Jen Grimes

Email: ac67a8@r.postjobfree.com

LinkedIn: https://www.linkedin.com/in/jengrimes1

Summary

Seventeen years of experience in compliance assurance in the form of training, mentorship, extensive auditing and investigation and fifteen years of experience in the development, customization and implementation of Corporate Compliance Plans provides me the ability to quickly interpret the needs of an organization and seamlessly initiate the necessary steps and staff to ensure appropriate reimbursement and accurate documentation. Six months in to my employment at Presbyterian Homes, I was asked to join the Corporate Compliance Committee (CCC). One of the concerns I was requested to address was regulatory compliance with Medicare, Medicare Advantage, commercial insurance and Medicaid resident services. Through a combination of staff education, training and the development and implementation of new workflows which focused on improved documentation, charge capture and the building of better relationships with vendors, all campuses increased their program compliance success rate from less than sixty percent to over ninety percent in six months. All campuses maintained this ninety percent success rate during my employment. My management experience includes teams of all sizes, ranging from 5 people to 200+ and encompasses managing both individuals and other managers. I provided training across multiple disciplines to include the Directors and Assistant Directors of Nursing, Healthcare Administrators, MDS Coordinators, Rehabilitation Directors, Social Service Directors, Healthcare Admission Directors, Business Office Managers, Medical Supply/Records/Accounting Clerks and Executive Directors. Regular interaction with residents, their families, vendors, campus leaders, vice presidents and C-level executives either in person or via telephone and email exchanges means I am comfortable interacting and collaborating with any and every client, vendor and employee on any platform. Core Competencies & Technical Skills

Medicare, Medicare Advantage and Medicaid Regulatory Compliance Clinical Documentation Compliance Medical Billing and Coding Regulations Medicare and Insurance Claim Denial Management CPT, ICD-9 & ICD-10 Staff Supervision and Development Physician Credentialing Medicare Skilled Nursing Facility Credentialing Patient Admissions Management Revenue Capture and Cash Flow Management Insurance Pre-Certification/Pre-Authorization Medical Billing EMR Systems

System Selection, Implementation, and Training

PointClick Care, Vision, eClinical Works, Medics Elite, DocAssistant, Medical Manager, Lytec, HDSI, InfoSys (MedSys and HomeSys), Paradox, Galaxy & Practice Fusion

Ancillary Systems

MyAbility Suite, Availity, CareWatch,

UBWatch, FileZilla

Kronos – Implementation and Training

Professional Experience

Aperion Care Lincolnwood, IL

Corporate Clinical Documentation Specialist (Remote & Onsite) September 2017 – April 2018

• Claim ADRs

o Reviewed clinical documentation to respond to claim ADRs, HEDIS Audits, Medicaid Audits and appeals o Identified issues causing claim ADRs and Audits

o Trained facility staff on more efficient systems to accurately document care provided. o Updated claim ADR and Audit submission processes to align with HIPAA standards.

• Triple Check Process Training

o Educated interdisciplinary teams on more effective ways to Triple Check claim data and clinical documentation to avoid rejected claims, claim ADRs, and focus audits.

o Coordinated with Billers, Reimbursement Consultants, and facility IDT teams and created a recurring Triple Check meeting schedule to avoid inefficiencies.

• Internal Medicaid Mock Audits

o Team Lead during the mock audits, created and maintained audit and re-audit schedules. o Selected audit sample medical records in preparation for the mock audits. o Reviewed documentation in preparation for real Medicaid audits. o Completed and submit the mock audit result reports. o Trained facility staff on more efficient systems to accurately document care provided for more successful real audit outcomes.

• CareWatch

o Worked with vendor to set up seven newly acquired facilities, obtain usernames and passwords for all users at new facilities. o Established six new corporate regions within the software and ensure all existing users have appropriate access. o Coordinated training for new and existing facilities.

• Subject Matter Expert

o Acted as a resource for the Clinical Reimbursement and Billing Teams for billing and or regulatory questions related to Medicare/Medicaid.

o Presented at Regional MDS meetings upon request on Medicare/Medicaid regulations, Triple Check process, ADRs and audit documentation compliance.

Presbyterian Homes Evanston, IL

Corporate Billing Manager

September 2014 – September 2017

Lead a team that encompassed Corporate Physician Billing/Coding Coordinator, Business Office Managers, Accounting Clerks and SNF Medicare Billing/Coding coordinators. Provided concierge-level customer service and engaged residents participating in various committees to educate them on their rights and benefits within various payer programs. Served as Subject Matter Expert on Medicare, Medicare Advantage, Medicaid, and commercial insurance plans and benefits. Collaborated with Admissions and Billing teams to obtain appropriate authorizations for care services.

• Implemented and managed Medicare Compliance program for all Life Care Community (LCC) Campuses and Outpatient Therapy Clinics o Audit Medicare, Medicare Advantage, Medicaid, and Insurance claims for regulatory compliance and accuracy o Increased Medicare A, B, & C initial claim submission success rate to over 90% for 15 consecutive months o Medicare 855 Credentialing applications for Re-organization, separating CCRC into individual entities

• ICD-10 Training and Implementation at all LCC Campuses and Outpatient Therapy Clinics

• Responsible for billing and collecting approximately $120M annually o Ensured the following: therapy logs met requirements for MDS reimbursement RUG, campus census documentation supported the dates of service on claims, diagnosis codes supported the claim for daily skilled services and ancillary charges supported the diagnosis and MDS assessment

• Created quarterly presentations for the Corporate Compliance Committee with detailed statistics and data analysis indicating the effectiveness of our billing compliance programs and the implemented adaptations for regulatory changes.

