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Manager Process Improvement

Location:
United States
Posted:
April 25, 2014

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Resume:

Deborah Hand, CPC

**** ***** **** *****

Conyers, GA

770-***-****

acduy5@r.postjobfree.com

Career Summary

Seasoned health care professional with over 10 years’ experience in the managed care

industry. Experienced in Medicaid, Medicare and commercial market; ability to develop

strategic and visionary solutions to business problems; committed to continuous quality

improvement and operational excellence within the healthcare delivery system.

Certified coding professional with sound knowledge of anatomy, physiology and medical

terminology; capacity to work independently as well as part of a team; ability to exercise

discretionary judgment and problem solve; excellent communication, interpersonal and

organizational skills; ability to meaningfully engage other coding professionals, provide

feedback, teach and lead by example.

Employment History

Account Receivable Specialist 2/2012- Present

Medlink Georgia, Colbert, GA

• Maintain knowledge of coding and billing guidelines and regulations to ensure

compliance

• Facilitate effective and efficient operations for reimbursement activities

• Training physicians and staff on ICD-10

• Establish A/R policies and procedures with current billing company in EPM as well

as EHR.

• Oversee all aspects of A/R responsibilities in decentralized billing department

• Responsible for or contribute to billing, coding and collection education for new

employees

• Provide ongoing education for billing staff regarding coding and billing functions

• Analyze denial reports from Next Gen Revenue Cycle Management. This operation

includes correct coding of CPT and ICD-9 coding in EHR.

• Collaboratively work with Next Gen to ensure self-pay collections and budget plans

are in place and processes are working in a timely manner.

• Maintain contact and relationships with payer representatives of third party

networks

• Submit initial credentialing applications for physicians to managed care

organizations and Medicare and Medicaid and maintaining their credentialing is

current in all lines of business

• Maintain credentialing in CAQH, NPPES and PECOS for physicians and mid-levels

• Other responsibilities include yearly UDS reporting, meaningful use application,

ACO initiative, Medicare cost reporting and contributions in annual audit.

Billing Specialist 11/2009 – 1/2012

Helping Hands Health Center, Conyers, GA

• Assisted with front desk responsibilities

• Coded daily encounters

• Consistently met improvement initiatives and established stronger physician group

relationships by educating doctors and staff on managed care concepts and the

marketplace.

Manager, Provider Relations 7/2005- 10/2008

Amerigroup, Atlanta, GA

• Enhanced servicing standards by educating client staff on the benefits of using

ERA (Electronic Remittance Advices and EFT. (Electronic Fund Transfer)

• Identified changes needed to client servicing standards which resulted in a 30%

increase in quality client visits.

• Contributed to earnings improvement opportunities and strategic direction of the

network by identifying needed changes.

• Ensured accurate configurations of contract, reimbursement rates and benefits

were up-to-date by building relationships with relevant departments.

• Ensured clients claims and coding questions were answered accurately and timely

by developing a report which tracked completion rates.

• Realized timely and accurate feedback to clients for each rural hospital in the rural,

northern region of Georgia by managing the scheduling for Joint Operations

Committee (JOC) meetings and outlining all issues in a problem matrix for all

departments.

Provider Relations Representative 5/1996- 9/2005

Amerigroup Corp. Edison, NJ

• Achieved more accurate data by maintaining up-to-date knowledge, best practices,

applications, and policies and procedures on clients.

• Participated in network contracting for existing and new ancillary contracting and

provider relations issues that resulted in an appropriate network of physicians and

allied professionals to serve our members.

• Attained greater efficiencies in by way of shorter response times and resolutions

through the development of a tracking tool.

• Reduced billing, collection and reimbursement times for services for managed care

members through the identification and implementation of process improvement for

recurring issues.

• Assisted in streamlining procedures and requirements needed for various policies

through revenue enhancement projects (proper referrals, preauthorization, coding,

billing denials and appeals).

Education

B.A. - Laboratory Institute of Merchandising, New York, NY

C.P.C. - American Academy of Professional Coders

Vice President- AAPC Stockbridge chapter



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