MEDICAL PRACTICE ADMINISTRATOR/MANAGER/AR SPECIALIST
** ***** ** ********** ** Healthcare Arena, with proven success in directing top-performing teams. Adept at evaluating medical facilities coordination to maximize operational productivity, efficiency, and profitability. Credentialing, Knowledge of Medical billing, coding and reimbursement. Applied advanced communication skills toward interacting effectively with physicians, staff and patients including senior executives and vendors. Highly versatile; Reputable for integrity, decision making abilities, work ethic and analytical skills.
EDUCATION and TRAINING
•Technical Career Institute (Associate Degree in Applied Science)
•Business Training Institute (Certified Medical Billing, Coding & Insurance Specialist)
•Nationally Certified Insurance & Coding Specialist, Equal to CPC.
•Bilingual Spanish fluent
Gwinnett Psychiatry, P.C 05/2017-Present
Maintain providers credentialing, licenses, hospital privileges, healthcare networks, insurance participation, hospital on call schedule
Maintain time keeping, Maintain staff attendance, hours worked, personal time off, etc… Submitted bi-weekly payroll. Updated all office technology like computers, telephones. Revised the Practice Policy Handbook.
Dekalb Medical Center 01/2017-04/2017
Collector/Primary & Hospitalist (Contract)
Performed collections for Primary Care Physicians and Hospitalist
Worked on claim denials, rejections, and collection accounts
Worked on Allscripts Application System
Pediatric Services of America 02/2016 – 07/2016
A/R Collector (Temp position)
Performed account receivable collections for home health services provided by RN and LPN nurses
Worked claim denials, rejections, worked insurance carrier reimbursement projects
Obtained reimbursement thru TPL letters, Prior Authorizations and Denial letters
Worked various programs, Image Freeway, Encore, ZirMed, Healthcare Insurance portals
Promedical Billing Services 2015-2014
Private Business Owner
Provide medical billing, coding and account receivable management services to a Multi-Physician Pediatric Organization with 3 locations with medical staff of 6 providers and 3 Nurse Practitioners.
Enter all provider charges, ensure clean claim submission on Athena Health EMR System, review, appeal claim denials, ensure proper reimbursement from insurance companies based on fee schedules.
Handle patient calls regarding account balances, send statements, and work aging reports. Provide monthly reporting on practice activity.
ABC Pediatric Group, P.C 2014-2011
Coordinated and provided administration for a Pediatric practice with a staff of 8 employees, 2 providers and 1 Nurse Practitioner and a Physician Assistant.
Maintained providers credentialing, licenses, health networks, insurance participation, and on-call schedules.
Maintained human resources to include 401K retirement plan. Maintained staff attendance, hours worked, personal time off, etc… Submitted bi-weekly payroll. Updated all office technology like computers, telephones. Revised the Practice Policy Handbook.
BiCounty Gwinnett Pediatrics, P.C 2010 –2007
Practice Administrator/ Manager
Coordinated and provided administration for a Pediatric practice with a staff of 10 employees, 2 providers and one Nurse Practitioner. Handled human resources to include employees medical, dental, vision and supplemental benefit packages.
Performed provider credentialing, negotiated insurance contracts. Organized provider participation on over 25 health insurances and 2 health organization networks.
Monitored employees timekeeping and attendance. Performed bi-weekly online payroll. And taxes. Maintained QuickBooks accounts receivable, payables, vendors, 1099’s, accountant reports, reconciliations with bank information.
Coordinated marketing strategies and advertisements. Updated all office technology like computers, telephones, and alarm systems and the practice policy handbook. Proposed and completed transition of 8,000 paper charts into EMR system. Reviewed and corrected superbills for proper coding and submission of clean claims. Reported monthly charges, reimbursement, adjustments, provider productivity, new patient growth etc…
InHealth Billing Systems, Atlanta GA 2007-2007
Medical Billing Supervisor
Supervised and monitored five account representatives which handle 7 multi-specialty providers’ accounts ensuring proper preparation and submission of medical claims in a timely manner. Responsible for a specialty provider’s account.
Prepared initial claim submission, follow-up on claim, reviewed denial codes, performed appeals and reimbursement disputes with various insurance companies for potential reimbursement on claims. Gathered, compiled and analyzed billing and statistical analysis. Audited inpatient and outpatient charts for E/M coding to maximize reimbursement. Met with providers/clients on a weekly basis to verify any issues with software, coding questions, claim reviews, consulting Etc…
Allied Ankle & Foot Care Centers, Lawrenceville GA 2007-2006
Medical Billing Manager
Responsible for coordinating, administering and building structure in a billing department with a staff of six employees.
Create, review, and submit medical claims for a Podiatry Practice with six locations, 5 providers, and participation of over 25 insurance carriers. Contact major medical insurance companies for claim appeals and proper claim processing. Post insurance payments and review EOB for proper reimbursement. Handle month-end report, charges, and payment and batch logs. Etc…
Premier Orthopedics Sports & Medicine, Suwanee GA 2007-2006
Billing Project to recover unpaid claims, Enter BB2 forms into Billing System, Bill to insurance, ensure proper reimbursement Appeal, dispute and recover reimbursement from Medicare (primarily)
International Pediatrics (La Clinica del Nino, P.C) 2006 –2004 Practice Administrator
Manage Responsible for entire administration of the medical facility with a staff of 13 employees and 3 providers. Handle human resources, credentialing of provider, Ceridian online payroll. QuickBooks, accounts receivables, payables, vendors, reports of profit & loss, 1099’s, payroll, accountant reports, reconciliation with bank statements. Hiring and firing of employees, timekeeping and attendance, budgeting. Provider enrollment and participation of health insurances and contract negotiations.
Created, reviewed, and submitted medical claims for Pediatric Practice with a volume of over 6,000 patients. Contacted major medical insurance companies for claim appeals and proper claim processing. Post insurance payments and review EOB for proper reimbursement. Handled monthly aging, and collections for self pay patients.
PediMedica, PA 2004 – 2002 Medical Billing Manager/ Claims specialist
Reimbursement follow-up and collections for Pediatric Practice of 14 providers and six offices, handle monthly aging, contact major medical insurance companies for proper claim processing,
Handle collections for self-pay members. Provided monthly revenue report for reimbursement, adjustments and collections
Patrick Coverson: 678-***-****
(In Health Billing Systems and Bi-County Gwinnett Pediatrics)
Angela Earls: 678-***-****
Healthcare Consultant, Provider Relations