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Manager Medical Billing

Location:
Beltsville, Maryland, United States
Posted:
February 18, 2019

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Resume:

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J A N I C E C . M I T C HELL-G A R R AWAY

ac8i04@r.postjobfree.com

Cell Phone: 240-***-****

Accomplishments

Twenty-five (25) + years of Medical Billing and Practice Management experience in the Health Care Field.

Developed, researched and delivered on-time Billing Procedures & Guideline.

Increased cash-flow from 90 days to 10-15 days.

Recovered payment of $108,000 from $150,000 bad debt write off within 45 days of appeal.

Re-negotiated contract and double the previous fee scheduled.

Achieved over monthly goals revenue from $189,000 to $225,000. Key Skills

Teambuilding & Supervision

ICD-10, CPT-10, & Medical

Terminology

Excellent Interpersonal Skills

Formulation &

Implementation of Policies &

Procedures

Office Management

Payroll

HIPAA Compliance

Account Payable

Accounts Receivable

Claim Entry & Payment

Posting

Microsoft Excel

Various Practice

management Software

Experience

SurgCenter of Greenbelt, LLC. November 2015 to July 2018 Business Office Manager

Proficient knowledge of Freestanding Ambulatory Surgery, business office staffing, computer systems, finance and business services/billing, coding, reimbursement and receivables management multi-specialty ambulatory surgery center (Podiatry, Orthopedic, General Surgery, ENT, Pathology & Neurosurgery)

• Provided leadership in Revenue Collections, Reimbursement Strategies, Process Improvement.

• Credentialing & Re-Credentialing medical provider and insurance payor.

• Negotiate legal settlement with attorneys’ office to collect at least 60% of billed charges.

• Account payables/receivables management, setting staff goals and monitor staffing plans/schedules to optimize productivity and ensure quality services.

• Implemented processes and strategies to maximize customer revenue collections in compliance with federal, state and regulatory billing and collection health care guidelines.

• Developed and proposed revenue cycle management functions including, but not limited to, registration, medical records, chart audit, billing, account receivables follow-up, cash posting, trending of denial adjustment, utilization review, compliance, and customer service.

• Prepared Balance sheet and Profit & Loss financials statements.

• Reviewed QuickBooks daily and monthly bank reconciliations.

• Prepared End of Month Closing (EOM) reconciling Monthly Bank Statement, Practice Management software Revenue and QuickBooks.

• Prepared monthly profit distribution for board members.

• Worked closely with Regional Director, Certified Public Accountant and Physicians. 2 P a g e

The Frances Group, LLC. December 2013 November 2015 Independent Billing Consultant-Contractor

Experience in: Obstetrics & Gynecology, Optometrist, Family Practice, Cardiology, Internal Medicine, Podiatry, Ophthalmology, Orthopedic, Skill Nursing Facility, Home Health, General Surgery, Ambulatory surgery & Anesthesia/Pain Management.

Experience in: Obstetrics & Gynecology, Optometrist, Family Practice, Cardiology, Internal Medicine, Podiatry, Ophthalmology, Orthopedic, Skill Nursing Facility, Home Health, General Surgery, Ambulatory surgery & Anesthesia/Pain Management.

• Reviewed and electronically submitted claims. Payment posting, working rejected claims.

• Aggressive account receivables clean up. Reduced account receivables to 32 days. Improved revenue for most providers over 52% with same patient load.

• Reviewed EMR for accurate ICD-9 & CPT Codes for various specialties.

• Credentialed and re-credentialed for new and establish physicians as payor required. Negotiated and re- negotiated Providers Contract with new and established Insurance Payers (MCO, Commercial, Medicaid, etc.).

• Set –up Practice Management Software for submission of electronic claims to clearing house. Eye Associates of Washington, D.C, P.C. September 2012 to November 2013 Billing Manager/Assistant Practice Manager

Responsible for the practice overall financial performance, cash flow and reimbursement performance ensuring operation and strategic functions of a 5-physician Ophthalmology/surgical practice that includes 1 satellite offices, an accredited office-based surgical suite.

Credentialed providers with health plans and re-credentialed providers as often as the payor required.

Developed, implemented, and managed efficient and effective operational policies, processes and best practices within functions of the revenue cycle which include provider enrollment, pre-registration, insurance verification, authorization, charge capture, coding, claims processing, payment posting/credit balance management, third-party follow-up and patient A/R management.

Improved aged account receivables from 120 days to 56 days by eliminating manual processes and redundancies by implementing effective technology (EFT and ERA). Established effective workflow and implemented a denial management process. Reduced denials by 75%. Increased cash flow from cosmetic services by 60% while productivity grew 5%. PM selection and implementation.

Implemented and maintained best practice/integration initiatives to improve the performance of the front-end and back end billing operations.

Managed account receivables staff to maximized revenue opportunities, optimize productivity and ensure quality services. Trained new hires and existing employees.

Reviewed bi-weekly statement for collection. Maintained accurate ICD-9 codes and modifier are current on fee tickets.

Easter Seals Society of Washington Baltimore Region Sept 2007 to Sept 2010 Billing Director – Finance Department

Managed billing department for Adult and Child Development Center. Supervised 7 center’s account receivables. Reported directly to the Chief financial officer (CFO).

Managed the billing work flow to ensure all critical deadlines are met. Responsible for accuracy of charges on invoices, auditing clients records for accurate billing, and controlling refunds.

Kept abreast of all reimbursement procedures for third party, private payors and government relation.

Evaluated, negotiated, and renegotiated all payor contracts. Succeeded in renegotiating several Managed Care contracts from 110% of Medicare fee schedule to 180% and 200%. Terminated unprofitable contracts.

Collaborated with the Center Directors to share information and coordinate on new billing and collection ideas at weekly meetings.