• Completed and maintained credentialing for Physicians and Nurse Practitioners

• Maintained, updated and troubleshot Vision and billing software for LCC Campuses and Outpatient Therapy Clinics

• Created, implemented and updated corporate billing policies and procedures and authored job descriptions for both corporate and campus-based billing employees

• Member of Corporate Compliance Committee Internal Investigation Team Infinity Healthcare Management, LLC Des Plaines, IL Billing and Credentialing Manager

December 2013 – September 2014

• Managed a group of 7 Medical Billing Specialists/Coders

• Completed and maintained credentialing for 11 physicians

• Supervised billing for 6 clinics, physician hospital rounds, nursing home visits, and home health certifications

• Managed the implementation of new EMR program at 2 clinics (eClinical Works) Chicagoland Medical Billing Specialists, Inc. Rockford, IL Co-Owner

May 2007 – November 2013

• Managed billing for 17 medical practices with over 50 medical providers including Family Practice, Physical Therapy, Pain Management, Social Worker, Psychologists, Psychiatrists, Chiropractors)

• Completed and maintained Provider Credentialing with CAQH, insurance companies, and hospitals

• Negotiated billing contracts with medical providers as prospective clients

• Conducted client meetings to ensure that CMBS was providing exceptional customer and billing services

• Trained and supervised billing, insurance verification, and credentialing employees

• Performed QuickBooks entries and managed accounts payable, payroll, banking, and invoicing billing clients

• Created and presented Marketing, Public Relations and Expo presentations

• Implemented the office network set-up and managed IT support

• Authored the policies, procedures, and employee handbooks Suburban Pulmonary and Sleep Associates, Ltd. Westmont, IL Billing Manager

November 2006 – November 2007

• Responsible for billing and collection of approximately $5M monthly.

• Supervised billing for Suburban Pulmonary & Sleep Associates, LTD. o Billed for the rounds and emergency on call services provided at local hospitals, four pulmonary function testing locations, and five sleep centers.

• Supervised billing for Pulmonary and Critical Care Consultants, LTD. o Billed for rounds and emergency on call services at two hospitals, two pulmonary function testing locations, and two sleep centers.

• Under my leadership, grew the billing department from 11 physicians to 27 physicians in one year.

• Collaborated regularly with the clinic supervisors and the accountant for the billing company. INFOSYS, Inc. Schaumburg, IL

Applications Trainer

January 2006 – November 2006

• Completed custom onsite set up of newly installed billing and clinical software.

• Trained clients on various applications of the software, regulatory guidelines and proper claims submission in medical practices including: Long Term Care Facilities, Home Health Agencies, and Hospice Companies.

• Assisted with initial billing submission to ensure constant client cash flow. Tutera Health Care Services Kansas City, MO

Director of Business Office Services

January 2002 – January 2006

• Responsible for financial operations of all long-term care facilities under Tutera management nationwide including revenue capture, billing, and collections for 55 locations, inclusive of cash collections of approximately $27M monthly

• Responsible for supervision and training of approximately 200 employees in 15 states, this included the training of all new Regional Business Office Managers and Field Financial Analysts as well as ensuring Corporate Financial Consultants were appropriately scheduled at the long-term care facilities with the greatest need

• Served as an integral part of the acquisition team for new facilities which included assisting with the set-up of computer hardware and software, training of facility personnel and establishment of new bank accounts

• Responsible for the implementation of new payroll software including training of all corporate and facility personnel

• Acted as the team leader and was primarily responsible for writing the user manual for payroll software, also co-wrote the custom user manual for the new Accounts Receivable billing software

• Revised and implemented numerous new policies and procedures affecting the business offices in multiple states

• Lead team responsible for assisting with and responding to CMS, FBI, and IRS investigation into previous ownership/management of a newly acquired facility

Senior Field Financial Analyst

October 2000 – January 2002

• Promoted to Director of Business Office Services

• Responsibilities included the training of three Field Financial Analysts with the acquisition of 32 new long-term care facilities and the education and development of the Administrators, Business Office Managers, Directors of Nursing, and Physical Therapy Managers in those new facilities as to how to better manage and capture revenue for the Medicare patients

• Lead team responsible for assisting with IL State Police and IL District Attorney investigation into employee fraud Field Financial Analyst

April 2000 – October 2000

• Promoted to Senior Field Financial Analyst

• Responsibilities included acting as a consultant to nine long-term care facilities operating in Illinois and training and monitoring of staff for compliance to corporate and regulatory standards in the departments of Accounts Receivable, Accounts Payable, Resident Trust, Payroll, and Human Resources for each home

Education

Benedictine University - Lisle, IL

Bachelor of Arts in Psychology

Certifications

Certified Professional Medical Auditor (CPMA)

Expected December 2018

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