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Manager Project

Location:
Delray Beach, FL
Posted:
October 05, 2018

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Resume:

Deborah L. Jones

*** ***** ***** *., ****** Beach, FLA. 33444

Email: ac7aip@r.postjobfree.com Mobile: 215-***-****

Summary

Medical Office Administrator with years of documented accomplishments providing excellent leadership and management skills. Strong analytical skills with proven ability to implement effective process improvements. Prioritizes effectively when working on multiple projects. Can quickly establish a rapport with patients, clients, peers and all levels of management. High motivational level reinforced by a professional attitude, attention to detail and pride in generating quality work.

Professional Experience

Urology Health Specialists & Ambulatory Surgery Center 2/2016 to 9/2018

Administrative Director

Responsible for the daily opertaion of 6 offices for a urology group of 14 physicians 3 NP’s and an Ambulatory Surgery Center, providing urologic, reproductive and oncologic care. Manage clerical and clinical office staff. HR,OSHA and infection control compliance. Oversees the QAPI programs. Assures appropriate staffing for office and surgical suite efficiency. Maintain credentialing for all hospital appointments, Joint Commission accreditation as well as up to date licensing with all federal, state and local agencies.. Maintain, update and report all CME activity. Update and communicate physician schedules/on call schedules. Oversee daily billing procedures. Approve all office expenditures and cap ex recommendations. Manage and facilitate all building maintenance contracts and daily operations, and manage all relocation activities.

Abington Pulmonary & Critical Care Assoc. Ltd

Practice Administrator

Oversee the day to day operation of the practice, assist in development of the operating budget, identify capital needs and manage expeditures. Manage accounts receivable, productivity, and identify benchmarks, best practices, delegate staff appropriately. Assures adequate staffing, monitoring overtime and HR compliance. Oversee vendor contract requirements and compliance. Identify and communicate IT needs and assures HIPAA and security compliance with IT software/hardware infrastructure. Develop and implement marketing strategies and materials. Plans and facilitates management and staff meetings. Communicates the mission, vision and values of the practice ensuring the highest standard of patient care and services are provided.

Center For Women’s Health

Manager

Responsible for A/R cycle management to include ; charge capture and posting, CPT/ICD coding principles, payment posting, write off controls. Responsible for credentialing, contract negotiatition, fee analysis

hiring, training, personnel issues and month end financial reporting to partners. Authored RFP for EMR/Practice Management software selection and implementation. Project Manager for NextGen purchase and software conversion. Promote and market ancillary services offered as a women’s center, i.e. Skin care, Apogee Laser, Massage, Nutrition and Acupuncture.

Implemented lockbox for cash deposits/posting

Implemented ERA for insurance payment posting

Created SOP for all billing office procedures

Enrolled practice in Care Credit Patient Financing

Improved net collection ratio through process improvements by 12% in 90 days

Authored/implemented HIPAA training and compliance manual.

Maintain PC’s and address all software/hardware application needs

Create marketing materials (flyers, brochures, Media ads, Facebook and website)

Documented all billing department job descriptions

Project Manager for Nextgen EMR implementation

1201 PEDIATRIC GROUP

Independent Consultant

Analyse office processes, documented all office processes and procedures and facilitated implementation of recommended changes. Documented all personnel job descriptions, authored / published employee handbook. Analysis of A/R with recommendations for assignments after bringing billing in house. Recruitment and hiring of an Office Manager with ongoing mentoring and training.

INTERNATIONAL SOS Assistance,Inc

International Claims Billing Manager

Responsible for the daily operation of the “health care management” staff negotiating discounts, processing claims, working with providers, PPO networks and corporate clients to ensure American quality health care delivery, access, and guarantee of payment for expatriate medical expenses. Liaise with insurers to provide cost containment services for medical expenses of international employees working in the Americas. Responsible for all CPT/ICD9 coding/ training. Manage the Americas Tricare claim process for all Active Duty military members.

Documented and implemented standard operating procedures for the claims department.

Created, implemented “webinar” CPT/ICD9 training sessions for European/Asian offices.

Implemented a Productivity and Quality Control benchmarking program for claims and invoices.

Facilitated testing and training for billing software upgrades.

Drafted HIPAA compliance manual for International SOS Assistance (Philadelphia).

Interpreted HIPAA implementation guidelines for IT Project Manager and mapped ANSI 837 & 835 for claims submission/ remits.

