Directors to anticipate needs. Revenue Cycle Manager, CareAll Home Care Services, Nashville, TN 2014-2017

Managed the Private Duty billing department that performed services for 63 home health offices across Tennessee.

Managed Receivables and Collections.

Worked with payers on large projects. Usually involving insurance companies’ upper management as a result of paying under the contractual amounts.

Managed the billing software including maintaining various contract rates, claim setups, and various scripts.

Professional Coder/Biller, Petty Orthopaedics and Sports Medicine, Nashville, TN 2014

Reviewed clinical documentation and Operative Reports to assign appropriate CPT/ICD codes.

Perform all claim submitting, Patient Billing and collection functions.

Scheduled surgeries and obtain pre-authorizations. Revenue Cycle Manager, Ridgeview Psychiatric Hospital and Center, Oak Ridge, TN 2011-2013

Managed several departments including Admissions, Credentialing, Collections, and in-patient, out- patient, and facility billing.

Participated in Executive planning and management meetings.

Acted as internal consultant in the selection of a new PM and EMR system. Level II Support Analyst, Healthport/CompuGroup, Columbia, SC 2008-2011

Performed Tier 2 support for software issues that arise from clients (Physicians, Hospitals, DMERC, and Medical Billing Companies).

Investigate data elements, verify data, and evaluate specific routines based on individual clients' needs.

Research EDI Payer requirements and implement changes as needed.

Created reports for clients.

Trained clients on new modules and yearly updates. Business Service Consultant/Administrator, Cherokee Health Systems, Knoxville, TN 1999-2008

Managed 90+ Staff, Physicians, and Mental Health Professionals

Recruit and hire Physicians and staff.

Corporate Software Trainer for all new hires.

Managed the Central Billing Office for services generated out of 35 satellite offices. ADDITIONAL EXPERIENCE

Certifications

CPC-A, Certified Professional Coder Apprentice 2022-Present Memberships

AAPC- American Academy of Professional Coders 2021-Present Hobbies/Personal Accomplishments

Second Degree Black Belt in Taekwondo 1990-Present Charity Bicycle Ride - Two Day, 165 miles from Miami, FL to Key West, FL 2012

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