Home Health Medical
Resume:
VIVIAN BENSON
Dallas, TX *****
************@*****.***
Objective
I am a focused individual and I believe in getting the job done right and
on time. I work with integrity and honesty. I am confident and assertive
with exceptional communication and interpersonal skills. I have an intense
sense of urgency and desire for results coupled with a sense of humor,
positive spirit and passion for being the best I can be every day.
Credentialing Consultant 03/2010-08/2010
Radiology Consultants of North Dallas Dallas, TX
*Credentialing of physicians, allied health and other practitioners
*Collect and maintain an accurate practitioner database and analyze
verification information
*Maintain compliance with regulatory and accrediting bodies
*Develop and implemented credentialing/privileging processes and procedures
*Develop and implement provider enrollment processes and procedures
*Overseeing development of and adherence to:
*Policies pertaining to medical staff, practitioner/provider, and the
organization
* Department rules and regulations and
*Governance bylaws
Reimbursement Supervisor
03/2000-02.2010
Alta Medical Group
Plano, TX
*Supervised 24 AR/credentialing reps
*Assigned duties to Client Service Reps
*Oversaw and reported production trends/ call metrics
*Handled appeals related to non payment of hospital and clinic claims
*CBO coder (for claims that needed code review)
*Negotiated OON claims for payment
*Maintain fee schedule database
*Bi-Monthly payroll duties
*Follow-up on outstanding account and credit balances for final resolution
*Audit accounts and post payments as needed
*Responsible for ensuring all claims are billed within timely manner and
followed up on
*Special projects related to reimbursement as needed
**Monitoring existing contract performance, including appropriateness of
payment, changes in volumes and case mix, comparison of expected to actual
profitability
*Prepare monthly and yearly financial reports and closes
*Negotiate and maintain financial agreements
*Advanced knowledge in Medicare 60 day pmt episodes, case mix adj., outlier
payments, consolidated billing for HHA/SNF
*Advanced knowledge in billing for ESRD (method 1 and 2) and home dialysis
equipment
*Knowledgeable in DMERC codes for billing on HCFA-1500 as well as billing
with the G codes
*Managed the appeals database for non-payment of claims/procedures
*Billing/collections/insurance verifications for out of network claims
*Monitor average patient charge, payer mix, cash performance, and DSO
trends by contract and payer
*Coordinate and provide assistance with outside auditors for annual and
special projects as needed
*Maintained Home Health Consolidated Billing Master Code List, including
rates, payment methodology
*Certified in Medicare Home Health Diagnosis Coding /HIPPS CODES
*Resolution of contract payment issues
*Analyze contract performance
*Trained in PACE (Programs Of All Inclusive Care For Elderly)
*Maintain and build strategic and operational partnerships with the payors
*Medicaid Integrity Program member
*Maintain the rate database and contractual terms of Medicaid managed care
contracts
*Approved all contract coordination polices, procedures and standards
*Monitor Medicaid managed care contract performance and address related
concerns
*Communicate payor contract compliance issues at payor meetings
*Communicate and update management and staff of new or revised contracts
/agreements
Reimbursement
Supervisor
08.1997-03.2000
Burlington Health
Group
Arlington, TX
* Planned, directed and coordinated the day to day operations that
consisted of cash applications, accounts payables' & receivables and
Medicare, Medicaid, VA, hemodialysis, transplant and Commercial and
Managed Care Insurance Billing departments. This also included
Medicare & commercial claims adjudication for out of network
negotiations & revenue tracking utilizing ICD, CPT, HCPCS, and DRG.
* Directly managed 32 employees within two separate facilities. Duties
included staff development, JACHO and HIPAA compliance as well as day
to day operations of the business unit.
*Experienced with FISS-Fiscal Intermediary Standard Systems.
*Advanced Knowledgeable with Medicare reimbursement methodologies
*Negotiated and maintained managed care contract and patient financial
agreements
* Responsible for credentialing, contracts, billing, collecting,
finance and ensuring success of off site facilities this included
hospital and physician based billing.
* Pursue continuing education on Medicare and other billing laws and
regulations
**Perform month-end financial review to detect reporting errors and to
recommend accrual adjustments to Corporate Accounting
* Ensured accuracy of inpatient and outpatient coding of medical records
using EMR, ICD-9, CPT-4, and DRG coding systems. ( 3M encoder and CPT
finder also)
.* Handled internal provider relations issues and external price and debt
resolution.
* Emphasis on DRG within contracted facilities, paying special attention to
trending outcomes for capitation
agreements.
* Month end cost containment and bad debt financial planning.
* Coordinate activities of all billing and collection's departments to
ensure prompt billing and payment and clean claims submissions.
* Ensured accuracy of Charge capturing and reconciliations.
* Implemented daily charge master review and month end analysis.
* Interview, hire and evaluate employees. Mentored, coached and motivated
as needed.
* Calculated claim payments based on established payment methodologies.
* Developed and maintained a reconciliation process for claim payments.
* Coordinated with internal departments on the compilation of financial
reporting related to claim payments.
* Compiled and submitted various internal and external workload reports
* Developed and maintained workload-specific databases
Reimbursement
Analyst
09/1992-08/1997
Blue Cross Blue
Shield
Richardson, TX
* Processed, collected, billed on medical, dental and life insurance claims
for payment in a call center.
* Promoted to Customer Care Supervisor in 1994.
* Supervised call center of 38 reps
Education (double major):
BS- Business Management & Health Administration
09/1988-05/1992 San Diego State Univ./ San Diego, CA
CFE- Association of Certified Fraud Experts 04.2005 (HFMA)
CPC-Certified Professional Coder -JPS Health Institute 01/1994
Skills
*OBR
*Master Database Contracts
* ADP
* Quicken Pro
*ECommerce
*Best Practices
*EWeb
*HMS
*Artiva
*CenterVu
*QMS
*Great Plains
*CWF (common working file)
*NexGen
* Peoplesoft
*IEX
* Microsoft Office Suite
* Meditech
*Freeview
* Medisoft
* Medical Manager
*Advantx
* Medic
*Mckesson
*Davinci
*GAAP
*Medipro
*Sarbox
*ASAP
* Mysis
* Millbrook/ Centricity* Lytec
*AdvancedMD*EncounterNotes*Misys
*NetSuite*Axium*Medicserv*Intellisoft (Credentialing
software)*TotalView*ACD*Peachtree* WinMed
* AS 400* Primus
* SAP GL, A/P,A/R
* SAP* IDX* Laser fiche* Procomm Plus*TDH Connect
Excellent references available upon request.
Contact this candidate