Customer Service Management

JASON ELLTON

**** ******* **** • La Mesa, CA ****1 • 619-***-****

E Mail: ***********@*****.***

OPERATIONS MANAGEMENT TEAM BUILDING MEDICAL ACCOUNT MANAGEMENT

PROFESSIONAL PROFILE

Solutions driven, medical professional, with exceptional knowledge of federal regulations and policies pertaining to patient health care

insurance systems and documentation for accurate medical billing.

Skilled at counseling and advising inpatient and outpatient clients of insurance benefits/eligibility, payment arrangements, financial

responsibilities and ensuring authorizations and pre certifications are in place for services rendered.

Highly adept at collaborating and interfacing with decision makers in top medical insurance firms as well as acting as a strong resource

for physicians and patients.

Experienced in training and coaching effective customer relations to teams of professionals for continuity of care

and to create a culture of teamwork/service that results in an optimum experience for patients, physicians, and staff.

Expect in analyzing existing operations and implementing the necessary strategies and business practices to control costs and improve

overall operations.

Polished communicator with exceptional relationship building skills. Foster an environment of high productivity and team approach to

problem solving.

PROFESSIONAL EXPERIENCE

SAN YSIDRO HEALTH CENTER San Diego, CA 01/13 to 03/15

Business Services Supervisor

Supervised the Reimbursement Specialist, Collectors, Payment Poster Charge Entry Provider Enrollment Refunds, and File Maintenance

Staff with daily operations which included 12 satellite clinics, 3 dental clinics and 3 schools based mobile sites. Managed monthly

revenues of $6 million, reducing adjustments and denials while increasing the payment amount by $600,000.00, decreasing the aging to $4

million. Supervise staff of 32 employees, recruit, train and evaluate all staff... Assisted in system conversion from MegaWest to NextGen

and implementing EHR 5010 conversation.

Played in instrumental role in converting office to a paperless process and an FTP server for automated billing and ERA downloading.

Assisted in reorganizing departmental structuring, reducing the Charge Entry staff, developing a refund & credit team, billing analyst,

follow up team all by location of facilities in coordination with the existing teams, Dental & Pharmacy, Payment Posting, Collector’s and

Billing Support.

Core Member of ICD10 Project Implementation Team, toolkit review and testing, review of program’s eligibility requirements, review and

revision of current clinical documentation policies, communication and training on revisions of process, enforced accountability to

changed process, cross–departmental communication and participation, creation and validation of new extracts for submission, creation of

new fields to capture any required data that is not currently being captured.

Collaborated with management to assess the business needs, prioritized and submitted state Medicaid applications with credentialing

documentation.

Member of Ergonomic injury Review Team

Member of Quality Management Committee

SHARP HEALTHCARE San Diego, CA 03/08 to 07/11

Account Analyst II

Defined policies, procedures, training and documentation requirements to support effective, well communicated timely process/policy

changes.

Ensured that Sharp Healthcare remained at the forefront of its industry and up to date with third party payer changes that impacted the

revenue cycle and the company’s ability to submit the cleanest claims.

Identified root cause claim exceptions, resolved escalated issues and made recommendations for business action as appropriate for prompt

and effective resolution.

Participated in regularly scheduled meetings with management to discuss key success metrics regarding billing activity,

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account set up requests, denials, and A/R reports.

Helped identify process changes that would prevent failed registrations from reoccurring while maintaining confidentiality of all company

and patient information in accordance with HIPAA privacy regulations.

Interpreted benefit/insurance policies as it related to exceptions and made key decisions on business actions to resolve.

SCRIPPS CLINIC La Jolla, CA 10/06 to 03/08

Patient Access Representative

Obtained and maintained current contracted fee schedules for existing managed care agreements and provided current information to

billing department for uploading into billing system.

Used medical billing software in conjunction with HIPAA privacy standards to act as resource for physicians, providers, administrators

and patients, regarding health insurance claim policies, procedures and requirements.

Searched account receivable system database and compiled payer claims, billing and payment history as it relates to managed care

contracting.

Communicated routine changes to payers as required (i.e. billing address, phone numbers, updates to liability

insurance policies, etc.).

Worked aged accounts on monthly A/R spreadsheet with billing coding issues and patient denials; provided A/R management for self pay

accounts and balances.

Ensured accurate medical coding, CPT, ICD 9 CM diagnosis and procedure codes to render appropriate reimbursement and meet federal

regulatory coding requirements.

TELETECH HOLDINGS, INC. San Diego, CA 10/05 to 09/06

Patient Access Account Analyst

Served as inter department resource and subject matter expect on patient access related projects and implementations

as it relates to registration, verification authorizations and ongoing eligibility checks.

Maintained current patient account information at all times, with excellent knowledge of, and in accordance with federal laws and

regulations.

Demonstrated extensive understanding of COBRA benefit options and commercial insurance plans (PPO, HMO, POS etc).

Communicated all necessary information to patient or responsible party regarding out of pocket expenses, date of service, where to report,

time of appointment, etc.

Ensured new patient insurance records are established timely, accurately, and maintained properly to ensure accurate billing for treatments

and services provided.

Contacted patient or responsible party to confirm demographic and insurance information.

CAREERSTAFF UNLIMITED San Diego, CA 08/04 to 10/05

Operations Manager

Developed and executed customer service excellence initiatives including a “low value” complaint system and employee retention program

in conjunction with division goals and imperatives for increasing company revenue.

Improved operational system processes and policies in support of the organizations mission including (better management and clear

information work flow).

Conduct meeting agendas, presentations, monitored critical action items, and provided timely updates to management.

Evaluated budget preparation, payroll, A/P and A/R to ensure cost maintenance, timely payment to vendors and projected yearly revenue

along with employee reimbursements/salary requirements.

Processed new hire documentation (including I9 form completion), orientation, training/handbooks; advice on employee counseling

discipline, termination and wage issues.

Oversight of facility management and timely resolution of service repairs.

Coached employees to ensure service quality generated customer loyalty and repeat business.

XEROX CORP., San Diego, CA 08/04 to 03/01

Shift Supervisor/Reprographics

Led production team in processing reprographics requests, troubleshooting of design graphics and equipment in a prestigious legal and

corporate environment

Completed over 105 of reprographic requests, while monitoring workflow and managing queues to ensure job completion, efficiency and

accuracy within specified deadlines.

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Supervised and trained 5 employees on company policies & procedures, planned the prioritization of multiple priority project tasks while

determining appropriate delegation of duties for optimum production, using best equipment & resources.

SOFTWARE EXPERTISE

Adv. Microsoft Office 40+ WPM Mac OSX/Windows

Int. Microsoft Excel Adv. Microsoft Outlook Adobe Acrobat Professional

HTML/JavaScript Int. Microsoft Project Int. PowerPoint

QuickChart PMA Code Correct/IDX

CarePoint Centricity OnBase Illustrator/Photoshop

MegaWest NextGen BrightTree

EDUCATION & CERTIFICATIONS

Medical Procedural Coding Certificate University of California Extensions, La Jolla, CA. 2012

Professional Certificate in Multimedia Production, Grossmont College, San Diego, CA. 2001.

Associates of Arts in Business Information Systems, San Diego City College, San Diego, CA. 1999

MEMBERSHIPS

Member, American Medical Billing Association (AMBA).

Member, AAPC

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