Planned, developed, and implemented in-services education program for new and establish staff members. 3 P a g e

Worked in conjunction with the Centers Directors on implementation of policies and procedures as it related to the daily operations.

Allheart Medical Center

Oct 2001 to May 2006

Practice Manager/Billing Manager -Cardiologist/Internal Medicine Managed practice development, installed and managed systems, designed and implemented office policies and operational procedures, established new banking relationships. In charge of operations and management of large healthcare group including, claims, collections, payments posting, A/R, reporting: human resources, benefits, staff training, payroll, credentialing, bank relations, and other day-to-day operations.

Identified and implemented Practice Management software within first 2 month in position. Developed, supervised and coordinated successful completion of all A/R activities. Consistently maintained low percentage of 55 days aging A/R. Reduced denials and streamlined denials appeal processes.

Monitored contractual obligations. Evaluated, negotiated and recommended managed care contracts to provide optimal and prompt reimbursement. Provided updates of changes in payor trends and related to medical staff members. Maintained current knowledge of all federal regulations and changes as they pertain to billing and collections operations. Studied and helped implement new HIPPA requirements.

Conducted the recruitment and interview process for all business operations. Assigned and closely monitored duties as needed to various business personnel. Supported and trained employees and physicians regarding policies and procedures, billing practices, coding and compliance.

Analyzed physician notes (ICD-9 Coding) for accurate diagnosis, verifying signatures, checking medical charts for accuracy and completion. Also inspecting notes to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code.

Executed all phases of billing for a multi Physician Practice. Entered charges, posted payment for insurance companies, Attorneys, patients, etc. Processed electronic claims, edited electronic reports for rejection and resubmitted for processing. Aggressive Account Receivables follow-up on claims over 25 days and older to ensure accurate payment and avoid timely filing/bad debt write off. Appealed all denial (Low payment, not medically necessary, not eligible, no prior authorization/Pre-Certification, etc.). Star Billing/Washington Hospital Center Jan 2000 to Aug 2001 Billing Supervisor

Trauma & Critical Department Supervised 10 employees in account receivables.

Delegated all charged entry, payment posting and account receivables to all staffs’ to be process in a timely manner.

Prepared end of month reports for monthly meets with upper management to discuss problem with coding and continues denial.

Followed up on Account Receivables over 60 days. (Medicare, Medicaid & Blue Cross Blue Shield).

Posted Payments, submitting electronic claims & paper claims.

Assisted with payroll and new employee training. Oluremi T. Ilupeju, M. D., P. A. July 1998 to Jan 2000 Practice Manager/Billing Manger

Managed the dynamic and growing practice operations of the Obstetrics & Gynecology office. Managed the front and back office (15) employees (3) locations as well as managed the billing and account receivables, payroll, ordering supplies, maintains physician calendar and account payables.

Managed and evaluated clinical and administrative staff, responsible for hiring, implemented disciplinary action as needed, training, assigned staff duties, account payables, maintained physician calendar conferences

& Continue Education requirement.

Prepared & maintaining all credentialed and re-credentialed application and license.

Scheduled surgical procedures, obtained authorization for In-Outpatient procedure. 4 P a g e

Reviewed all Superbill/Encounter Forms for accurate ICD-9 & CPT Codes billing, before charges are entered. Submitted electronic and manual claims, Account Receivables follow-up, appealed denials for low payments.

Performance as lead in resolving escalated billing problems requiring management intervention. As necessary, contact senior management at insurance companies and pursue, with fervor, the timely and accurate compensation of physicians' charges.

Children National Medical Center March 1996 to July 1998 Business Operation Specialist III – Finance Department Accountable for the day to day operations of the Anesthesiology & Cardiovascular department Billing.

Managed billing and collect for Anesthesia ($9 Million) and cardiovascular surgery ($5 Million) departments.

Tracked the procedure of the clinical operation department used the correct CPT & ICD-9 Code according to the guidelines of the insurance companies. Interaction with all major insurance carriers such as (Medicare, Medicaid, Managed Care, HMO, PPO & Commercial) to ensure all accounts are being reconciled per contractual agreement.

Prepared spreadsheets for monthly meeting with the department chairman, physicians and manager to discuss status on issue regarding updates and new requirement from the insurance companies. Visiting Nurses Services of New York, New York

June 1990 to March 1996

Billing Supervisor –Finance Department

Supervised, trained, assigned duties and reviewed productivity to (20) medical billers for Home Health Aid/Long Term Care Department.

Assigned staff daily assignments to provide a level of service that met or exceeded the minimum Account Receivable Management Practical. Meeting periodically with billing staff on billing and collection matters.

Data processed reports and claims form prior to submission for payment. Verify all patients’ eligibility, manually completed 1500 claims to Medicare, Medicaid, for Home Health visit. Analyzed and researched denials to ensure accuracy of information for rebilling claims.

Maintained static and prepared monthly Excel reports on all process activities. Education

University of Maryland

Major: Bachelors Science HealthCare Administration Attentive Graduation: 2021

Farmingdale University, Farmingdale, NY

Major: Business Management/Accounting

1988-1990

Community Leadership

TESST College of Technology- Advisory Board Member for Medical Billing & Coding Program Computer Skills/Practice Management

Program and Software Skills

Programming and Software Skills

Advanced Microsoft Excel, Microsoft Windows® 2010

Medical Billing Software: Advantx ASC version 7.0, Office Ally/Practice Mate, TotalMD, Athenahealth, Advanced MD, Medical Mastermind, Practice Fusion, Adventia Health, CBSI, Office Mate, MediSoft NDC Health (All Version), Allscript Pro, Quality Data Electronic Billing Software, IBAX, HBOC, AS400, EZclaims, Medical Manager, EClinical, Eclipse.



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