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Customer Service Management

Location:
Yukon, OK
Posted:
September 29, 2018

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Resume:

Pang Amanda Xiong

*** **** *****

Yukon, OK *****

720-***-****

ac676k@r.postjobfree.com

Highly motivated professional with 15+ years of experience in HealthCare, Facility and Physicians Accounts Receivable, Commercial Managed Care in Facility, Physicians, and Correctional Care Payer Contracting, Team management, and Staff training. Organized self-starter who takes initiative in developing, motivating, and mentoring staff members in order to build employee engagement and maximize productivity. Quick learner with adaptable skill set, including strong technology skills and background in accounting, as well as exceptional interpersonal skills, with proven success in developing new ideas and advancing company objectives with consistent adherence to deadlines to include decrease in A/R Aging and Positive Financial cash collections.

Core Competencies:

Strengths includes; Development, Visionary Leadership and Organizational execution

Direct Commercial Payer Contracting and Reimbursement (Facility, Physicians and Non Contracted Payers)

A/R trending analysis experience. in Health Care: Payer Contracting, Revenue Cycle in Commercial A/R and Reimbursement.

Staff Development & Leadership

Positive Payer contracting relationship with the largest Commercial Payers to include Anthem, Cigna, UHC, Aetna and Kaiser

Experience in process design, implementation and planning of Systems

Highly organized, Self-motivated, with the ability to multi-task.

Outstanding communication skills both written, verbal, and Leadership experience.

Technical Skills; Exceptional knowledge of EPIC, HURON STOCKAMP System, Siemens Contract Management System (CMAR), Sorian Financial, MS Office Applications, Invison/SMS, EDM, Signature, Crystal Reports (SQL), Med Assets Claims System, NTHRIVE Electronic Billing System. MS Office, Visual, Excel

Excellent problem solving and customer service skills, as well as a strong positive work ethic

NICHE specialty clinics: Educate providers and staff regarding performance on RBRVS, RVU’s and RVP

Coordinate Operational and Clinical JOC meetings with Key Commercial Payers

High familiarity with HIPPA Standards (including PHI)

L.E.A.N process improvements

Professional Experience

Children’s Hospital of Colorado, Commercial Contract Managed Care

Operations Supervisor Aurora, CO July 2015- July 2018

Supports Director and Manager on day to day operations of the Commercial Programs Department.

Manages system reports pertaining to the department.

Analyzes and reviews high dollar reports to address, escalate, and resolving complex high risk accounts with all Commercial Payers

Reviews and approve accounts for contractual adjustments, requests for write offs, and Denials Management.

Reviews performance of associate’s work list and work queues to ensure inventories are effectively flowing.

Assists associates with A/R high dollar collection efforts as needed.

Negotiates discounts with non-contracted payers through LOA and SCA,Have full understanding of payer contracts and reimbursement methodologies.

Responsible for coaching, mentoring, modeling best practices, scheduling, managing Kronos Paid Time Off (PTO) and day-to-day performance for direct reports.

Performs random audits on patient representatives’ accounts for quality control.

Attends and facilitates internal, external department and payer meetings to improve overall operations and collections.

Assists in the development of policies and procedures for the department.

Supports associates in training needs and day to day floor operations.

Performs personnel performance appraisals and disciplinary actions.

Performs customer service and problem solving with patients and Children's Hospital Of Colorado customers in mind.

Recruits, screens and selects applicants for Accounts Receivable Representative roles. Evaluating and selecting internal and external talent to ensure the best match between the individual and the work requirements.

Develops clear goals and objectives for performance management and effectively communicates accountability. Setting high goals for personal and group accomplishment; using measurement methods to monitor progress toward goals; tenaciously working to meet or exceed goals while deriving satisfaction from that achievement and continuous improvement.

Provides supervision to a team of 15+ Accounts Receivable Representative professionals in the Commercial Contracting Managed Care /Patient Financial Services department.

Sisters of Charity Leavenworth Health Care Systems (SCL), Commercial Programs

A/R Commercial Programs Supervisor Denver, CO Sept 2012- Jan 2014

Supervise, manage and lead all Commercial Programs Analyst team members

Proactively engage with client specific Project Managers to ensure the CPA team members are meeting their performance expectations in order to achieve desired metrics, desired client performance satisfaction levels, and to operate in a profitable manner

Performs personnel functions such as counseling, coaching and performance review

Review the daily AR and aging report for 7 Facility in the country to include identifying trends

Assist analyst with AR follow up on high balance accounts and working with Payers to resolve issues either via phone calls or JOC Meetings

Manages over 10+ employees

Hospital billing and collections for all medical financial classes (i.e. Medicare, Medicaid, WC, HMO, PPO, CI and Self Pay)

Review, monitors, and oversee Denials management

Denver Health, Contract Management Denver, CO May 2006-May 2012

Contract Administrator & Reimbursement Analyst

Responsible for the management of several commercial contracts, contract negotiations, contract reimbursement modeling, Coordinates communication with Payers including monthly/quarterly Joint Operations Committee (JOC) meetings for Behavioral Health, Clinical JOC, Physician and Facility. Handles operational issues, under payments audits, maintaining payer report cards, and staff education/presentations on new and existing contracts and financial reports for various departments. Knowledge of commercial and government rules and regulations regarding billing and reimbursement, development of useful tools related to contracts for billing and registration staff.

