Customer Service Manager

TONIA THOMAS

Texarkana, TX

PHONE 360-***-**** EMAIL: **************@*****.***

Professional Affiliations:

AAHAM, HFMA, NAHAM

Extensive knowledge of HCFA 1500, UB 92, UB 04, ICD9-ICD10, CPT, HIPAA X12 4010-5010

EDI, Compliance and Auditing, Microsoft Word, Microsoft Project, Microsoft Access, Excel,

Outlook, Meditech (Magic, Client server, and 6.0), Premis, ePremis, RevRunner, QMS, PCIS,

HPF, PHS, Wa-med Web(ACS), AS400, Dairyland, PES, DDE, CPSI, HBO, HBOC(STAR),

Mysis, Cerner, Med Assets, Code Correct (Accuro), and EMTALA regulations. Excellent phone

and customer service skills. Extensive knowledge of Medicare Intermediaries (WPS,

Trailblazers, Novitas). Proficient knowledge of Washington, Idaho, Georgia, Oregon, Texas,

Arkansas, California (Medi-Cal) and Montana Medicaid. Extensive knowledge in CAH (method

I & II), RHC, OPPS/IPPS, Pediatric, Physician, Ambulance and Dialysis billing.

SUMMARY

I have worked in the health care field for 15+ years. I have specialized in the full gamete of

patient accounting operations; CDM Manager, set-up and review; and billing systems

implementations for hospitals, Physician Practice groups, Pediatric facility, ESRD and Specialty

facilities. In the role as the Interim Director, PFS Operations/Systems Analyst I am responsible

for the daily operations of billing, collections, cashiering, cash posting and customer service. I

am also the liaison to the IS services group for revenue cycle systems review and

implementations in order to bring systems into compliance.

EXPERIENCE:

Wadley Regional Medical Center, Texarkana, TX, 300 bed April 2012 to March 2013

Wadley Regional Medical Center, Hope, AR., 75 bed

Wadley Rural Health Care Clinic, Hope, AR.

Business Office Director

Responsible for the day to day activities of a hospital's business office including RHC,GERO

PSYCH, Surgery Center, ER, Medical Office Building, OB/GYN clinic, and Breast center.

Responsibilities include admitting and registration, patient billing and collection, third-party

payer relations, and preparation of insurance claims. Administer, create and implement policies

and procedures and ensures all office activities comply with hospital standards and government

regulations. Familiar with a variety of health care concepts, practices, and procedures. Lead 119

employees in the day to day operation. Education and training in federal, state and local

regulations to ensure compliant and accurate processes. AR reporting to administration and

corporate team members.

Delta County Memorial Hospital December 2010 through March 2012

Business Office Manager

Responsible for day to day operations of PFS, Central Scheduling and Admission in a 49 bed

facility. Oversaw 26 staff members. Managed systems implementation. Revised and updated

policy and procedure manuals. Streamlined PFS processes. Updated and streamlined admissions

processes. Worked with all departments in the hospital to create compliant and efficient

processes. Retrained and updated staff on all aspects of HIPAA, EMTALA, and CMS

regulations. Oversaw all cashier posting and processes. Reviewed and updated all CDM

processes. Oversaw and updated system analyst positions and process. Reorganized PFS

positions. Updated and implemented new electronic billing software. Implemented and trained

new Central Scheduling department.

Dell Perot Systems September 2008 to September 2010

Consultant

-Valley Medical Center, Renton WA (CDM Manager, Systems Analyst) September 2008-July

2009

-Northern Arizona Health Systems, Flag Staff, AZ (Refund Analyst) July 2009-November 2009

-West Georgia Health Systems, LaGrange GA (PFS Director, Systems Analyst) November

2009-May 2010

-Tufts Medical Center Boston, MA (PFS Director) May 2010-Septmeber 2010

Interim PFS Director/Business Systems Analyst-Part of RCO startup team. Traveled to various

healthcare facilities when a new contract was signed with Dell Perot systems, to review analyze

and update all policy and procedures. Retrained staff and oversee all new system

implementations.

PFS Director

Responsible for day to day operations of PFS in a 300+ bed OPPS/Teaching/Research

facility. Oversee 20 staff members. Manage systems implementation. Revise and update

policy and procedure manuals. Streamline PFS processes. Work with all departments in

the hospital to create compliant and efficient processes. Retrain and update staff on all

aspects of HIPAA, EMTALA, and CMS regulations. Work with Dialysis and SNF

departments to retrain and update billing practices. Oversee all cashier posting and

processes. Review and update all CDM processes. Oversee and update system analyst

positions and process.

System Analyst

Responsible for system implementation and update. Staff training and mapping of all

modules from HIM, ADM, CDM, MM to HIS systems to ensure HIPAA compliant

billing and correct claim billing processes. HIPAA X12 4010 EDI transactions (837/835,

270/271, 276/277) verification, testing and implementation.

CDM Manager

Review, audit and update CDM for 300+ bed facility. Update all changes and compliance

auditing. Review, audit and updating of physicians group CDM for accurate billing.

Coordinate with clinical staff to ensure compliance. Education of clinical staff for

compliant billing. Enter/Edit all new and existing charges. Set pricing for hospital based

on internal methodology and regional comparison. Set Pricing for physicians based on

RVU and Fee schedules. Compile reports for administration for various revenue cycle

audits and reviews.

