Medical Manager
Resume:
Khatira Ibayeva
Vacaville, CA *5688
Ph: 925-***-**** Email: ********@*****.***
OBJECTIVE:
To seek a position where I can utilize my skills and experience to contribute to the growth and success of the company
SKILLS:
Multilingual: English, Russian, Turkish
MS Word, MS Excel, Power Point
Software knowledge: MDI, Matrix, Point Click Care, Vision, Unix/Linux
EDUCATION:
Az. State Institute of Languages-B/D 08/1992 – 08/1997
Real Estate Agent
RCFE Administrator
WORK EXPERIENCE:
Plum Healthcare - 01/18/16 - current
100 E. San Marcos BLVD, CA 92069
Position: A/R Consultant/Northern California
Responsibilities:
1. Audit: Medicare, Medical and Managed Care (HMO/PPO), CIF’s, Appeals
2. Help billing department to resolve the problem accounts
2. Month end closing. Review aging with Administrator.
3. Verify, submit E-TAR and eligibility. Responsible in training
4. Develop and implement billing policies and procedures.
5. Establish and maintain billing and performance benchmarks.
6. Prepare comprehensive billing, management and compliance reports.
7. Audit charts and charges and provide coding recommendations to maximize reimbursement.
8. Communicate effectively with supervisors, team members.
9. Responsible for Matrix Software issues for each facility including adding payers, removing payers, changes rates.
10. Heavy patient account collections and follow up
11.Current knowledge of various insurance carriers including government, managed care, fee schedules, cash management, HIPAA, billing rules and regulations.
12. Payer denial reviews and resolution
13. Various project as assigned
14. Travel to facilities as necessary for software and billing training, assist BOM’s with the collection process, working with Social Services (Medical eligibility) and Admission Coordinators (Correct admission information), with Administrators about training, collections need’s and improvements.
Episcopal Senior Communities – 06/16/14 to 06/15/15- Corporate Office for:
Independent Living, Assisted Living, Memory Care and Skilled Nursing Facilities
2185 N. California BLVD Suite 575
Walnut Creek, Ca 94596
Position: Revenue Cycle Manager
Responsibilities:
Oversee centralized billing team, train billing coordinators, admission coordinators, sales and marketing team in software and billing related sections at the communities. Travel to the communities and audit triple check for each community, responsible for month end close, audit Cert/Re-Cert to prevent future Medicare technical eligibility, admission and payer processing, charge capture, claims processing, revenue collection, contract negotiations and rate proposals.
Provides consultation & recommend solutions to difficult eligibility & admission problems. Evaluates & improves the delivery of service by initiating & promoting best practice models engages managers and staff in problem solving coverage or financial sponsorship opportunities. Provides education & direction to direct reports & medical center constituents. Identifies opportunities & provides support to assist with the implementation of revenue cycle performance improvement actions, Monitors the efficiency of the workload & process improvement.
Responsible for planning, directing and managing Patient Financial Advisor operations and admitting functions in a community center, responsible for financial liabilities, ensuring compliance with all regulatory requirements, policies & procedures, including readiness for external surveys & audits.
Coordinates with Utilization Review Management, Social Services, Patient Care Services & Discharge Planning to facilitate appropriate financial sponsorship, authorization, report & discharge process compliant with payer & government regulations. Insures timely & accurate coverage assessment (financial rounding) of all inpatient hospital patients
Works with accounting team as needed, resolving difficult issues, accountable for external vendor, performance & relationship for services supporting eligibility to other coverage or payer sources.
Hires, coaches, develops & disciplines staff as necessary.
Responsible for Financial Software (Vision) issues, working with Software team and vendor regarding financial software issues. Deeper education for key community users on insurance and reimbursement, orbit charge capture review, refinement, therapy process review. Responsible Party and Related Party (Vision) - audit and decisions. Set goals for the Revenue Cycle program to show progress and improvement. Help create a strong resident pre-approval process. Determine what other community resources are needed for complete revenue cycle.
Demonstrate ability to provide superior customer service
Maintain performance goals and regularly provide information to senior management.
Ability to manage multiple initiatives, identify and prioritize issues to meet aggressive deadlines and organizational goals.
Demonstrate supervisory, problem solving and decision making skills.
Working knowledge of revenue cycle including: Insurance coverage, benefits and authorization requirements; Payer specific requirements (e.g. workers' compensation, managed care, commercial insurance, third party liability, Medicare, Medical, and other government programs)
Comprehensive knowledge of laws, rules, regulations, procedures and departmental policies relating to admissions and eligibility for reimbursement from Medical, Medicare and other public and private medical/financial assistance programs including basic principles of hospital administration.