Working with CDM, Facility and Physician Billing on contract issues, understanding contracted rates, claim denials, improving A/R days and increasing revenue.

Performs periodic audits to ensure compliance with billing requirements and reimbursement policies for Facility, NICHE Clinics, and Providers. Handle weekly reimbursement analysis for Facility and Physicians. Reviews of coding issues/guidelines, commercial contract carve outs to obtain a higher payment rate, Negotiate Letter of Agreements with Non Contracted Payers for patients. Address operational and contract issues between Denver Health providers, patient, registration, utilization management, staff at current hospital/facility and insurance company to ensure that we maximize the highest reimbursement for our level of care.

Implementation of the Siemens Contract Management System (CMAR), Responsible for the loading and maintenance of Contract terms within the Contract Management Module. Work closely with the Siemens Consultant team. Assure that contracting rates are loaded based on the terms of the contract agreement. Results with the development of underpayment variance reports

Reviews and analyzes reimbursement reports from contracted and non-contracted payer sources for payment discrepancies. Calculates appropriate reimbursements based on State and Federal regulations and contracted terms.

Tracks and prepares summary and detailed data regarding denials, and payment discrepancies by Payers in a format appropriate for presentation to executive staff.

Plans, develops, and executing strategic initiatives related to the development and growth of contracts.

Preparation of initial proposals and updates for integrating programs with other entities.

Denver Health, Patient Accounting Denver. CO Aug 2005-May 2006

Cash Application/Accounting Technician:

Process internal reporting related to period end financial statements and the timeliness of each period end close.

Process/ review complex journal entries and oversee day/ week period end closing journal entry.

Prepare/review monthly/quarterly deposit and posting accounts. Maintain necessary paper work related to journal entries and reconciliation.

Research and respond to all cumulative and yearbook report questions/inquiries.

Reconciliation of balance sheet accounts in a timely manner to ensure the accuracy of financial statements, making recommendations to distribution staff regarding the correctness of these accounts and correcting entries deemed necessary through analysis.

Exporting Medicare, Medicaid, and Daily Cash data reports through Monarch importing through Access into excel files.

Work with management to identify and develop enhanced reporting.

Duties also consist of Charge Capture Specialist stated as below.

Backup to Application Analyst on month end reports

Denver Health and Hospital, Patient Accounting Denver, CO Feb 2003-Aug 2005

Charge Capture Specialist:

Accurately resolve patient and insurance credit balances through researching a variety of sources including PB balances, outstanding patient and insurance balances.

Process refund requests and ensures timely, accurate data entry for the cash application team.

Works closely with A/P in the check writing process.

Reconcile check register with refund payment request.

Initiates proper contact with third party payers, DHHA clinics, agencies, and patients/guarantors to obtain information for the resolution of payment issues.

Utilizes software applications and information systems to perform work process with patient accounts.

May assist in batching or vouchering payments, or assist with distribution of work to other members of the unit.

At all times, ensure accuracy of payment posting.

Back up to Accounting Technician for all reporting

University Physician Inc. Denver, CO May 2001-Feb 2003

Fee Coordinator/ Facility Coder:

Review and process professional charges for the Department of Orthopedics, Sports Medicine, and Denver University Physical Therapy and ensure accurate and timely billing. This included verifying billing information, assigning accurate ICD-9 codes and determining the need for any CPTs or modifiers.

Provide research and analysis of patient accounts to maximize faculty professional income.

Codes surgery procedures as well as data entry of UPI charge and payment batches, completion of control totals and submission.

Verifies financial information for Pre-Certification of surgeries.

Worked edits and rejection reports.

Interact with supervisor, physicians or administrative personnel to communicate documentation issues, coding concerns, and changes in coding rules or other information relative to coding and documentation

Adhere to AMA coding guidelines

University Physician Inc. Denver, CO May 1999 - May 2001

Accounts Receivable Specialist/Billing:

Follow up and collect on accounts for assigned medical school divisions using the online PCS process.

Review and resolve accounts and prepare charge corrections as necessary.

Appeal assigned carrier denials, recall accounts from collection agencies, and work with carriers, physicians, and/or staff to resolve account issues.

Verified Medicaid eligibility through the COIN and Winasap systems.

Assisted with special project.

Retrieve information form Clinical workstation. Posted insurance denial and patient co pay into the system. Transfer and move co pay to corrected invoices.

Research insurance and patient overpayments and make refunds if necessary. Process daily cash deposits.

Education:

Diploma- General Education

References available upon request



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