Manager Billing
Resume:
Passaic, NJ *****
NICHOLE
WEDDERBURN___________________________________________________________
Professional Profile: Billing Director-Good communication, written, verbal,
interpersonal, and organizational skills, HIPPA, OSHA, CLIA compliant,
Staff educator, Train, launch and set up master files for physician
practice management systems, provide support for system application
(upgrades and implementations), strong problem solving experience,
extremely responsive to organizational needs, positive work ethics
internally and externally, cultural competency and ability to work with
diverse populations, team builder, adept to motivating staff, visionary
with forte for realizing solid results. Ability to multi task and
prioritize multiple projects, Type 70 W.P.M, All Scripts, Electronic
Medical Record, Excel, Power Point, Microsoft Word, SSIMED, Eclipse,
Premier Medical Manager (PCN), Netilla, IDX, Omnipro, ADS Premier, Epaces-
Medicaid, and Soapware, Misys Vision.
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EXPERIENCE
2002 - Present Prohealth Physicians
Billing Director
. Manage day-to-day operations for a large Multi-Specialty
Group, Hospital and Physician Billing, Billing and
Collections, Resolution of all billing issues, reconciling
billing, payment and collections. Direct and oversee staff
of twenty five.
All aspect of Office Management, Hire, Train, Supervise,
and retention of reception and staff. Accounts Payable
and Accounts Receivable, Payroll, Bank Reconciliation,
Trail balance, Adjust journal entries, Monthly Financial
statement preparation and year end reporting, Monthly sales
tax returns, Inventory, Order supplies for clinical and
front staff. Weekly meetings with staff, Monthly meetings
with all physicians.
. Follow up and updates Federal and State agency coverage
Medicare, Medicaid guidelines, and Third Party guidelines,
regulations and updates. All Commercial and Third Party
Insurance, MVA/WC billing.
. Oversee Billing Dept, Patient scheduling, Referral and
Authorization Dept, Credentialing, Physician scheduling and
templating, registration and posting of all encounter data.
Charge entry- CPT hash totals, Payment posting and
submission of claims to secondary and tertiary carriers.
. A/R analysis-corrections and resubmissions, 4-step
collection protocol, Reports done weekly to establish and
track pt's seen. Wellness reports and recall reports done
via Excel.
. Electronic claims submission and payments, corrections of
reports on rejections via EDI, Technical Support for all
Managed Care referrals and Prior Authorizations Procedures.
Physician credentialing and Licensures, Payroll-Quick books-
monitor all staff on time off's,
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. Updates on Fee Schedules, and Provider Contracts-
Healthcare. Liaison for Laboratory billing
. Charge entry and billing inquiries. Contract Administrator
and agreement for the affiliated Hospital IPA/Physician
Healthcare Organization (PHO)
. Proper reimbursement on all procedures done, CPT and ICD-9
coding on procedures done, broad knowledge of all
specialties.
. Patient inquires on accounts daily, Timely and effective
resolution of problems and issues presented by customers
regarding reimbursement and billing.
. Management and retrieval of data accumulated as a result of
billing and collections, Ensure development and collection
of employee's performance, evaluations, and personnel
development plan. Implemented hardship letters for clients.
. Coordination with all insurance plans to impact effective
and accurate reimbursements,
. Oversee all staff on all duties daily, Prescription
refills, and System updates monthly to ensure proper
reimbursement and work flow.
1995-2002 Armanti Financial, LLC
Billing Manager
. Patient registration, Charge entry, Electronic and claims
payment-correction of claims via web portal before
transmission, Denials, follow up and appeals.
. A/R done on excels bi-weekly, Medicare/Medicaid.
. Commercial and third party billing WC/MVA, Payment posting
on all insurance co's,
. Pre Certification on procedures and guidelines, oversee
staff of twenty, track employee vacation and time off's.
. Met monthly income goals on reimbursement of claims,
Physician Credentialing, Fee schedule updates, Contract
reimbursement updates, Hire and train new employees.
. Payroll. Daily interactions with patients on account
inquiries daily.
. Resolve all issues that occur. HIPPA guidelines.
1991-1995 Columbia Presbyterian Hospital
Provider Relations Specialist
. Intravenous billing, In/Out patient billing, DRG,
Medicare/Medicaid.
. Commercial and all third party billing, patient eligibility
thru Omnipro.
. Payment posting, denials, follow up and appeals, EDI
submissions-corrections and resubmissions on all
rejections, patient inquiries on accounts, physicians
inquiries on proper coding guidelines.
. Educate physicians on how to proper bill for level of
services provided
. Correct reimbursement follows up on all partial or improper
payment of claims.
. Long term care, billing, payment posting, charge entry,
Medicare/Medicaid and all Third Party Billing.
EDUCATION Queens College
B.S. Healthcare Management/Business Administration
Star Technical Institute
Cardiovascular Technologist (accredited)
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