Healthcare Resource Group November 2003 to July 2008

Consultant

Permanent Full-time positions going to various hospitals as interim staff and consulting for

billing medical insurance, insurance follow up, cash posting, collections, P&P's, A/R

management and staff training. To include the following:

*(Interim HRG) University California San Diego Dialysis Center, 2/08 to 5/08

Follow up and billing for all dialysis claims. Training of new PAR for ongoing f/u on

dialysis billing. Implemented policy and procedures for billing and follow up on all

dialysis claims.

*(Interim HRG) Bonner General Hospital Sandpoint, ID/08 to 4/08

CDM review and update. Dictionary update in Magic (Meditech)

*(Interim HRG) St John's Lutheran Hospital, Libby, MT 08/07 to 7/08

Interim Director of Patient Financial Services. Managed a staff of 14 including PAR s,

admission representatives, Prompt Care and Specialty physicians practice. Office policies

and procedure reviewed, updated, and implemented. Review and audit of patient account

processes. Retrained all staff on insurance billing and follow up processes. Created

financial counselor position and implemented P&P s for that position. Implemented,

reviewed, updated and trained clinical and fiscal staff on CDM P&P s. Implemented and

trained staff on new ABN program. Updated and corrected dictionaries in Meditech s

(Client Server). Implemented new EBS (ePremis) & trained staff. Reviewed and update

Charge master. Served on several committees including CDM, Corporate compliance,

denial management, patient satisfaction and Collections. Implemented P&P s for

physicians practice group owned by the hospital. Trained clinical staff on ABN & CDM

procedures. Created auditing process for all admits by staff. Updated all admitting P&P s.

*(Interim HRG) Ashland Community Hospital, Ashland OR 06/06 to 11/06

Interim Business Office Manager. Managing a staff of 8 in the business office. Office

policies and procedure reviewed, updated, and implemented. Review and audit of patient

account processes. Staff training for Oregon Medicaid (OMAP), Medicare, and

Commercial billing procedures. Audit and update write off procedures including

community care applications. Work with admitting and medical records managers to

create denial management team. Update EPremis and Meditech claims edits. Set up new

contracts with outside vendors for out of state Medicaid, collections and statements.

Implement new programs and training for staff.

*(Interim HRG) Gritman Medical Center Moscow, ID 05/06 to 6/06

Washington and Idaho Medicaid billing and follow up. Update Idaho Medicaid billing

regulations. Staff training for PES and ACS (WAMED WEB) Workman s Comp for

Idaho and Washington billing and follow up.

*(Interim HRG) Seattle Children's Hospital, Seattle, WA 11/05 to 05/06

Follow up of commercial, Medicaid, out-of-state Medicaid inpatient and outpatient

accounts. Charge correction. Implementing and training staff on ACS (WAMED WEB).

Secondary claims management.

*(Interim HRG) Enumclaw Community Hospital, Enumclaw, WA 06/05 to 11/05

Conversion support from OPPS to CAH for Medicare Billing. Daily billing of all

inpatient and outpatient claims. Staff training of Medicare and Medicaid billing

procedures. AS400 close out.

*(Interim HRG) Eastern Idaho Regional Medical Center, Idaho Falls, ID 05/05 through

06/05 Billing of secondary insurances, Medicaid follow up and account resolution.

Posting of contractual adjustments. Research accounts for patient liability.

*(Interim HRG) Prosser Memorial Hospital, Prosser, WA 09/04 through 05/05 Billing

reoccurring accounts for SNF, PT, OT and ST claims. Medicaid billing, Medicare and

Medicaid follow up. CHPW/Molina follow up. AR management, cash posting, and denial

management. Conversion assistance. Staff training for cash posting, CPSI and OMAP

billing, and account follow up. Developed policies and procedures for Medicaid

department, the rural health clinic billing and customer service.

*(Interim HRG) Providence Medical Center, Seattle WA 03/04 through 09/04 Refund

clean-up for several Doctors, Insurance follow up, and Cash posting.

*(Interim HRG) Seattle Physician Billing Group 01/04 through 03/04 Account research

for aged inventory over 1 year from DOS. Refunds, Billing, Appeals, and resolving

patient complaints. Timely filing adjustments and reversals.

*(Interim HRG) Seattle Cancer Care Alliance, Seattle, WA 12/03 through 1/04 Insurance

follow up for all commercial and managed care companies. Appeals for Medical

necessity on reoccurring cancer treatment accounts.

Whidbey Island Chiropractic Center Oak Harbor, WA 2000-2003

Office Manager: Medical billing to several major carriers including Medicare and workman s

comp claims. Appointment scheduling, insurance follow up, Insurance verification, Updating

HIPPA compliance, Organizing office procedures, Monthly accounts payable, Payroll, Quarterly

taxes.

Whidbey General Hospital Coupeville, WA 1998- 2000

Medicare Specialist/Collections: Submission of Medicare claims electronically, Medicare

follow up, Posting remit advices, Updating Compliance Manuals, Checking claim status and

eligibility, follow-up phone calls for collections on cash patients, Educating staff on Medicare

rules and regulations.

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