Manager Medical Billing
Resume:
Boca Raton, FL *****
******@*****.***
MARILU BUSTILLO-HIDDO
OBJECTIVE
Endowed and skillful Healthcare Staffing and Financial Services proficient with wide-ranging background with Healthcare compliance and legal experience. Fervent team player with a robust work ethic and innovative complex problem-solving skills. Able to develop and implement effective policies and procedures, perform strategic planning, and carry out information system design and management. Proficient at re-organizing processes to expand operations. Prior knowledge in account management. Ability to advance associations with clients, partners, and government agencies with outstanding presentation complimented with communication skills.
PROFESSIONAL
DIRECTOR OF COMPLIANCE– THE TREATMENT CENTER OF THE PALM BEACHES
4/2018 – Present Implements systems and processes designed to ensure compliance with applicable laws, regulations and standards. Interprets federal and state regulations and develops administrative policies and procedures to implement them. Provides compliance monitoring, reporting, training and advice to the department. Translates vision into tangible plan and develops clear compliance goals and objectives that support the department. Investigates reports of problems or suspected violations and takes corrective action as necessary. Oversees completion of all compliance applications, correction plans and reports as required. Works with Department Directors and key staff regarding compliance issues, applications, audits, scheduling, reports and documentation. Audits systems and evaluates processes to ensure compliance to standards and policies. Establishes methods to improve efficiency and quality of services, and to reduce vulnerability to fraud, abuse and waste. Develops, coordinates and participates in educational and training programs that focus on the compliance program for staff, subcontractors, vendors, etc. Oversees development data collection tools and gathers statistical data as required by regulations. Provides coordination and oversight for state and federal monitoring visits and compliance. Liaisons with the Law Department for interpretation of laws and regulations. Ensures compliance with all treatment center regulations. Provides supervision and oversight to the Program Coordinator assigned to manage and HIPAA compliance for the department.
CREDENTIALS MANAGER/HEALTHCARE COMPLIANCE CONTRACT OFFICER
NIGHTINGALE NURSES, BOCA RATON, FL
7/24/05 – 4/11/18
Audit, process, and distribute confirmations/professional services agreement. Review all submitted placements for accuracy against contract terms. Create confirmations for both clients and travelers that reflect commitments. Respond to requests for clarification of placement contract terms. Financial reporting and financial analysis. Coordinate and execute a comprehensive Joint Commission Standards audit of submitted assignments to verify all elements. Act as liaison between sales representatives, hospitals and support departments. Responsible for training analysis, design development, and appraisal of a wide variety of compliance training initiatives. Safeguarding Manage Ethics the company adheres to legal standards and in-house policies. Providing guidance regarding established corporate wide compliance program, policies and procedures to ensure adherence to applicable laws, regulations and other governmental requirements as appropriate. Investigate compliance related concerns ethics cases, HIPAA/HITECH violations, controlled substance and ADA complaints. Expertise in Criminal Background and Drug Screenings, Health Care documents, as well as American Heart Association Guidelines and various specialty requirements for RN's and Allied professions.
Leads, coordinates, and monitors the review and analysis of clinician applications and accompanying documents, ensuring eligibility. Managed Third Party VMS Systems - ShiftWise, People Fluent, Vizient, Zero Chaos, Field Glass, etc. Monitors the initial, reappointment and expired process for all medical staff, ensuring compliance with regulatory bodies, as well as Medical Staff Bylaws, Rules and Regulations, policies and delegated contracts to insure files are prepared for audits. Reporting directly to the Vice President serving as a regional compliance resource. Responsible for the company’s Code of Conduct implementation, protocols, internal audits and investigations. Assist Travelers with Joint Commissions and Hospital Specific Requirements to be compliant for contract. Ensure consistent and complete verification of traveler’s credentials prior to start date. Serves as the main point of contact for Document Compliancy for the company for license and employment verification, references, skills checklist, certifications and client specific requirements. Scheduling medical documentation for travelers.
MANAGER BILLING & COLLECTION - SAGE LAW OFFICE
SUNRISE, FL
01/01/99 – 06/01/05
Assist the Director of Administration for the FDCA as well as state and federal collection laws. Training of collectors to all levels of management compliance healthcare laws and knowledge HIPAA regulations in all phases of medical billing Managed Care Compliance, Medicare, Medicaid, Tricare, HMOs, PPOs, and private insurance carriers, including secondary insurance claims with outstanding record with Worker’s Compensation, auto, and personal injury claims. Working with Billing Analyst to complete QC and audit projects. Negotiate hospital contracts, managing accurate billing, reimbursement and overall troubleshooting. Knowledge of healthcare billing policy & payer requirements with strong organization skills. Providing solution and strategic planning activities to internal clients and region. Implemented successful system for intensive and comprehensive follow-up for nonresponsive insurance companies approaching the 30-day limit for payment. Improved practice’s collections/cashflow; organized record keeping and ageing report, significantly reduced bad debt write-offs. Recommendation of filing suit to clients. File appeals with insurance carriers, prepare correspondence for bank and payroll garnishment, negotiates settlements options. Participate in regular meetings and communicates opportunities for process improvement.
LANGUAGES - FLUENT SPANISH AND ENGLISH
CERTIFICATES - A.C.A – Certified Collector, C.P.A.R and Advanced C.P.A.R.
EDUCATION
BACHELOR OF SCIENCE: BUSINESS ADMINISTRATION 3.5 GPA - ITT TECH ATLANTA, GA
INSURANCE BILLING FOR 3rd PARTY BILLING - National Education Center
MEDICARE GUIDELINE – Medicare Guideline & Billing Seminar
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