Hospital System
Resume:
Bruce, J. Mosley, MBA, E.d.S, Consultant
Lakeland, Florida 33813
***********@*****.***
OBJECTIVE
Healthcare Hospital Reimbursement Contractor seeking a permanent position
that would utilize my diverse hospitals electronic billing/hospitals
rebilling, hospitals collections, hospitals underpayments, and backlog
experience. Specializing in rebilling claims using billing software such as
Zirmed while responding to electronic denials. Strong background in
analyzing payer contracts, payer denial management, analysis, claims
management, and appeals/denials management.
BILLING EXPERIENCE
Health Management Associates (HMA)
12/2012-Present
Revenue Recovery Variance Specialist (Hospital Billing)
Responsible for identifying hospital underpayment variances, denial trends,
and root problems
V Successfully acted as liaison with hospitals l CFO's, Hospital
Managers, Patient Registration Directors, Directors of Reimbursement
and various hospital reimbursement staff-Revenue leakage
V Provided on-site support for hospital reimbursement issues, monthly
reports/status meetings, collections reports and scheduled Process
Improvement meetings
V Implemented and developed internal hospitals Intranet with links to
all payers reimbursement manuals, denial policies and procedures,
denial patterns, Provider rep listing and electronic appeals
guidelines
V Maintained, analyzed and negotiated all hospitals contract language
for review leakage that improve hospital future contract negotiations
with payers
V Assigned to Hospital in the following states, FL, GA, NY, TX, WA, KY,TN
V Successfully, rebilled using SSI found 50 million incorrect denials
and collected over 25 million dollars.
V Audited a HMO Medicare payer finding a contract discrepancy with fee
schedule. Successfully negotiated an underpayment of $137,000
underpayment WITHOUT using appeal process
Trilogy Health (Hospital Contract)
Billing Manager
07/12 to 11//12
Responsible for improving hospitals collections, billing, reimbursement and
operations overall improvement
V Duties including monthly client meetings for hospitals CFO and
Director Reimbursement
V Successfully used Change Management strategies to motivate employees
that lead to increase in collections efforts by 30 percent and an
overall positive change to business environment
V Responsible for managing 100 employees, 5 remote hospitals nurses
and 8 attorneys
V Successfully improved billing from 800k to 1.2 million per month using
a collection system that was similar to the functions of Zirmed.
V Developed innovative ways to improved the business climate and
resolved hospitals A/R denials by 30% that led to the profitable sale
of Trilogi to Recondo Technology
V Successfully managed over 30 different hospitals acting as Central
Billing Office (CBO) while reviewing contract language versus payer
fee schedules to ensure claims paid at correct reimbursement rate
Amerigroup Inc., Tampa, FL
09/10 to 07/11
Billing Analyst (State of Tennessee Contract)
Responsible for adjudicating Medicare hospitals claims and LTC Medicaid
claims edits for State of Tennessee
V Conducted and participated in monthly conference calls and on-site
meetings with State of Tennessee concerning implementing procedures to
reduce errors and improve production rate
V Successfully found hospitals claims system error (Facets) that led to
a $70k savings based on fee schedule miscalculations for Long Term
Care(LTC)
V Implemented hospitals claims policy and procedure that lead to
improving team error by 2%
V Recognized by reimbursement department for maintaining an 0.0 quality
error rate
V Utilized Facets system for rebilling and solving over 300 hospitals
claims denial edits per week.
V Using Zirmed billing software increase monthly billing from 1.2
million to 2.1 million.
V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes
Mosley Group Services-Lakeland, Fl.
08/06 to 08/10
Healthcare Hospital Billing Consultant
Mosley Group Services (MGS) is a full-service hospitals reimbursement
consulting company
V Successful developed innovative reimbursement method using
Reimbursement Pro to dispute and validate
V Inpatient and hospitals Medicare payments that lead to over $150,000
in underpayments
V Implemented and designed reimbursement strategies with hospital claims
lines denied for missing NDC number, this strategy led to over
$750,000 in hospitals underpayments
V Implemented hospitals reimbursement strategies without APPEALS that
lead to a $150,000 underpayment for hospital reviewing the contract
that had specific diagnosis that would pay for cosmetics procedures
V Implemented coding change for a new hospital sleep apnea home product
that lead to over $200,000 in reimbursement for hospitals and
physician groups
Wellcare - Tampa, Florida
10/05 to 07/06
Hospitals Billing Supervisor - (Medicare/Medicaid State of Georgia
Contract)
V Successfully lead calibration meetings/onsite with State of Georgia
CFO, auditors, and Directors based contract performance, quality,
contract deliverables, and specific hospitals contractual amendments
V Primary duties included supervising a reimbursement team of 35
Hospitals /Physician employees while processing hospitals claims using
the Diamond Paradigm billing adjudication system.
V Secondary duties included supporting two Director of Claims with RFP
responses to State of Georgia,
V Subject Mater Expert (SME) concerning Georgia hospitals claims.
Specialized in claims backlog, PowerPoint presentations, Visio,
IntelliClaims, UB92, HCFA-1500, HCPCS, ICD-9, CCI edits, and CPT-4
codes. Diamond Paradigm billing system.
