Tyler, Texas, **503
Home Phone: 713-***-****
Bachelors Business Administration in Healthcare Administration, University of
Houston – Victoria (Victoria, Texas)
To strategize, develop, and manage efficient and profitable compliant lab business processes
Summary of Qualifications
Administrative Lab Knowledge and Experience:
Leadership and team player
Customer service and client retention
Third party billing and compliance for Commercial, Medicare, and Medicaid health plans
Direct Contract Client billing and billing compliance
Billing Client mix: Independent Labs and Hospitals, Rural Hospitals and Clinics, Independent Physician, Pathology, Dermatology, and OB-GYN Practices, Skilled Nursing Facilities, Assisted Living Facilities, Petrochemical Industries, Urgent Care Centers, Ambulatory Surgical Centers, FQH Centers, …
CPT, HCPCS, Billing Modifiers, HIPPA, ICD – 10, Stark, AKB, False Claims Act, …
Front-end and back-end revenue cycle management
Outpatient Hospital and Provider-Based lab billing processes
Management of Lab Charge Description Masters
Financial reporting and management
Fluent in English and Spanish
Information Technology Knowledge and Experience:
McKesson STAR Hospital Information System
Epic Hospital Information System
McKesson Horizon Lab IT System: Horizon Order Management, STAR SQL Vista Reporting System, STAR Compliance Module, STAR Lab Description Master
Cerner Millennium Lab Information System
MISYS Laboratory Information System
MedAssets Revenue Cycle Management System
TELCOR Revenue Cycle Management and Billing System
Relay Health ePremis Claims Billing System
CARE-EVOLVE Lab EMR: ABN Medical Necessity Compliance, Lab Test and Insurance Compendiums, Lab Charge Description Master, and Contract Client Billing Modules
FrontLine Lab Inventory and Logistics Tracking Information System
Microsoft Office, Open Office, LibreOffice Suites
Health System Laboratory Billing Manager, CHRISTUS Trinity Mother Frances Heath System, Tyler, Texas 2016 - present.
Successful management of the health system's lab billing and compliance processes within the eight Hospitals, eighty-two clinic locations and Urgent Care Centers, and the health system's Independent Lab - CHRISTUS TrinCare Laboratories.
Led and managed the 2016 CMS PAMA (Protecting Access to Medicare Act, 2014) commercial payer lab fee schedule reporting project for TrinCare Laboratories. The project was completed successfully and prior to deadline.
Manage and maintain Lab Charge Description Masters. The system is comprised of multiple lab test ordering, test performing, and billing locations. Lab Charge Description Masters are continually monitored for optimum billing and compliance performance.
Within six months of employment, successfully reduce insurance claim bottleneck issues of approximate twenty-one million dollars in held outpatient claims due to lab billing and compliance issues related to outdated Lab Charge Description Masters, unresolved NCCI and MUE Edits, out of range dates of service issues, and medical necessity billing issues.
Perform lab review and adjustments on all insurance claims flagged for billing issues.
Continually improving medical necessity outcomes by continued monitoring, developing best practice processes and physician alignment throughout the health system and at TrinCare Laboratories. Within the health system, in the past two years, denials due to lack of medical necessity have decreased by approximately thirty percent. Lab billing outcomes continue to improve.
Developed more efficient and compliant billing processes at CHRISTUS TrinCare Laboratories so-as-to solidify their foundation for successful growth within and beyond their current marketing regions. By continued review of lab denials with staff billers, this company has dramatically decreased first pass denials. Medical necessity denials decreased by approximately twenty-five percent within fourteen months and lack of authorization denials decreased by approximately twenty-five percent within the same time period. Lab billing outcomes continue to improve.
Provide ongoing training and education regarding billing compliance, Stark Law, Fair Market value and pricing, Anti kickback Statute, False Claims Act, and HIPPA to TrinCare staff Billers, Marketing Reps, IT staff, Customer Service, and upper leadership for continued efficient and compliant billing outcomes.
The health system employs both hospital-based and provider- based billing processes and therefore, billing for services are performed on both CMS 1500 Claim Forms and CMS 1450 (UB-04) Claim Forms.
Act as a daily resource for solutions to lab billing issues and inquiries by Corporate Business Office Billers, Hospital Billers, Revenue Integrity Staff, TrinCare Laboratories Billers, and Certified Professional Coders who are positioned in the community clinics located throughout the health system.
Laboratory Financial Coordinator, St. Joseph Medical Center, Houston, Texas, 2004 – 2016.
Management and development of all daily, weekly, and monthly lab financial reports for Lab Leadership, Hospital Accounting and Business Office departments, and lab clients.
Management of lab outpatient third party Commercial, Medicare, Medicaid, and Direct Contract Client billing, billing compliance, and Customer Service departments.
Involved in interviewing, hiring, and training lab Customer Service staff and Lab Registration staff in correct registration processes, confirming patient identity, insurance verification and authorizations, medical necessity, correct information on lab requisitions and contacting ordering clients regarding incorrect or missing information on lab requisitions, and HIPPA requirements.
Lab liaison to all lab clients regarding customer service, billing, billing compliance, credentialing, maintaining appropriate lab supply inventory, and other problem solving.
Lab liaison team member on Corporate billing denial teams, billing compliance teams, and Hospital Managed Care Payer contract review team
Development, management, and quality control of lab billing compliance, Charge Description Master, and lab billing information systems.
Two successful Lab Charge Description Master integrations through two merger and acquisition conversions. Received excellent audit results from two separate Corporate Compliance departments, Lab Leadership teams, Business Office departments, Revenue Integrity and Accounting departments.
Development and maintenance of all lab billing, billing compliance, and registration policies and guidelines for Hospital Lab Outpatient, Lab Outreach, and Reference Lab departments.
Close team work with other facility departments to develop more efficient and successful lab billing and compliance processes and outcomes. Reducing first pass denials, improved AR, improved customer service, and reduced client turnover.
Management and maintenance of all facility contract client bill accounts. Management and maintenance included Customer Service, Invoicing, Accounts Payable, Accounts Receivable, Financial tracking, Pricing review and adjustments, and Billing compliance.
Laboratory Reimbursement Coordinator, CHRISTUS St. Joseph Hospital, Houston, Texas, 1999 – 2003.
Laboratory Liaison team member involved in installing facility wide McKesson Horizon Lab Compliance Information system. Management of lab billing compliance, Lab Charge Description Master, and lab test compendium data bases.
Management and maintenance of CARE-EVOLVE internet-based physician lab order entry and result, and electronic medical records information system.
Management of Lab Customer Service and Lab Outpatient Registration departments.
Reduced billing denials by approximately forty percent within the first three months.
Performed as Laboratory Safety and Security Officer and liaison to Hospital Safety Security teams from 2001 – 2003.