Customer Service Manager
Resume:
Lisa Serratore
Ridley Park, PA 19078
*****************@*******.***
OBJECTIVE
Highly motivated, dedicated Reimbursement Manager with a
demonstrated success within the healthcare environment. Proven history
of providing effective Leadership, with the effective ability to drive change,
bringing a new approach to Accounts Receivable anagement. Extensive
M
knowledge in Home Infusion, Biotechnology/Biosimiliar Drugs, Specialty
Pharmacy/Pain Management, tra-Operative Neuropsychological
In
Monitoring (IONM) and Out-of-Network Providers issues with Billing and
collections and the impact of reimbursement.
SUMMARY OF QUALIFICATIONS
Leadership & Strategy.
Ability to develop and implement plans accelerates cash flow; provide oversight
and direction for charge master maintenance and compliance with payer
requirements.
Providing leadership and guidance to Accounts Receivable department by
training staff, setting goals, monitoring work and evaluating performance.
Reimbursement expertise and optimization, extensive knowledge of infusion
therapy, pharmacy, physician, and nursing.
Reimbursement expertise and optimization in Medicare Parts B, C, and D, as
well as numerous Medicaid, Managed Care, and Indemnity payers both in and
out of network.
Process Improvement.
Problem Resolution/Decision Making.
Comfort with initiating and responding to change, demonstrated ability to
identify, develop and implement process/system improvements to a known or
supposed weakness.
Effective communication skills including the ability to listen to the needs of
others, research and comprehend complex issues, articulate issues in a clear
concise matter, and present findings as well as recommendations, in both oral
and written presentation.
Month-End Close.
Reporting/Documentation.
Directly responsible for initiating all payer contracts.
Compliance and Regulatory matters in multi-site, multi-state environment.
Intake and Case Management expertise in areas of intake coordination, benefits
verification, coordination of patient care and communication.
PROFESSIONAL EXPERIENCE
CarePoint Partners/InfusionCare
Reimbursement Specialty Pharmacy/Pain Management
April 2013-January 2014
Hired for opening of new service line of business; Intrathecal/Pain
Management to oversee business operations for refilling and maintaining all
patients with implanted intrathecal pumps for pain management.
Initial job duties would include assist with billing and collections with all
patients in Aston office.
As intrathecal business expands would be responsible for all functions from
intake, authorization, billing and collection
Responsible for all pain management patients for all of CarePoint Partners
locations in the company.
Field Reimbursement Marketing to physician’s offices for new patient referrals,
reviewed patient referral process, assisted staff with questions on getting
patient on service.
T&C Neuromax, Home Infusion
Consultant Pain Management Infusion Services
February 2012-February 2013
Obtain new contracts with insurance companies
Re-designed the receivables management process by creating and
implementing plans for correction and improvements.
Reviewed aged receivables, made corrections, provided resolution and
submitted requests for payment adjustments
Monitored payer reimbursement for adherence to contract provisions, fee
schedules and resolved inconsistencies
Reviewed payer sites for medical policy changes, manual updates and provider
bulletins.
Created internal review process to track all expiring authorizations, missing
patient information and termination of insurance.
Completed manual for HIPPA training for all employees.
Developed all templates for authorizations, fax transmittals, letterhead, billing
notes, communication documentation and patient letters for insurance.
Verified all new patient benefit information, if required, obtained, contacted
patient to discuss insurance coverage entered all patient information into
system and informed internal personal of referral.
Created and implemented comprehensive billing, collections and intake policies
and related procedures for departmental, inter-departmental and external
personnel, increasing productivity and communication and decreasing errors
and redundancy.
NPS Pharmaceuticals
Consultant Reimbursement/Customer Service/Patient Assistance Program
April 2012-December 2012
Developed all Standard Operating Procedures for new Patient Service
Department (Hub) scheduled to be opened by December 2012, completed
ahead of schedule.
Developed Training Manual for Care Coordinators.
Interviewing and Hiring of Care Coordinators.
Customer Service and Reimbursement Training and Manuals.
Created Templates for all patient, physician, and specialty pharmacy.
Developed templates to assist physician with Prior Authorizations, Appeals,
Letters of Medical Necessity and Clinical Information Requests.
Wrote all telephone transcripts for care coordinators to use when getting calls
or making calls to patients to review benefit information.
Surgical Monitoring Associates, Inc
.
Reimbursement Manager /Director
June 2009-February 2012
Manager of a team of supervisors and representatives to ensure service line
revenue is appropriately billed, collected and applied to accounts. Monitors
progress in billing, claim resolution, cash posting and other issues that impact
service line third party billing and accounts receivable.
Successfully implemented new billing and collection policies for reimbursement
services department, for JACHO accreditation.
Set up practice management software for submission of electronic claims to
clearinghouse.
Submitted any needed enrollment forms to insurance companies, solved all
issues.
Developed month end close process, as well as bonus structure for members of
the department.
Worked with various insurance companies to evaluate existing contracts.