Responsible for various projects:
Implementation and upgrade of Software, Implementation of ICD-10 coding starting from 10/01/15, implementation and improvement of POS(Points-of-Sale)/Dining Software, financially responsible for merge in affiliation process and need to be ready for any upcoming new projects
Windsor Healthcare/SNF Management-Corporate Office - 08/13/12 to 06/01/2014
9200 Sunset BLVD
West Hollywood, CA 90069
Position: A/R Analyst/Regional Billing Manager for six buildings
Responsibilities:
1. Audit: Medicare, Medical and Managed Care (HMO/PPO), CIF’s, Appeals
2. Help billing department to resolve the problem accounts
2. Month end closing. Review aging with Administrator.
3. Verify, submit E-TAR and eligibility. Responsible in training
4. Develop and implement billing policies and procedures.
5. Establish and maintain billing and performance benchmarks.
6. Prepare comprehensive billing, management and compliance reports.
7. Audit charts and charges and provide coding recommendations to maximize reimbursement.
8. Communicate effectively with supervisors, team members and physicians.
9. Responsible for developing and implementing a full revenue cycle management program (accounts, billing, charge entry and reconciliation), review facilities monthly PNL reports with Administrators to identify opportunities and create objectives is important.
10. Heavy patient account collections and follow up
11.Current knowledge of various insurance carriers including government, managed care, fee schedules, cash management, HIPAA, billing rules and regulations.
12. Payer denial reviews and resolution
13. Various project as assigned
14. Have to travel to facilities as necessary to collect information, assist BOM’s with the collection process, also working with Social Services( Medical eligibility) and Admission Coordinators (Correct admission information).
AT ASSOCIATES 07/06/09 to 08/01/2012-Corporate Office for SNF
1355 Willow Way
Concord, CA 94520
Position: Regional Billing Manager/Collection Specialists/Accounts Payable
Responsibilities: Accounts Receivable
1. Billing: Medicare, Medical and Managed Care (HMO, PPO), CIF’s, Appeals
2. Month end closing. Review aging with Administrator.
3. Verify TAR and eligibility. Responsible in training
4. Develop and implement billing policies and procedures.
5. Establish and maintain billing and performance benchmarks.
6. Prepare comprehensive billing, management and compliance reports.
7. Audit charts and charges and provide coding recommendations to maximize reimbursement.
8. Heavy patient account collections and follow up
9.Current knowledge of various insurance carriers including government, managed care, fee schedules, cash management, HIPAA, billing rules and regulations.
10. Payer denial reviews and resolution
11. Responsible for three facilities, have to travel to facilities as necessary to collect information and to assist BOM’s with the collection process, also working with Social
Services (Medical eligibility) and Admission Coordinator’s (Correct admission information). Responsible in training new BOM’s
Responsibilities: Accounts Payable
1. Review, code and input expense reports, ensuring all charges and documentation are in accordance with Company policy.
2. Review cash flow reports and determine, by working with Development contracts, which wires should be remitted each week.
3. Create wire transactions, apply payments in A/P module, and provide vendors with confirmation information.
4. Respond in a timely manner to all vendor inquires and requests.
5. Perform data entry of invoices and vendor information.
6. Assist with weekly check run, assemble checks for signature, and mail checks.
7. Monthly bank reconciliation
PLEASANTON NURSING & REHABILITATION CENTER 01/16/08-07/02/09
300 Neal Street, Pleasanton, CA 94566
Position: Bookkeeper/Business Office Manager
Responsibilities:
Daily Census
Weekly Medical Billing
Co-Insurance billing
Check Insurance verifications
Prepare documentations and apply for E-TAR
Refunds
Write-offs
Adjustments
Private statements
Medicare and HMO Billing
GATEWAY CARE & REHABILITATION CENTER from 08/05/2004-03/27/07
26660 Patrick Ave., Hayward, CA, 94544
Position: Administrative Assistant
Responsibilities:
Answer phone calls
Order and maintain office supplies and equipment
Sort and distribute mail
Clerical support to staff
Daily Census
Co-insurance billing
Prepare documentations and apply for E-TAR
Check insurance verifications
Knowledge of ICD-9 Coding
Monthly Certs
Prepare and deposit daily cash
Check and send invoices to Corporate
Assist BOM with weekly Medical Billing, do it completely in her absence
Typing, faxing, making copies, making appointment and cancellation of appointment both in person and over the phone.
References available upon request.
Contact this candidate