Qualink Inc. /NCO- Lakeland, FL
05/04 to 08/05
Hospitals Billing Supervisor - (Hospital Contracts)
V Primary duties included supervising 15-18 employees serving as Central
Billing Office (CBO) reimbursement team for 12 different hospitals.
V Created rebilling appeals strategy which produced a 1.6 million
dollar reimbursement for Bronx Lebanon Hospitals and 3.2 million over
the next 8 months
V Provided insurance verification support, resolution, and appeals,
claims phone support, re-billing support, denial, and researching
denied claims to identify root causes.
V Responsible for reviewing SSI denial reports to review bills against
billing policies and procedures.
V Successfully reviewed Bronx Lebanon Hospitals SSI billing system that
resulted in a 1.6 million reimbursement in 6 months. Specialize in
Medicare/Medicaid, claims backlog, HCFA-1500, COB, CPT-9, and UB92
forms.
ACS Inc. Medicaid Fiscal Agent - Alpharetta, GA
04/03 to 04/04
Claims QA Supervisor/-ACS (State Contract)
V Primary duties included providing call center reimbursement/claims
audits for 200 employees at the ACS Inc. office in Atlanta, GA Ravina
Perimeter Mall location.
V Primary duties include auditing call center employees to improve
hospitals claims processing quality and production using the Avaya
auditing system.
V Duties included providing written policy and procedure updates for the
Georgia Department of Community Health (DCH) for physician and
hospitals claims.
Claims Billing Supervisor/ Trainer - ACS Inc. (State Contract)
Provide on-site training to 400 hospitals and physician groups rolling out
HIPAA reimbursement and EDI
V Successful training over 400 Medicaid hospitals s and Physicians in
Washington, DC and Maryland groups covering HIPAA privacy, security,
standard transaction, and standardized code sets.
V Supervised and lead a team of five consultants providing onsite
PowerPoint training and workshops to the Medicaid provider community
V Resolving billing issues, EDI issues, HCPCS, CPT-4 codes, ICD-9,
claims backlog barriers, denied claims, reoccurring billing issues,
and addressing any claims that need adjustments.
Ross Perot Companies - BCBS of New Jersey - Rutherford, NJ
04/02 to 04/03
NASCO BCBS Claims Reimbursement Billing Lead-(Ross Perot Contract)
V Responsible for COB Claims reimbursement adjustments in accordance
with BCBS claims policies and procedures. Duties included analysis
claims system edits make correction action reports for management.
V Duties included senior level knowledge of benefits contracts, ICD-9,
CPT-4, HCPCS, adjudication edits, coordination of benefits (COB) and
healthcare terminology.
V Supervised and lead a team of 10 employees while being held
accountable for hospitals claims resolution and production.
V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes
(Claims Backlog)
IBA - Frederick, MD
09/01 to 04/02
(SME) Claims Billing Contractor (Health & Human Services Contract)
V Responsible for creating reimbursement-coding crosswalk that would
indentify 911 supplies and claims that would match the standardized
HIPAA coding structure.
V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes
V Responsible for gathering Medicare/Medicaid crosswalks creating new
codes for procedures not present in the Medicare coding system, in the
event of another 911 incident.
V Responsible for subject matter expertise and updating of RFP as each
phase of the project was completed. Claims coding assignment and
claims workflows. The system would duplicate Medicare/Medicaid
hospitals policies and procedures
Ross Perot Systems - Magellan Behavioral - Columbia, MD
01/01 to 06/01
Claims Billing Analyst Contractor (Ross Perot Contract)
V Duties include analyzing Ad-Hoc reports for improve processes and
reporting for mental health and substance abuse claims.
V Duties included training on CPT-4 and ICD-9 proper claims combinations
preventing appeals and denials. Responsible for providing claims
management for Behavioral and EAP accounts.
V Accountable for processing coding of mental health claims and
substance abuse claims, while ensuring proper claims adjudication in
Claim Operations while improving workflow processes.
V Responsible for maintaining a 95 percent claims resolutions production
standards. Also responsible for claims resolutions of any claims over
90 days backlog.
V Understanding of CCI edits, CPT, HCPCS, ICD-9 and Revenue Codes
EDUCATION
Webster University of Business and Technology - Jacksonville, Florida - MBA-
Masters in Business Administration graduated (1999)
Liberty University-Lynchburg, Virginia-Ed.S-Educational Specialist
graduated 06/2010
SOFTWARE
Microsoft Professional Office 2000: Word, PowerPoint, Excel, Access,
Outlook, Lotus 1-2-3, Lotus SmartSuite, Works, WordPerfect, Visio, Adobe
PageMaker, CorelDraw, Photoshop
CLAIMS SYSTEMS & E-COMMERCE Hospital HPF, Hospital EDI Tracker, Hospital
Revenue Cycle Pro, Webstrat, iSynergy, SSI Billing System, CMS Inpatient
Pricer,IntelliClaim, Diamond Paradigm, OmniTrack, SIR, Mercy Hospital
Patient Registration System, Illinois Hospital Billing System, SSI Hospital
Billing System, Passport, Availity, Medi-Tech, Amisys claims system,
Cerner NEBO Patient Registration, Humana Claims Imaging processing, BCBS
electronic Processing system.
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