Assess workflow and operational processes identifying opportunities for
improvement.
Analyze aging on a routine basis and understands what factors influenced any
significant changes or trends.
Assigns team member responsibility according to operational need.
Establishes and monitors team goals and ensuring that they are met.
Coordinates and conducts team member training.
Handles escalated issues related to billing and accounts receivable.
Follow up with providers, payers, hospital contracts and clearinghouse as
necessary.
Effectively lead, coached and counseled team members as necessary.
Review action plans and educates associates on proper follow up techniques.
Review operational indicators or benchmarks and takes appropriate steps with
associates to improve achievement levels.
Identified billing problems or issues, communicate with management team,
participate in problem solving and educated when appropriate.
Complete audits of department functions as necessary and appropriate to
ensure compliance with company policies and procedures.
Contracting, Price Negotiations, Fee Schedules, Pricing for supplies.
Pentec Health, Inc.
Sr. Manager, Reimbursement Services/Financial Case Mgmt.
July 2004-February 2009
Responsible for reimbursement of Specialty Pharmacy Division of a J.C.A.H.O.
accredited organization providing specialized home care and infusion services.
Responsible for highly complex reimbursement strategy (national and strategic
in scope) along with reimbursement decisions and price negotiations across all
states and multiple payer sources, including Medicare, Medicaid, and hundreds
of managed care and indemnity insurers in such therapies as pain
management, spasticity, growth hormone, IVIG, hydration, antibiotics, IPN
and IDPN and multiple of other miscellaneous IV drugs.
Successfully developed, designed and implemented new billing and collection
mechanisms with new incentives plan that significantly reduced DSO from 100
days to 58 days for specialty pharmacy division.
Success implementation and conversion of all Medicare, Medicaid, and top
commercial insurers representing over 100 payers to Electronic Media claims
processing.
Reduced monthly close and billing cycle from 21 days to 5 days providing both
an increase in cash flow and, in concert with newly designed graphical and
trending management reports and analysis.
Provided management with more timely and accurate access to monthly
statistics necessary for decision-making.
Directly responsible for implementation of policies and procedures for intake
coordinators, case managers, worked with nursing staff, account executives and
pharmacy to insure good communication and consistent coordination of patient
care.
Worked with Vice President of Division to implement process improvement, for
existing, and all new lines of business, successfully developed patient
communication process and created new patient consent forms, introduction
letter, and plan of treatment forms for physician offices.
Worked with Nursing Supervisor to develop a process to track nurse visits, to
improve document-tracking process, drug delivery dates, and to ensure
important patient information is being received and sent to physician office.
Supervised staff of 10 for the National Specialty Pharmacy Division including,
billing, collections, case management, verification of benefits, prior
authorizations, pre-determinations, pricing agreements.
Directly responsible for contracting and credentialing for all insurance
companies, developed website access for all employees, to ensure proper
verification of benefits, usage of insurance specific forms, to receive plan
specific benefit information and contact information to improve accuracy of
Information given by Insurance Companies.
Member of clinical Process Improvement Committee, and Corporate
Compliance Committee.
Internal educator to all sales personnel, on a regular basis concerning infusion
reimbursement.
Developed and successfully implemented an internal patient Financial
Assistant Program.
Milmont Park Family Practice/Crozer Keystone Health Network
Office Coordinator/Manager
August 1995-April 2004
Responsible for office staff of 10, conducted all interviews for new employees,
trained new hires, and conducted yearly performance evaluations for merit
increases.
Responsible for physician scheduling, employee scheduling and creating
templates for patient scheduling.
Assisted physician with minor surgical procedures, flex sigmoidoscopies,
pulmonary function testing and suture removal.
Assist with patient care ex: phlebotomy, injections, holter monitors, EKG’s,
urinalysis, and administering nebulizer treatments.
Responsible for all supply ordering, inventory and budget.
Triage of patient calls, informed patient of test results, called all prescriptions
to pharmacy.
Developed electronic referral process, and trained office staff.
Cash posting, bank reconciliation, audits, appeals and denials.
Member of Management Team at Crozer Keystone Health Network
communicated all information to physicians, staff and informed management
of all office activity.
Credentialing and Re-credentialing of physicians with Health Plans.
Reduced high office staff turnover, keeping all informed of issues, changes or
Updates, team motivator, honest and worked with all employees to improve
relationships.
EDUCATION
National School of Health Technology- Philadelphia, PA
Med Surgical/Tech Program (Full Scholarship)
GPA 3.5, Associates Degree (1988)
CERTIFICATIONS
Coding and Collections Certificate of Completion 2003
Case Mgmt.- Infusion Therapy Certificate 2004
Medicare Certified Billing Course Certificate 2004
Manager Training Course- Certificate of Completion 2001
Time Management Course Certificate of Completion 2001
OSHA, HIPPA Compliance 2008
COMPUTER SKILLS
Microsoft Word, Excel, Powerpoint, Office, Outlook, Access
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