Project Manager Quality Control
Resume:
Loretta L. B er
Nashville, TN 37221
abibda@r.postjobfree.com
Professional Summary and Qualifications
. 18 years of Healthcare experience with strengths in Revenue Cycle
Management.
. Implementation of A/R processes and Practice Management Software
. Contracts, Credentialing and Charge Master set up
. Eligibility, Benefits Verification, Billing, Cash Posting and
Collections of all payer; Commercial, Medicare, Veteran
Administration, Medicare & Medicaid Replacement Plans and Workers
Compensation.
. Month End Financial Reconciliation, Monitor payment trends and issues
. UB04 & HCFA 1500 coding & data requirements; CPT, ICD-9, HCPCS, DRG,
Revenue Code and HIPAA transactions and code set standards.
Technical Skills & Software
Proficient in Microsoft Word, Excel and Access, PowerPoint, Outlook, Visio,
CSC Healthcare System, QRS/Paradigm, Arpeggio, EZ Cap, iMedicia, Emdeon,
Mantis, DDE, Passport, Pearl, Medical Manager, Medical Management Systems,
MDeverywhere, Encore, Promed, CareNet, FileNet, InVision, Teleform, Poise,
OCR and document imaging software.
DSI - Diversified Specialty Institutes www.dsi-corp.com
Nashville, Tennessee - Corporate Office
November 2008 - May 24, 2010
Billing Director
. Manage the Corporate Billing Office's operations and processes for
over 100 dialysis clinics across the nation.
. Submission of claims to various health plans for hemodialysis
treatments and other related ESRD services for in-center and home
dialysis patients.
. Participate in monthly A/R Compliance Committee meetings
. Work closely with IT and programmers to develop system enhancements
. Develop and implement efficient business processes & policies
resulting in increased revenue
Take Care Health Systems formerly CHD Meridian Healthcare an I-Trax Inc.
Company http://www.takecarehealthsystem.com/
Nashville, Tennessee - Corporate Office
January 2008 to October 2009
Director of Medical Billing - CBO
. Oversee the Central Billing Office operations and processes; billing,
cash posting and collections.
. Manage the coding and scrubbing of encounters, submission of claims to
various health plan carriers and payment posting for services
rendered.
. Serving 107 clients at 238 nationwide locations.
. Daily interaction with site management, vendors and clinical staff.
. Provide various reports to the Controller and CFO.
INSPIRIS formerly Geriatrix www.inspiris.com
Brentwood, Tennessee - Corporate Office
March 2004 - December 2007
Claims and Billing Manager June 2005 - December 2007
. Manage the productivity, performance and quality of the claims
department.
. Oversee the charge entry, billing, follow-up and collections of the
billing team.
. Develop and implement improved claims processing polices & procedures
. Process and cut capitation and case rate checks for contracted
providers
. EZ Cap software implementation team; installation, configuration and
testing of new software.
Operations Analyst March 2004 - June 2005
. Release claims for payment in compliance with contracted turn around
time. Print checks and EOBs.
. Compile data & generate monthly health plan compliance report.
. Compose and submit various types of provider and health plan
contracts.
. Load contracts and fee schedules into EZ Cap system.
. Generate & analyze various operations reports; Aging, Pending, Turn
Around report.
. Successfully improved provider payment accuracy and saved money with
an internal audit project of our contracts, providers, and overpayment
files.
Solutia Healthcare Services, Inc. www.solutiahealthcare.com
Franklin, Tennessee - Corporate Office
2002-2003
Director of Physician Services
. Implemented and managed multi million outsourced billing and
collections contracts.
. Developed a successful A/R management approach resulting in increased
revenue and productivity.
. Supervised staff performance, quality and productivity goals.
. A/R analysis and Charge Master review.
. Increased client revenue and productivity by reorganizing the billing
and collections processes.
. Assisted in planning, development and implementation of information
technology and collections program/software.
. Accounts receivables analyst, auditing, project manager, supervise &
train collectors, new client implementation, quality control and
operations efficiencies, invoicing.
Samuel O. Okpaku, M.D., Ph.D.
Nashville, Tennessee
1998 - 2001
Office Manager
. Managed daily operations of the business office and staff.
. CPT and ICD-9 coding, post charges, post payments, transmit electronic
claims, produce statements.
. Contracts, credentialing, analysis managed care reimbursements, build
profiles & discrepancy report.
. Market and export books authored by Dr. Okpaku.
. Posted charges CPT & ICD-9 coding, post payments, paper & electronic
claims submission, generate self pay statements.
. Provided clinical data for treatment authorization, verify coverage &
benefit limitations.
. Collected and researched data, created presentation overheads and
arranged speaking engagements.
Tennessee Oncology, P.L.L.C.
Nashville, Tennessee - Corporate Billing Office
1996 - 1998
Contracts & Credentialing Coordinator
. Contracted & credentialed 21 physicians for 28 managed care plans and
22 hospitals.
. Resolved provider related billing and reimbursement issues.
. Distributed managed care policy and procedure changes.
. Loaded provider information into billing system for claims submission.
. Collected demographic & health statistical data for marketing
strategies.
Primary Case Management, Inc. ProCare, CalOPTIMA, Laguna Hills Medical
Group
San Diego, California
1992 - 1996
Assistant Director of the Claims Department
. Supervised claims processors, including managing of workflow to
maintain turnaround times, establishment of productively standards and
the administration of verbal and written disciplinary actions.
. Coordinated and assisted in establishment of policy and procedures for
the claims department.
. Collections, adjustments and refunds of reimbursement.
. Verification of third party insurance and CCS (California Children's
Services).
. Provided all Administrative Assistant functions to the Claims
Director.
Claims Analyst
. Reviewed, adjudicated and priced claims for payment or denial.
. Insured compliance with State and Medi-Cal regulations for various
entities with our management company.
. Identified Workers Compensation and third party liability claims.
. Provided verbal and written billing information to individuals, groups
and agencies.
Credentialing Assistant
. Responsible for set up and maintenance of provider files.
. Requested and verified credentials.
. Assisted in the organization of the contracts department.
Data Entry Specialist
. Data entry of medical insurance claims and research.
. Quality Control Auditor.
. Establish new standards, procedures and guidelines for the data entry
department.
Salary Requirements: $90,000+ per year
references available upon request
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