Project Manager Medical Billing

renia shade

Fayetteville, GA ***** ( **********@*****.*** 678-***-****

Expert medical biller, training and project manager

revenue cycle Operations management ? Leadership & Team building

TRAINING & DEVELOPMENT ? MEDICAL BILLING

SUMMARY OF QUALIFICATIONS

> DEMONSTRATED MANAGEMENT AND STRONG LEADERSHIP SKILLS; PROVEN TEAM BUILDER

> Strong analytical, decision making, and problem solving skills

> Skilled in learning and adapting new techniques and procedures to enhance

productivity

> Proven expertise in medical billing, revenue cycle, managed care, denial

management, cost savings, revenue enhancement, information systems and

operations

> Expertise in full-cycle Hospital Physician Billing, Acute Care and ASC

> Practice Management Systems: NextGen 5.8, AdvancedMD, Medisoft, EMA-EMR,

Office Ally, Practice Mate, Cerner/Prism, MPM, AMS, Medical Manager,

Compulink, MDRythm, U.S. Medical, MD-Online, Medicare DDE, Phreesia

Check-In

> Well-versed in Medical Coding and Terminology, Electronic Claims

Processing, PQRS, Meaningful Use, EMR/EHR

> Office Suite including Word, Excel, PowerPoint, and Outlook

career achievements

> Independently owns and operates a successful billing and collections

company with annual sales in excess of $200,000

> Implemented new billing procedures, resolution techniques and protocols,

saving the company over $150,000 a year

> Extensive contact with outside industry sources such as accountants,

consultants and physicians

> Clear measures of success in the industry which resulted in over $128,000

in collections within 5 weeks

> Provide leadership to ensure effective, efficient billing and

reimbursement operations, optimizing performance and continually

improving quality in a vastly changing health care environment

Professional Experience

OWNER OCTOBER 2000 - PRESENT

medspec medical billing Fayetteville, Georgia

MedSpec Medical Billing is a medical billing and collections company

providing customized services to clientele in the healthcare industry.

> Increase the collection revenues for 100% of the client base of small to

medium sized clients in various specialties

> Responsibilities include contract management and negotiations, billing

system, upgrade planning and customization, audit billing department,

incident to billing, physician enrollments, and reimbursement analysis

> Manage all facets of operations including business development, marketing

and advertising, strategic planning, and subject matter expertise.

> Oversee the daily operations including coding, charge entry, patient

billing, payment posting, and AR follow-up

> Work with customers on site and many inside groups to ensure the

successful completion on all projects

> Increase client revenue through timely billing processes and effective

collections progression

> Manage Charge Documents and Charge Description Master

> Consult with clients to creatively implement and improve business

operations

> Provide tailored services for multi-state, multi-specialty practices

including Ophthalmology, Dermatology, Primary Care, Acute Care, DME,

Skilled Nursing facilities, and Behavioral health providers resulting in

maximum efficiency and costs reductions

> Ensures resolution of escalated problems/issues with operations, clinical

services, employees within department or payers

> Provide regulatory guidance on compliance, HIPAA, medical terminology and

coding, and collection legalities

EPM Implementation Specialist-Consultant, NCP EPM/SCT June 2012 - Oct

2013

West Dermatology Management, LLC Las Vegas, Nevada

Located in Las Vegas, Nevada, California and Arizona, West Dermatology

Management is a multiple physicians dermatology practice that offers a

comprehensive list of services which includes: psoriasis, reference lab,

clinical research department and micrographic skin cancer surgery.

