Manager Insurance

LISA SAN ROMAN act1h2@r.postjobfree.com

***** ****** ***** 561-***-****

BOYNTON BEACH, FL 33437

ACCOMPLISHMENTS Handled the implementation of the delegation process for multiple new insurance plans.

Collected over two million in revenue doing special “uncollectible debt” projects from Medicaid and Medicare HMO’s.

Developed the initial set up for new MSO’s and IPA’s. Completed conversion and set-up of credentialing software. Ability to negotiate and re-negotiate a multitude of managed care contracts on a regular basis for a higher rate.

Successful at appealing denials and corrective action plans for Medicare, Medicaid and other payers at a high volume with successful outcomes. Effectively managing a team and obtaining all prior objectives and goals set. EXPERIENCE

June 2014 to MSR TECHNOLOGIES OF SOUTH FLORIDA- Boynton Beach, FL Present ADMINISTRATOR

Serving as Bookkeeper, running all reports for the company as needed, as well as handling the quarterly and annual taxes.

Handle A/R, A/P, and budget planning and invoicing the customers for services rendered.

Negotiating and handling the yearly contracts for the facilities we provide services to.

Hiring appropriate staff for particular projects and Human Resource issues.

Scheduling of weekly and monthly client appointments.

Marketing and advertising of services offered, as well as maintain website.

Ongoing ordering of supplies and maintenance of inventory.

Assist with computer installations, re-installations and repairs. April 2012 to TENET FLORIDA PHYSICIAN SERVICES, LLC- Boca Raton, FL May 2014 CREDENTIALING COORDINATOR/PHYSICIAN ONBOARDING

Processed physician credentialing/re-credentialing for over 180 multi- specialty physicians & 80 locations to bring them on board

Made sure all DEA, Medical licenses, Board Certifications, etc. are all up to date with hospitals, payers, practices, etc.

Broad knowledge of Medicare, Medicaid & commercial credentialing/ billing

Created and maintained spreadsheets and reports. Utilization of Symed software.

Worked directly with Managed Care Department, Contracting & billing company to resolve any and all applicable issues that arise

Maintained constant contact with revenue cycle manager to help review the routine audits and reviews to help resolve the ongoing issues.

Provided documented reports of findings of ongoing issues to appropriate directors and helped to give feedback regarding resolution

Ran reports to make sure corrective action after internal audits were being complied to.

Obtained the Physicians Medical Staff Privileges at the local hospitals

Preparation for ICD-10, Medicare compliance and working with individual offices to stay compliant with billing and collection issues. September 2009 to PALM BEACH CANCER INSTITUTE, LLC- West Palm Beach, FL April 2012 MANAGED CARE and Credentialing Supervisor/ Financial Counselor

Management of staff in all insurance and managed care issues

Negotiated all managed care contracts, new/existing. Credentialing for 30 doctors, 4 ARNP and their hospitals

Responsible for conducting routine audits internally.

Providing feedback on the outcomes from the audits to my superiors.

Resolved all Medicaid issues and analyzed all accounts for collections.

Processed Medicare and Medicaid billing and also Medicare and Medicaid appeals and redeterminations

Created and maintained excel worksheets of all the payers/fee schedule and their current reimbursement

Monitor, maintain and Renew all Malpractice Policies for Physicians and Practice.

Entered all new drugs and insurances in medical software and expire old ones, (all fee schedules-creating and updating changes on an on going basis)

Responsible for all ME licenses, DEA's, all permits, etc for the MD's and facility to operate

Coordinated with physicians and hospitals on a daily basis regarding a variety of issues.

Prepared for ICD-10 and EMR programs and helping with any upcoming billing software upgrades, administrator for all insurance websites. October 2007 to PALM BEACH PHYSICIANS, P.A- Palm Springs, FL December 2008 OFFICE MANAGER/BILLING MANAGER

Billing of all payers with our electronic systems and posting of charges and payments daily

Made sure Accounts Receivable was worked, run reports daily

Handled all collections and payment plans for patients

Office management functions (13 employees, 2 doctors.1 ARNP)

In charge of internal audits for managed care and appeals & documentation of such

In charge of all patient grievances and appeals.

Coordinated credentialing and negotiating contracts for all doctors and nurse practitioners and responsible for hospital and insurance contracts.

Maintained physician's licenses and NPR credentials on an ongoing basis

Submit all necessary paperwork such as DEA reg., ME, CLIA cert., etc.

Handled all A/R, A/P, budget planning, payroll, etc.

Completed all bi-weekly pay-roll of staff December 2005 to BRIGHT FUTURES INTERNATIONAL- North Palm Beach, FL August 2007 ESE CONTACT/PROVIDER/ SCHOOL COUNSELOR

ESE Contact/LEA responsible for all IEP's and 504

Handled all observations, interventions and assessments for all Gifted, ESE and ESOL students.

October 2004 to TRANSITIONS- West Palm Beach, FL

November 2005 LIFE COACH/COUNSELOR

Used Counseling to train and motivate adults and children to achieve life skills and goals

Taught people to re-learn simple tasks and complex tasks April 2004 to THE RETINA INSTITUTE OF FLORIDA- West Palm Beach, FL October 2004 BILLING/INSUR/COLLECTIONS SUPERVISOR- (TEMP.Position)

Daily surgery and all other charges billed out on a daily basis to insurance and posting of all payments into system

Obtained authorizations for office visits and procedures

Medicare and Medicaid appeals and action plans.

Collected payments (collections) and payment plans, all Accounts payables

Renegotiated contracts and credentialing and re-credentialing December 2002 to HEALTHLINK- Royal Palm Beach, FL

March 2004 SUPERVISOR OF OPERATIONS

Maintenance of all insurance contracts and reimbursements

Responsible for the credentialing on new insurance contracts as well as ongoing insurance

Identifying improvement opportunities through audits and patient complaints.

ICD9/CPT billing and coding, all posting payments, scheduling front desk

A/P. A/R. payroll, computer month end close out and 30 plus employee troubleshooting/training

Submit all required licenses and permits or other required paperwork to hospitals and insurances such as DEA, ME, CLIA and CEU's in timely fashion. Keep licenses renewed

Responsible for our case management as well which involved counseling and coordinating care for our HIV patients.

Met with families and made sure patients were on medication and attending meetings. Helped patients get funding to meet needs to stay on meds April 1998 to UROLOGY ASSOCIATES OF THE PALM BEACHES- Palm Bch Grdns, FL June 2002 BILLING & INSURANCE SPVR. / OFFICE COORDINATOR

Insurance billing and collections/supervisor for 3 doctors and two offices

Responsible for all Medicare compliance and HIPPA, all software related computer support, troubleshooting and daily back-ups and month end close outs for all offices

Responsible for all internal audits and compliance.

Responsible for all hospital paperwork and credentialing and to fill out correctly & include any required documents

Negotiated all maintained all contracts for better reimbursement April 1997 to HEALTHLINK, INC. - Davie, FL

June 1998 COUNSELOR AND PROGRAM MANAGER

Maintained appropriate paperwork and helped with initial licensure for RX programs through Healthlink-Lifeline Pharmacy.

Responsible for program management, direction of the entire program and coordination of care between the other four offices. EDUCATION FLORIDA ATLANTIC UNIVERSITY-BOCA RATON, FL M. Ed Mental Health Counseling

FLORIDA STATE UNIVERSITY-TALLAHASSEE, TALLAHASSEE, FL BACHELOR OF SCIENCE- REHABILITATION COUNSELING AND SERVICES

UNIVERSITY OF SOUTH FLORIDA

ASSOCIATE OF ARTS- GENERAL STUDIES

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