Director of Billing Operations & Provider Credentialing

CHABEL JIMENEZ

Wellington FL. ***** 561-***-**** ********@*******.***

Professional Summary

Director of Billing Operations & Provider Credentialing

Work experience

Assistant Billing Director, Exact Billing Solutions WPB FL. 2017-Present

•Created and analyzed weekly, monthly, quarterly and yearly A/R reports.

•Managed the facility’s Accounts Receivable reports.

•Assisted in the development of the billing department guideline and procedure handbook

•Created customized reports as needed from collaborate MD.

•Defined and executed best practice strategies to manage aged receivables and optimize collection outreach activities to achieve targeted goals.

•Developed and ensured that Billing/Collection Policies and Procedures were implemented always based on JCAHO criteria and all legal and federal regulations, compliances policies and HIPPA.

•Full revenue cycle oversight (credit approval, monthly billing and timely collection of cash).

•Executed all revenue Month-end closing

•Planned and implemented quality and compliance assurance for all processes.

•Negotiated and maintained third party vendors and contracts.

•Directed personnel development; staff meetings

•Staffing discussions and planning/interviews; Team building

•Designed, implemented, and enforced policies and procedure.

•Prioritized, plan, and directed the billing department

•Streamlined effective billing processes across multiple payers and facility locations

•Directed all provider and facility insurance credentialing and contracting processes

• Handled all payment posting and account receivables and balances.

• Reviewed and completed insurance audits.

•Trained and provided guidance to staff and assessed employee performance.

•Provided direct support to billing director

•Sent monthly statements to patients.

•Oversaw and participated in the development, negotiation, implementation, monitoring and management of all managed care agreements.

•Analyzed and monitored financial aspects of existing managed care contracts.

Reason for leaving: professional growth and work opportunities.

Claims Billing & Coding Administrator, Supportive Healthcare, Delray Beach FL. 2016-2017

• Claims submission including but not limited to; inpatient, outpatient, laboratory, veteran's affairs, nutritionist, chiropractic and other ancillary services.

• Using coded data such as ICD-10 codes, CPT and HCPSC codes to produce and submit claims to insurance companies.

• Understanding all EOB or explanation of benefits.

• Working directly with the insurance company and submitting adequate documentation to get claims adjudicated and paid.

• Answering all billing questions.

• Workout bucket claims in timely manner

• Work on AR, denials and appeals

• Charge and coding Entry

•Ensured all claims were submitted daily with a goal of zero errors

•Timely follow up on insurance claim status

•Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles

•Reviewed patient bills for accuracy and completeness and obtain any missing information.

•Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.

•Worked electronic insurance rejections to retransmit with corrected insurance information.

•Worked rebills submitted to the billing department through the electronic billing system or payer source web portal.

•Comprehended authorizations and limits to coverage such as the number of visits and units.

•Submitted claims to Medicare and Medicaid and all commercial insurance companies.

Reason for leaving: professional growth and work opportunities.

Director of Billing Operations & Credentialing, Psychiatric Specialty Center LLC., W.P.B., FL. 2013-2016

•Lead and planned all billing operations for the facility

•Designed, implemented, and enforced policies and procedures based on JCAHO criteria and all legal and federal regulations, compliances policies and HIPPA.

•Prioritized a plan, and directed the billing department

•Utilized analysis for feedback on contract renewals, renegotiations or termination.

•Made recommendations regarding participation or non-participation with new or existing agreements.

•Provided technical assistance to Member Services, in charge of front desk responsibilities.

•Provided orientation, training, and evaluation feedback to the billing department staff.

•Conducted monthly staff meetings to review progress on compliance measures, discuss any changes in methodologies, review any new policies and procedures, and addressed other issues as appropriate.

•Analyzed and reported on billing revenues and trends on a monthly basis.

•Resolved staffing issues and facilitate conflict resolution for staff under direct supervision.

•Hired, disciplined, evaluated and terminated staff in coordination with upper management

•Effectively lead and retained staff by offering a good team environment and providing opportunities for staff to develop new skills

• Prepared and sent all monthly statements to patients.

• Handled collections on unpaid accounts.

• Managed all contracting and credentialing for the facility and new providers with Insurances Companies.

• Interviewed, trained and provided guidance to staff.

• Assessed employee performance.

• Maintained payroll information by collecting, calculating, and entering data as well as employee time management.

• Applied all payments in the practice management.

• Provided educational material for patients and staff members.

• Ordered medical and office supplies.

• Verifying patients’ insurance coverage.

Reason for leaving: Family emergency I had to attend to.

Personal Experience

Kipu EMR

Collaborate MD Billing systems.

Kareo Practice management and EMR.

Zencharts

Salesforce

Claims; UB04 &CMS1500

Management skills

Medical terminology.

Bilingual, English & Spanish.

Strong communication skills.

Detail oriented and work well with a high degree of accuracy and multitasking ability.

Problem analysis and solving with the ability to tactfully handle stressful and difficult situations both independently and team efficient.

Adaptability and ability to work under pressure.

Organizational skills, Planning and good customer relations background.

Employee training and hiring management.

Maintain employee confidence and protect payroll operations by keeping information confidential.

Knowledge in Microsoft Word, Excel, PowerPoint, Internet, computer savvy.

Knowledge in Electronic Medical Records, EMR, HER, ICD-10 codes, CPT and HCPSC codes and Practice Management.

Patient benefits and eligibility insurance verification.

Claims resolution

Provider contracting and credentialing.

Soft and Hard Collection

Education

Billing and coder Certification, FL AAPC – In progress

Registered Medical Assistant, FL. 2016

University: Universidad Central del Este, San Pedro D.R., Medical Doctor Degree 2013

Dominican Technical Institute, La Romana D.R., Certified Medical Billing and Coding 2012

Contact this candidate