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Manager System

Location:
Villa Rica, Georgia, 30180, United States
Posted:
March 13, 2011

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**** *****

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

Villa Rica GA ***80

Home Phone 770-***-****

E-mail ********@*********.***

http://www.linkedin.com/in/adamslisa

Objective: Improve service, increase productivity, profitability and secure

myself continued advancement and compensation through team and individual

contributions.

Qualification Summary: 14 highly skilled years. Knowledgeable in Cerner

Powerworks, Monarch, Crystal, Payerpath (AllScripts), Cyberquery (Advanced

Reporting tool), NextGen Practice Management, Gateway EDI solution, and

some knowledge of NextGen EMR.

Significant Experience

1996 - Current Wellstar Health System Marietta GA

Wellstar Health System

1996 Data Entry Clerk -Payment Posting

1997 Data Entry Supervisor/Interim Manager - Supervise & train 20

employees, posting & balancing the A/R billing system.

1998- 2008 Special Projects Manager - Liaison between the Business Office

and I/T

2008- current Manager of Billing Operations and Systems

. Key contact, owner and core member of the Practice Management system and

the Claims Manager system

. Instrumental in establishing the interface & transition between our

existing system and a new internal billing accounting system.

. Maintain entire General Ledger of Wellstar's billing system for 70

practices within the Physician's Group ensuring that the A/R is rolling

up appropriately and that all providers are compensated appropriately.

. Instrumental in the upload and updates of new payer contracts into the

billing system, track reimbursement and/or underpayments made by payers.

Trained/formed a Fee Schedule team to continue this process.

. Responsible for pricing and fee schedule analysis yearly to ensure no

monies are left on the table. Also, created CPT code specialty

spreadsheets for all payers by practice, provider, & business office to

view at a global level as opposed to looking at it per contract...great

analysis tool! Responsible for all physicians' group pricing methodology

for all specialties (based on RVUs).

. Instrumental in implementing, documenting, testing & training of our

current claims/EDI solution for 70 practices/1100 employees in less than

a year. Assists practices with issues or failed claims. Directly educate

vendor with system customizations needed via payer requirements and/or

practice. Customizations personally reviewed, tested & released to the

practices with documentation to support these changes.

. Instrumental in reducing the number of submitted paper claims, currently

we are at 95% electronic claims submission for both primary and secondary

claims with a 98% clean claim rate.

. Instrumental in reducing the volume of paper EOBs and the manual process

of posting remits by implementing electronic remits for 90% of our payer

mix as well as expediting payment via EFTs.

. Maintain the majority of the application master billing system tables.

Design, customize & provide reports for all areas of the Physician's

Group from administration to the end users. Instrumental with

interfacing & contacting billing systems providers & collection agencies,

reduce the number of statements delivered.

. Responsible in testing, documenting and training all practice management

system upgrades (usually twice a year)

. Facilitates a User Group meeting for all users every two months in

regards to both our claims and billing system.

. Continuously streamlines processes that benefit all users as we want "to

work smarter not harder"

. Oversees a Help Desk (5 System Analysts) that support both the billing

system and claims system for the entire Medical Group that encompasses

over 70 practices

. Work very closely with Coding/Compliance department to ensure that all

practices are standardized in our processes and code/document

appropriately meeting CMS guidelines.

. Currently, in the process of building/testing a new Practice Management

system (NextGen) and Claims EDI solution (Gateway) to be rolled out to

all 70+ practices with a completion date of 10/1/11 while also bringing

on all newly acquired practices as we move forward.

. Responsible for "go live" implementation for the billing/claims software

for all 70+ practices (team of 6 that includes myself) as well as

continuing to support the current practice management software.

1992 -1996 Tampa General/St. Joseph's Hospital Tampa FL

Data entry, payment & charge posting

Education 1983- Florida Junior College (Jacksonville Fl) Associate in Arts



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