Healthcare Revenue Cycle Medical Billing
Resume:
Santasha Calhoun
***** ***** ***** *****, ****** Garden Florida 34787
***************@***.***
Healthcare Revenue Cycle Medical Billing
Qualifications Profile
Highly analytical and goal-oriented professional, equipped with extensive knowledge in collecting, posting, and managing accounts
receivables; as well as identifying and providing resolution to client billing disputes and complaints. Knowledgeable of Six Sigma
and Lean processes necessary for medical billing and collection operations. Skilled at identifying and troubleshooting system errors,
while providing recommendations on necessary modifications and updates. Recognized for efficiency in working with discretion and
tact. Articulate communicator and team player with well-defined analytical abilities and well-honed technical aptitudes.
Professional Experience
Orlando Health, Orlando, FL
Corporate Charge Management Analyst Mar 2017–Present
Facilitate in-depth research of pertinent information to analyze charts.
Administer the collection and provision of statistical data to prepare reports to the manager.
Conduct audits and evaluate all medical record charts for appropriate documentation and charge capture hospital/professional
practice.
Fulfill a wide range of tasks in compliance with the company’s policies and procedures, including:
Project management for quality assurance;
Training and development of team members;
Evaluation of all medical record charts for proper documentation; and
Planning and coordination of facility team building activities and meetings.
Notable Accomplishments:
Performed and maintained 100% reconciliation of the time for charging accuracy.
Retrieved and prepared information for analysis from data systems for quality, cost, and utilization reports.
Assisted support staff, while coding, facilitating patient financial services, and providing nursing care in appropriate
documentation to support charging hospital/professional practice.
Maintained active involvement in quality assurance studies.
Departmental IS Consultant I Nov 2012–Mar 2017
Served as GE Centricity business consultant to oversee workflow and operational strategy of the billing software.
Took charge of determining options for the organization and offered recommendations for modification.
Developed and implemented additional resources to implement solutions.
Assumed full responsibility in directly reporting to the department manager.
Carried out key efforts, which included:
System module upgrades;
Development of system test plans;
System implementation, maintenance, and troubleshooting;
Modification of production systems and operational processes; and
Expertly handled BAR modules including, financial system classification (FSC), insurance management system (IMS), and claims form
generator system.
Notable Accomplishments:
Participated in vendor user panels or advisory groups as a subject matter expert.
Developed non-networked worksheets and databases through Microsoft Office tools, limited to purposes of individual user productivity
improvement or departmental file-sharing.
Monitored system performance and reports problems to Information Services for subsequent vendor follow-up if/as necessary.
Reviewed information technologies for future departmental use in conjunction with the consultant of Information Services.
Played a key role as project manager for the Cleanup Project on patient insurance information interfaced to and from the Affinity,
GE, and GEMMS systems.
Suncoast Medical Clinics (Acquired by St. Anthony’s Hospital) St. Petersburg, FL
Business Services Manager May 2009–Sep 2012
Managed the Accounts Receivable Business Services Department, encompassing Medicare/ Medicaid enrollment application, eligibility,
authorizations, and claims processing.
Provided expert oversight to a multi-specialty health care business services department throughout seven locations in South Florida
with over 2,000 employees and net revenues worth $9B in 2010.
Oversaw various hospital areas, including emergency care, laboratory, and radiology services, as well as primary and specialty care
medical group, while reporting directly to the chief executive officer (CEO).
Evaluated daily productivity to ensure timely processing of enrollment applications and verification calls.
Ensured prompt resolution to rejections within a 24-hour time frame.
Established and managed an Appeals and Denial Team.
Facilitated monthly one-on-one meetings with the staff to review productivity, work shortage, and quality results.
Notable Accomplishments:
Closely monitored collection performance that maintained accounts receivable by less than 40%; as well as monthly collections revenue
of $4.5M.
Demonstrated excellent skills in maintaining monthly avoidable Centers for Medicare & Medicaid Services (CMS) rejection rate by 2.5%.
Drove key efforts toward the development of quality assurance process to achieve production and performance goal by 98%.
Brought significant reduction to AR by less than 50% by thoroughly evaluating accounts receivable (Days A/R) days.
Gentiva CareCentrix, Tampa, FL
Finance Operations Supervisor Mar 2005–May 2009
Held full accountability in administering all inbound call center operations.
Provided first-rate customer service and implemented balance score cards to monitor the progression of outstanding receivables,
ensure efficient collections, and meet company goals.
Formed and managed the Patient Advocacy Team and reported directly to the department manager.
Expertly handled DME A/R valued at $20B; as well as Medicaid and Medicare accounts, including eligibility and referrals.
Prepared and submitted necessary reports by collecting and providing statistical data.
Closely monitored staff’s performance, identified training needs, and organized training sessions.
Notable Accomplishments:
Successfully reduced bad debt adjustments by 40% by developing the Patient Advocacy Team.
Created and implemented encounter sheets, which resulted in the decrease of denials by 25%.
Collected an average of $40K per associate on a monthly basis to meet collection goals.
Education and Credentials
Lean Six Sigma Green Belt Certification: 2017, Simplilearn University, San Francisco, CA
Lean Management Certification: 2016, Simplilearn University, San Francisco, CA
Medical Terminology Certification: 2012, Des Moines University, Orlando, FL
Front Office Manager Certification: 2001, Hillsborough Community College, Tampa, FL
Associate of Science in Business Administration, Major in Accounting: 1992, Buffalo State University, Buffalo, NY
Professional Development
Orlando Health Institute for Learning, Orlando, FL
2017
Coverage Determination for Medicare (CDM)
Sovera for Health Information Management (HIM) Customer Service Collections
2016
Leadership On Demand-Increasing Emotional Intelligence
Effective Listening Developing Relationships De-escalation Techniques
Leadership on Demand-Solving Business Problems Leadership on Demand-Productive Work Habits
2015
Understanding International Classification of Diseases (ICD-10)
National Labor Relations Act (NLRA) Insurance & Reimbursement Affinity Leadership Training
2014
Foundational Leadership Series–Effective Listening, Developing Relationships, Assertiveness
CRCR Exam Proctoring
2013
QBQ Revenue Management Only Session 2 QBQ Revenue Management Only Session 1
Technical Acumen
Sovera HIM SIS Sunrise Smart ID Polycom GE Centricity Business Solutions Affinity Athena Citrix Crystal Reports
GoToAssist GEMMS RICE PPID eCommerce ProVation
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