> NextGen Certified Professional-Implement policies and procedures to

increase both revenue and gross collections

> Responsible for implementing and training the group practices on NextGen

EPM & EHR software

> Serve in a train the trainer capacity for the clinical and non clinical

staff during EHR implementation

> Instrumental in working closely with the Director of RCM to ensure daily

RCM operations and tasks are moving in accordance with company policy

> Assist with correct coding, and charge captures to maximize reimbursement

> Educate employees, other managers in new procedures and skills to help

them become successful in increasing recovery percentages, and enhancing

work processes

> Participate in clinical department education on billing reimbursement,

PHI, compliance and other related topics

> Provide recommendations/consultation to Management on areas for

departmental or implementation process improvements

> Ensured standardization in operating procedures across all sites

> Communicate/escalate issues/problems to the appropriate Regional Practice

Manager and when necessary to the RCM department so the issues can be

handled promptly and efficiently

> Project Leader -restructured the referrals/prior authorizations

department resulting in reduced denials by more than 80%

> Provide strategic direction to ensure program and project development is

in line with current organizational direction

> Upgrade planning and customization

revenue cycle analyst-BILLING & Collections Manager April 2010 - June

2012

woodhams laser & lens implant center Atlanta, Georgia

Located in Atlanta, Georgia, Woodhams Laser & Lens Implant Center is a

surgical center specializing in Eye Care, Lasik, and other vision surgery.

> Responsible for day-to-day billing cycle operations for the ASC and

Clinic operations

> Developed, investigated, and maintained system problem analysis and

resolution techniques

> Updated the executive committee on trends, analysis, and improvements on

a weekly basis; make recommendations

> Acted as liaison to the Practice Management System vendor, Navicure

(clearinghouse), contract management and accountant

> Managed accounts receivable, credit balances, patient statements,

analyzed contracts, denials, and payer trends

> Conducted staff training on new processes and procedures such as

insurance verification, claim filing, clearinghouse issues, and account

reconciliations

> Facilitated monthly meetings regarding compliance and ICD-9, CPT-4, UB-

04, and Modifier changes and usage

> Assisted in preparation for both short and long range planning

recommendations for all Registration Process area including; Clinic and

ASC (Ambulatory Surgical Center)

> Met with the physician leadership weekly to identify trends impacting

clinical revenue. Also, discussed opportunities that would enhance

clinical revenue.

> Responsible for the monitoring of daily activity and completion of aging

and financial reports. Perform special projects when assigned

> Responsible for ensuring that projects are staying within the scope and

financial budget established

> Maintained oversight of the purpose and status of all projects related to

5010 and EHR

> Collaborated with IT and the executive committee to transition our

records into EHR/EMR

> Provided weekly project status reports, issue resolution and project plan

maintenance

> Ensured department software and systems are meeting company needs as well

as meeting HIPAA and EDI compliance standards

central business office director - Consultant August 2008 - July 2009

thomas eye group Atlanta, Georgia

Thomas Eye Group is a full service eye care provider with offices in seven

locations in the greater Atlanta area providing routine eye exams, glasses,

contact lenses, LASIK, as well as medical, surgical and cosmetic services.

> Increased savings by 150,000 dollars through the implementation of new

billing procedures and protocols

> Effectively restructured the billing department for utilization of staff

skills, expertise, producing a strong CBO team with greater billing

accuracy, and overtime and error ratio reductions

> Provide leadership and guidance to the department team members

> Utilized advance knowledge/proficiency with MS Excel, MS Word to develop,

manage and maintain implementation project plans

> Directed the day-to-day billing cycle operations for a multiple

physician, multi-million dollar medical facility

> Instituted training and development programs resulting in employee cross

training and skill efficiency; utilized coding manuals, ophthalmology

websites, and webinars to conduct training

> Effectively implemented revenue cycle projects to help identify and

manage accounts receivable; increasing collections and decreasing

denials; provided timely feedback to the owners, physicians, and managers

> Investigated, analyzed, and developed strategic tracking tools to provide

trend reports utilizing Excel, Accounts Receivable Report & Compulink

Practice Mgmt System

> Managed 10 Inbound Call Center staff members for effective and

informative communication and excellent customer service

> Evaluated and created the CBO training manuals for continual education

utilizing MS Office including PowerPoint

> Provided recommendations/consultation to Management on areas for

departmental or implementation process improvements

Additional EXPERIENCE

> Instructor, Corinthian Schools - Everest Institute, Jonesboro, Georgia,

2008

> Branch Manager, Medical Business Service, Incorporated, Atlanta, Georgia,

March 1997 - October 2000

Education And Training

BACHELOR OF SCIENCE IN EDUCATION

state university of new York Brockport, New York

Additional academic accomplishments

> NextGen Certified Professional

> Certification: Medical Reimbursement Specialist (AMBA), Certificate:

Medical Terminology, Sulphur, Oklahoma, 2008

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