Revenue Cycle Manager

LINDA A. CASEY CPC

*** ***** ***** ******, ****** Park, MD 20912• H: 301-***-****• *********@*****.***

PROFESSIONAL SUMMARY

Diverse experience with many specialties, strong leadership skills, skilled at developing policies and procedures that streamline tasks and maximize efficiencies, included but not limited to, oversite of billing, front desk and clinical departments, educating and training staff with a passionate work ethic that is infectious.

Create, develop and manage healthcare policy and procedures for 3 medical organizations and numerous clients during my tenure as a Healthcare Consultant

Hire, train and manage personnel, motivate, educate and promote teamwork among staff of 25+

Prepare and analyze monthly, quarterly and yearly billing and revenue reports of multi-million dollar practices, to ensure maximum reimbursement, timely appeal, and optimal patient payment

Prepare yearly budgets for organization with gross revenue of $950K, overseeing overhead costs with quarterly analysis

Provide professional services in organizing and operating physician offices to maximize efficiency and profitability, including front desk, billing and clinical departments

Certified Professional Coder; advise, perform chart audits, and instruct on ICD 10 and CPT coding, adhering to federal and state regulations while ensuring optimal reimbursement

Evaluate managed care contracts and reimbursement levels with ability to negotiate with managed care companies to maximize reimbursement levels

Extensive knowledge of third party billing including Medicare, Medicaid, Managed Care, Indemnity, Liability and Workmen Compensation

Extensive knowledge of State and Federal regulations concerning medical billing, Compliance and HIPAA

Oversee installation and implementation of computerized medical systems

Collaborate on innovative marketing strategies, successfully expanding client base through trade shows and seminar presentations

Advised law firms in the development of legal strategies to defend physicians on coding issues, including fraud, payback requests, and prepayment review. Prepare analysis that support physician coding practices, calculating estimated paybacks, and procedures to minimize the effect of prepayment review.

WORK EXPERIENCE

Robert C. Feldman MD PA April-August 2017

Contract Consultant

Worked with the Practice Manager to streamline billing procedures. Analyzed and improved work flow to ensure timely completion of all tasks, with a resultant increase in collections (and compliance).

Initially worked with the practice’s biller to bring charge entry, payment posting and claim submission current.

Developed processes to include reviewing and correcting claim denials that were rejected by the EHR billing system, clearing house, and carriers.

Reviewed the system databases to ensure they were created correctly, and made corrections as identified. This included working with Next Gen, if needed. These corrections included updating incorrect carrier information, changing defaults to the automatic posting of co-pays to stop the need for moving payments to the correct line item and stopping the creation of false credit balances.

Charge entry, including reviewing CPT & ICD 10 assignment and reviewed medical records to ensure appropriate documentation

Reviewed the claim process and developed the following:

oTimely filing of both paper and electronic claim submission including correction and resubmission of denials

oReviewing old AR to identify claims that were still within timely filing, initiating follow-up and resubmission

oWriting of uncollectable AR due to timely filing and timely appeal to create an accurate, collectable AR, creating specific write-off codes to capture not only the amount but to identify issues that resulted in non-payment

oDeveloped patient payment plans to work on improving patient payments.

oRevised the process of charge entry to include documenting the process of charge capture and timely posting, including working with the physicians as needed

Review and follow up with carriers to identify which physicians were credentialed, and which needed to be credentialed, including initiating the credentialing process

Education and training of the Front Desk and Call Center personnel on billing processes and dealing with the education of the patient, to ensure not only compliance but engaging them in being part of their care from start to finish

Advantia Health, Maryland Physician’s Edge 04/2016 to December 2016

Director Billing Department

Managed Billing Department for Advantia Health a physician founded, patient focused, future oriented company dedicated to focusing on women’s health issues. Having started with OB GYN services, they also have a Pain Management physician specialist and a therapist focusing on Mental Wellness and as well as a state of the art Ambulatory Surgical Center. Currently with 50 physicians on board, their goal is to continue to build an integrated team of multi - specialty physicians to provide services with a co-centric approach for the complete care of woman today. My current duties include the following offices OB GYN Associates, Advantia OB GY Germantown. Advantia Spine & Pain Management, Advantia Mental Wellness, and the oversite of the Advantia Health Indian Creek Surgery Center billing company. Duties not only include oversite, but completion of tasks whenever needed.

Oversite of the billing department and related departments including Front Desk staff, the OB coordinator, scheduling and surgical and procedural service authorization and reimbursement, disability forms and medical record requests.

