Business Office Manager

CARMEN L. CHAISSON, CPC

713-***-**** **** Aerial Brook Trail Fresno, Texas 77545

************@*****.***

OBJECTIVE

To secure a position in which I am able to utilize my coding skills within a hospital and/or

physician setting.

WORK EXPERIENCE

Mentis Neuro-Rehabilitation Hospital

Accounts Receivable Specialist July 2010 to present

Maintain successful revenue cycle for two hospitals {Mentis El Paso & Mentis Neuro-San

Antonio}. Verify all coding ICD-9CM, CPT, HCPCS, and Revenue Codes are accurate on

outgoing claims. Audit all accounts to detect inaccuracy billing and correct insurance

payment. Contact insurance companies for outstanding claims and patients for past due

balances. File insurance appeals. Process attorney correspondence. Bill all commercial,

managed care, and workers comp claims via electronic billing system {Availity, Office

Ally, and paper}. Monitor and report inaccuracy of patient demographic information to

facilities. Identify and resolve any issue affecting accounts receivables. Conduct accounts

receivable monthly conference call with staff. Post all payments & adjustment daily.

Reconcile both facilities at end of the month. Assist CFO with expected reimbursement

report every quarter. Report Monthly Operating Report to CEO, CFO, Administrators, and

staff for hospital expected reimbursement amounts.

North Star Healthcare

Palladium for Surgery Houston July 2008 to February 2009

Business Office Operations Manager

Direct all business office operation functions for Ambulatory Surgical Center. Managed

over 70 out of network entities. Oversee eight departments: Front Desk, Insurance

Verifications, Scheduling, Payment Posting, Billing, Collections, Medical Records, and

Coding. Verify accuracy of CPT, HCPCS, and ICD9CM coding for eight specialties.

Perform coding audits to track insurance carrier trends. Oversee operative report received

from physician within 72 hours of surgery then coded within 24 hours. Verify accuracy of

coding. Process and resubmit all rejected claims. Oversee all accounts receivables.

Responsible for month end process, department budget, reconcile department accounting,

maintain entity log and daily accounting report. Create accounts receivable strategies,

projections, quota levels, and productivity goals. Attend monthly accounts receivable

meetings with Director of Business Development and COO (Chief Operating Officer).

Various financial reporting to CFO (Chief Financial Officer). Weekly collection meetings,

payroll, bonus, performance evaluations, develop employee appreciation program. Hire,

supervise, evaluate and perform disciplinary actions as necessary following department

guidelines. Update business office policy and procedure manual for hospital accreditation.

Clear Lake Rehabilitation Hospital

Arlington Rehabilitation Hospital

Business Office Manager November 2005 to July 2008

Planned, organized, implemented and controlled all business office functions related to

billing and collections over two hospitals. Developed and analyzed administrative and

operational functions that improved billing practices and increased revenue. Reconcile

revenue for each department daily. Supervise collections of Medicare A & B, Managed

Care, Commercial, BCBS, Tricare, Champva, Workers Comp., Attorney, Medicaid and self

pay accounts. Institute second and third appeal letters. Maintain denial log and

communicate with various departments regarding claim denial to obtain resolution.

Approve refunds, all contractual and special adjustments. Approve bad debt accounts.

Maintain Daily Operational Report for corporate office. Assist with quarterly outside

audits. Verify daily cash deposits, and maintain log. Supervise billing office employees,

including hiring, training, evaluating and performing disciplinary actions as necessary

following department guidelines. Stay abreast with current Medicare guidelines, coding

requirement of: CPT, ICD-9 & HCPCS and responsible to communicate with various

departments and to update system. Managed database of charges, services, fee, and

allowances to assure that all billing and payments are accurate and reimbursement is

maximized. Prepare and download GL accounts, work directly under CFO (Chief Financial

Officer). Manage THCIC Discharge Reports to the state of Texas. Prepare Medicare Cost

Report. Supervise day-to-day operations of billing and collections for two hospitals: Clear

Lake 60 bed/in and outpatient and Arlington 24/inpatient bed facilities.

Baylor College of Medicine

Billing and Collections Team Leader/Supervisor March 1996-October 2005

Audit all adult physicians’ surgical cases. Verify CPT, ICD-9, insurance allowable and

payment accuracy. Resolve complex and difficult accounts requiring higher levels of

appeals. Assign PCS work files, monitor employee productivity, and with precertification

on surgical cases. If benchmarks not met, counsel employee. Knowledge of IDX,

Ecommerce (clearinghouse), STS (Surgical Tracking System), TES Work files, PWL,

ScanTrax, and hospital systems. Analyze and resolve NEIC and edit issues. Process

insurance and patient refunds; including under/overpayments, and recoupments. Assist with

posting payments and charge entry. Contact insurance companies for outstanding claims,

and patient s for past due balances. Assist with interview of new hire’s, verify employee

timesheets, conduct employee counseling and disciplinary actions. Attend BCUG coding

seminars and other billing and collections workshops. Conduct staff meetings. Meet with

physicians to discuss accounts receivables. Institute billing policies and procedures for

department. Supervise day-to-day operations of billing and collections department.

Radiology Management Services, Inc.

Accounts Receivable Specialist January 1995-March 1996

Audit monthly accounts to detect if payers paid claims correct. Contact insurance

companies for outstanding claims, and patients for past due balances. File first and second

levels of appeals. Process attorney and patient correspondence. Bill Medicare B, Medicaid,

Commercial, Managed Care, and Workers Comp claims thru billing system. Identify and

resolve any issue affecting accounts receivables. Assist in maintaining low A/R day count.

Identify uncollectible accounts to be turned over to outside collection agency. Post all types

of insurance payments. Close out daily, and reconcile daily journals.

EDUCATION

American Academy of Professional Coders Certified Professional Coder

Houston Community College Associates Degree in Arts

Houston Community College Certified Billing and Coding Specialist

Careers Medical Billing/Insurance Specialist

REFERENCES AVAILABLE UPON REQUEST

Contact this candidate