Experienced Revenue Cycle Professional

Tanya Miller

Accomplishments

Accomplished and integrity-driven revenue cycle professional offering 20 years of business with strong concentration in billing, insurance, account receivables and managing others. Uncompromising ethics and transparent communications fortify business-focus value that leverage competitive via top quality service.

Summary of Qualifications

Eight years management and leadership experience

Twenty years of healthcare, insurance, billing, doctors office, clinics and customer service experience

Excellent understanding of revenue cycle with focus in clean claim submission and accounts receivables

Working knowledge of ICD-9, CPT, and HCPCS coding

Ability to direct complex projects from concept to fully operational status

Organized, highly self-motivated, strong analytical skills, detail-oriented and a problem solver

Experience with Microsoft Word, Excel, PowerPoint and Outlook

Education

Master Business Administration, University of Phoenix Houston, TX Present

B.S., Business Management, University of Phoenix Houston, TX 2007

Certificate of Medical Coding, U N O New Orleans, LA 1997

A.A., Occupational Studies, Phillips Jr. College New Orleans, LA 1992

Professional Experience

Sr. Billing Specialist, Houston Methodist Hospital, Houston, TX 2012 – Present

Enter physician inpatient and outpatient charges into Next Gen, Athena and JEG billing systems.

Analyze charge tickets for correct CPT/ICD9 codes per LCD.

Assign task to billers to correct errors and/or edits. Post adjustments as needed.

Expedites and maximize payment of insurance medical claims by contacting third party payers and patients.

Review third party payers Aged Trial Balance Report to locate and resolve accounts.

Pull daily, weekly and monthly productivity and financial reports.

Investigate and appeal unpaid or partially paid claims by insurance companies.

Resolve denials as they appear.

Review claims to verify payments are made according to fee schedule and contractual adjustments are taken appropriately.

Identify claims processing issues and notify management to avoid further delay.

Generate invoices for self-pay patients.

Place unpaid patient balances to collection the agency.

Document clear, concise and complete follow up notes in system for each account worked.

Assure accounts are completed and worked at a high level of quality by visually proofreading and monitoring work output.

Train new team members.

Interview prospective employees.

Physician Billing/Team Lead, Children’s Hospital, New Orleans, LA 2010 – 2012

Monitor the day to day activities of the charge entry department processes, transactions and issues.

Manage the charge capture/reconciliation of various physician specialties.

Assists analyst in compiling data for reporting purposes.

Interact with various departments regarding charges and charge corrections.

Audit employees charge entry quantity & quality.

Maintain employee vacation and sick time request.

Manage employee day-to-day transactions and process, maintain

Train new employees, Temps and volunteers.

Train various departments on the new Next Gen System – registration and charge entry.

Develop new ideas resulting in major improvements to existing methods, processes, procedures and services.

Meet with director of physician billing and physicians on a monthly basis.

Accountable for ongoing professional growth and development.

Create and revise P&P’s and training documents.

Responsible for obtaining pertinent information from various facilities for inpatient charges.

Support the team in gathering and entering demographic and financial information and physician charges.

Backup Cashier, Post payments

Test and setup new systems for implementations – Sorian Clinical - IT Special Projects.

Process applications for the CHAP program.

Pay Medical and Dental claims submitted for payment to the CHAP program.

Respond to customer calls and questions.

Reimbursement Operations Specialist, University of Texas HSC Houston, TX 2007 – 2009

Responsible for the direction and coordination of the billing and collection of patient accounts, preparation of insurance claims, admitting/patient registration, etc.

Ensures that patient transactions are handled in an efficient manner.