Manage the global remote Tricare claims processes~EDI, coding, and AR management.

Internal Auditor for Tricare Latin America, and Philippine claims for contractual compliance.

Project champion for company developed billing software; performing end user testing and train the trainer procedures at the Singapore corporate headquarters.

ADPII Government security clearance (required for checking US Military benefits & eligibility).

FOUNDATION SURGERY CENTER

Independent Consultant

Audit and analyzed accounts receivable for coding inconsistency and errors for reimbursement remediation.

Implemented best practices for electronic claim submission and on-line denial procedures.

Trained staff; insurance reimbursement, EDI processes.

QUEST DIAGNOSTICS, INC.

National Cash Application Manager (post SmithKline acquisition/centralized billing)

Responsible for the all electronic cash application processes for a multi-million dollar national billing center for an independent clinical laboratory.

Utilized extensive knowledge of EDI and OCR (Optical Character Recognition) functions.

Analyzed and managed all third party receivables for West Coast entities. ($90MM)

Director of Billing (Decentralized Billing)

Managed the daily operation of the entire Billing function ($45MM) for the Philadelphia business unit overseeing a staff of 98 employees.

Led the integration process of Philadelphia local billing function into the National Billing Center.

Documented and implemented standard operating procedures throughout departments; cash applications, insurance denials, data entry and acquisition, patient billing, customer call center.

Reduced data entry/acquisition backlog by 75% with a one-day turnaround time by identifying inefficiencies, implementing process improvements.

Instituted protocols and metrics achieved “world class” goal rating in customer call center/ patient billing services, with 80% of all calls answered in less than 20 seconds.

Analyzed and managed all receivables including write off controls.

Prepared, monitored and reported weekly and monthly statistics for local and corporate benchmarking.

Member of internal corporate audit team for reimbursement and compliance.

Managed Care Billing Specialist

Billing Liaison to Managed Care representative in Sales and Marketing to ensure profitable, enforceable contract implementation.

Resolved all billing issues for managed care accounts.

Established and maintained key contacts with managed care organizations.

Identified and resolved reimbursement discrepancies through receivables analysis and on site visits to managed care companies.

Project Manager for billing systems software conversions.

Assured compliance with corporate integrity agreements with federal government.

Led all contract change processes for company name change ( MetPath to Corning Clinical ).

Insurance Cash Application Manager

Managed timely and accurate application of cash, insurance denials, controlled write offs.

Analyzed and managed all third party receivables.

Monitored and analyzed insurance denial trends.

Assured compliance with all government and private payor policy and regulation.

Developed and facilitated training program for sales department pertinent to billing issues.

Maintained third party master files for entire billing software system.

Key contact for government and private sector audits.

Performed month end close functions.

(Damon Clinical Laboratory – Billing Manager-Phila. & New York): integrated billing department after acquisition by MetPath Laboratory; AKA. Corning Clinical Lab, Quest Diagnostics.

KELSO-NEJMAN SURGICAL ASSOCIATES

Practice Manager

Responsible for the daily operation and financial functions for a busy three-surgeon, multi-specialty multi-office practice.

Proficient CPT4/ICD9 coding for surgical and office billing.

Medical Assistant-office colonoscopy, minor surgical procedures

Maintained Practice Profiles, ensuring maximum reimbursements.

Implemented computerized billing utilizing IDX systems.

Prepared contract applications for all fiscal intermediaries.

Coordinated the opening of two satellite offices.

Responsible for all human resource management for 16 FTE’s, clinical and clerical.

INCIDENTAL EMPLOYMENT

Holy Redeemer Hospital – Medical Record Transcriptionist

Frankford Hospital- Radiology Transcriptionist

Education

Philadelphia College of Textiles & Science

Healthcare Administration – Certificate Program

Professional Development

Center for Creative Leadership – North Carolina

“Foundations of Leadership

Building Effective Work Teams – Delta Consulting Group

Technical Training /conferences

Ingenix Medical Coding, Billing Conference, Las Vegas, Nevada

American Medical Association~“Practice Management”, NY.

Technical Skills/EMR’S

Proficient with Excel, Word, Visio, PowerPoint, Microsoft Publisher, Access, MS Project, Navinet, IDX, Doc.Com, NextGen, eClinicalworks, Medent, QuestCare360

Honors

“Gambino Award for Excellence”

Twice awarded as the Number One Lab in Billing and Operations by Quest Diagnostics CEO.



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