Oversite of posting charges, monitoring missing slips, working with physicians to ensure timely completion

Oversite of billing company of ASC, including monitoring and assisting in deposits, reporting to company, review of monthly billing reports and authorization of refunds.

Audited medical records, reviewed physician coding, and CPT & ICD assignment, educated and worked with physician on identified coding issues.

Reviewed, educated and worked with ASC coder to correctly code surgical claims and appropriate ICD 10 assignment.

Collaboration and oversite of consultant services assisting in resolution of old AR, COB, Hold and Manager Holds and scrubbed, soft and hard denials of electronic billing.

Oversite and review of payment posting by EMR company, identifying systems payment posting errors, coding errors and areas that need stronger policies and procedures

Reduction in Insurance AR, resolution of old AR to ensure accurate and collectable accounts receivable. This includes identifying claims that are past timely submission and appeal and implementing standards to reduce the reoccurrence of denials and uncollectable claims

Reduction in Patient AR through a proactive approach of setting up payment plans and timely review of accounts, to identify those that need to be turned over for further collection action.

Proactive approach, working closely with Supervisors in developing staff skills, to maximize their potential through training and education

Monitoring and completion of buckets, overseeing timely completion of staff buckets also,

Development of reports utilizing transaction wizard, report library, best practice reports and various others.

Strive to maximize tools provided by computer EMR system, Athena

Daily deposit creation from all departments and reconciliation

Special project to review patient credit balance, insurance refunds to validate and authorize appropriate refunds

Western Maryland Interpretive Association – Antietam National Battlefield Sharpsburg, MD 06/2012-06/2015

Operation Manager

Developed and implemented policies and procedures for both the sales floor and warehouse operations

Receiving, correct pricing, and organization of inventory in warehouse

Led shifts at store, ensuring excellent customer service and adherence to policies and procedures that included, restocking, internal controls and merchandising

Assisted in annual budget preparation and quarterly review of budget

Snyder Cohn 06/1999-06/2012

Senior Manager/Healthcare Consultant

Worked with numerous offices, completing office reviews, focusing on front desk and billing areas, scheduling and clinical staff to help improve efficiencies, develop strong policies and procedures with recommendations on how to implement these. Analyzed collections and reimbursement to improve both insurance and patient collections. Our approach was to work with management and staff in a collaborative manner to foster teamwork and success

Certified Professional Coder. Completed chart audits for benchmarking which also included physician training and follow-up as needed and second audits as indicated.

Collaborated with legal firms to develop compliance plans, assisted in legal cases, including but not limited to cases involving Medicare and the US Attorney General’s office

Prepared and analyzed monthly, quarterly and annual financial reports that included collections, insurance reimbursement, for numerous physician offices

Analyzed and negotiated managed care contracts to obtain highest reimbursement possible.

Developed and presented seminars including Front Desk training, ICD 9 and CPT coding, and Compliance to groups, including hospital physician offices and the D.C and Montgomery County Medical Societies

Washington Nephrology Associates November 1998-May 1999

Director of Patient Accounts

Oversaw all aspects of Accounts Receivable, including the Billing department with a billing staff of four, and Front Desk of six offices in the metropolitan area, developing and implementing policies and procedures, and training and educating the staff

Financial analysis of billing and collections and presentation of analysis weekly and monthly to Board

Professional Billing Associates, Inc. October 1990- June 1998

Medical Business Consultant

Founder and Vice President of a full service, central billing office company

Rendered consulting services to physicians, evaluating, recommending and managed staff

Trained, motivated and managed staff of eight account representatives who filed and tracked third party payments and billed patient account receivables for 28 practices

Friedel, Hinkes, & Schneider, M.D., P.A. June 1984-February 1991

Billing Specialist

Maintained billing department of multi-million dollar orthopedic practice

Completed, submitted and tracked third party insurance

Balanced billed patients, arranging payment plans when necessary, ensuring compliance with agreement, reviewed ICD and CPT coding, examined and analyzed managed care contracts, and ensured reimbursement was correct

Randolph Hills Therapeutic Services (Subsidiary of Friedel, Hinkes & Schneider, MD, P.A.)

Office Manager

Established and developed office protocol

Billed and tracked third party insurance, including ensuring all authorization needed was obtained, verified correct reimbursement was received, appealed claims as needed

Patient account receivables and

Collection work, including filing in small claims courts when necessary.

EDUCATION/SKILLS

Frostburg State University B.S., Political Science

Certified Coder

QuickBooks proficient

Continuing education in medical billing and management

Most current EHR systems, Athena and Next Gen

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