Follow-up with Manage care, Government and Commercial insurances to collect and resolve unpaid and underpaid claims

Collect and analyze financial information regarding charges, payments, and A/R

Create and audit spreadsheets to identify trends due to invalid CPT & DX Codes

Interpret insurance contracts and policies to reconcile reimbursement discrepancies for managed care, commercial, workers comp, and Medicare claims

Audit accounts for possible appeal, adjustments, write-off in the IDX system

Meet with the physicians and staff on a monthly basis to discuss collections projections and areas of concern

Monthly and bi-weekly meetings with Billing and Coding team to ensure goals are met and identify issues

Enrollment Supervisor, Heritage Health Systems, Houston, TX 2006 - 2007

Supervise the enrollment process for HMO Medicare Applications

Access Medicare database to download TRR files for weekly reports

Interview prospective employees

Assign task to various team members using CMS guidelines

Identify opportunities for development and implementation of new solutions

Record incoming Applications and distribute to team

Retrieve CTM complaints from HPMS database and assign to team to work

Oversee eligibility emails and distribute to appropriate employee

Generate reports for institutional facilities

Assist employees with daily questions and issues

Coordinate department files; Setup members for EFT withdrawal

Retrieve lockbox file from bank and submit ACH file to bank

Post various payment types to members’ accounts and process refunds

Train employees, Counsel employees, Accrete time cards

Audit & Adjustment Specialist, Sava Senior Care Houston, TX 2004-2006

Performs research and reconciliation functions to ensure that they are completed appropriately

Audit accounts, post cash and contractual adjustments

Review aged receivables and credit balance accounts to determine next steps

Receives and answers inquiries from residents, Medicare and other third parties regarding payments and accuracy of account balances

Completes Reimbursable Bad Debt report

Train employees

Underpayment Resolution Analyst, HCA Healthcare Company, Houston, TX 2001-2003

Analyze and interpret insurance contracts and policies to reconcile reimbursement discrepancies for workers comp, managed care, commercial and Medicare claims

Research, investigate and resolve underpaid claims

Pursued authorizations and/or referrals

Distribute work assignments for special projects

Create and audit spreadsheets for accuracy

Organize database to remove overpaid claims

Submit spreadsheets, appeals and/or discrepancy letters on denied claims

Train new employees.

Patient Account Rep II, Hopestar Medical Management, Houston, TX 2000-2001

Follow-up with insurance companies on physician and facility claims.

Perform follow-up procedures on workers compensation claims.

File medical claims on UB92 and HCFA 1500 forms to primary and secondary carriers.

Process adjustments and write-offs as needed.

Obtain authorizations and/or referrals.

Accounts Receivable Rep, Children’s Hospital, New Orleans, LA 1993-2000

File and resubmit medical claims on UB92 and HCFA 1500 form to various insurance companies.

Submit claims to secondary insurance carriers.

Complete follow-up procedures with insurance companies to insure timely payments.

Post timely HMO/PPO/Medicare and Medicaid adjustments as needed.

Do charge investigations. Place unpaid accounts in collections.

Contact guarantor, insurance denial of claims or patient portion.

Process refunds insurance and/or patient.

Attend insurance seminars.

Verify eligibility of Medicaid numbers.

CPT4 abstract coding for emergency room records.

Write appeal letters to insurance companies

Generate invoices for self-pay patients.

Train new employees.

Coordinate front desk activities in outpatient clinic and admitting and emergency room.

Schedule patients doctor appointments and test.

Obtain authorizations and referrals for outpatient and inpatient visits. Collect co- payments. Verify coverage and pre-certification for admits.

Assistant Manager, Church’s Chicken, New Orleans, LA 1992-1993

Supervise employees. Resolve complaints.

Handle daily paperwork and make bank deposits.

Manage food production and assign clean-up duties.

Conduct team meetings.

Interview prospective employees.

Train new employees.

Plan weekly employee schedules.

Open and close store

Assistant Manager, Majik Market, New Orleans, LA 1989-1991

Assist customers.

Order, price, and stock merchandise.

Coordinate daily paperwork and make bank deposits.

Interview prospective employees.

Train new employees.

Open and close store

Swing Manager, McDonald’s, New Orleans, LA 1987-1990

Supervise employees and assign clean up duties.

Balance daily cash and reports.

Open and close store.

Interview potential employees.

Plan weekly employee schedules.

Train new employees.

Contact this candidate