Conchita R. Kidd

Email: ad0gls@r.postjobfree.com Tel. 404-***-****

Experienced executive with over thirty years’ experience, with a demonstrated history of working in the executive healthcare office industry. Skilled in Operations Management, Customer Relationship Management (CRM), Team Building, Revenue Cycle Management and Analysis, Budgeting, Human Resources, Credentialing., and Business development, including marketing.

Objective/ Summary:

The opportunity to join and grow within an organization that has the need for someone who is versatile and dedicated, with the ability to assess situations and streamline processes in a challenging environment. Resolute, revenue cycle manager, medical biller, coder, and collector with over thirty years of multi-specialty practice experience. Additional twelve years’ experience as a firsthand consultant focusing on Revenue Cycle Management and as medical office administrative manager. I will deliver top performance and results and will be an asset to any team or organization.

Expert at addressing and concerns of patients, visitors, staff, and physicians and diffusing issues in a calm manner, investigating thoroughly and assisting with resolution daily. Expert in de-escalation.

Native Spanish speaker with over thirty years of professional translating and interpreting experience in healthcare field. Speak, read, and write fluently in Spanish and English. Excellent multi-language communication skills.

Great ability to inspire, recruit, coach, and train in various aspects of healthcare field. This includes teaching leadership skills to staff and new managers.

Expert in Microsoft Office applications including Microsoft Excel, Microsoft Word, Microsoft Power Point, Microsoft Outlook, Teams, Project, and others.

Proficient in QuickBooks and managing practice overhead.

Expertise in ICD-9/ICD-10, CPT, and HCPCS coding for multiple specialties including Family Practice, Internal Medicine, Orthopedics (including DME), Physiatry, Cardiology and Peripheral Vascular Procedures, Immunotherapy and Ophthalmology, among others. Obtained and kept CPC from 2006 to 2008.

Knowledge of licensing, reimbursement, and accreditation standards

Proficient in multiple Medical Information Systems which include Athena One (Super User), eClinical Works, Centricity, Cerner, Epic, Greenway, Lytec, Advanced MD, Office Ally, Medical Manager, Wallaby, PCN, and EDEX workers compensation system.

Highly skilled in multiple EHR software, including set up, mapping administration tables and implementation. • Proficient, but not limited to, use of multiple clearinghouses including TriZetto, McKesson, Office Ally, Navicure, and Gateway for filing and processing electronic medical claims.

Expert in collecting unmanageable debt from previously denied Medicare, Medicaid, Workers Compensation, and Commercial insurance claims, through persistent follow-thru and thorough Additional Development Requests (ADR) processes. When collaborating with patients, always maintain professionalism and follow FDCPA guidelines.

Built mutually respectful relationships with third-party payers, HMOs, PPOs, Medicare, Medicaid, workers’ compensation (WC) carriers and independent commercial carriers in the thirty years of working in the Healthcare Industry. • Have experience and have maintained extensive knowledge of revenue cycle and regulatory requirement associated with governmental, managed care, worker’s compensation, and commercial payers.

As a consultant for twelve years, I oversaw and coordinated revenue cycle activities with the goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state, and payer-specific billing requirements. Created and oversaw billing teams used Microsoft 365 applications and other software to obtain metrics for monthly updates to the physicians.

Education:

Clayton State College and University GED/High School Equivalency Certification

Insurance Collections and Office Management Certification

Healthcare Cash Management Seminars Inc., Medical and Private Insurance Claims Submission Specialist Certification 15 Hours of Continuing Education Small Business Administration.

Currently enrolled MSI to obtain Six Sigma Lean Black Belt in Healthcare

Skills:

•ICD-9-CM/ICD10, CPT Coding, and HCPCS coding

•Team Building

•HIPAA Regulations

•Insurance Reimbursement/ Collections

•Medicare/Medicaid Reimbursement

•Medical Information Systems

•Medical and Anatomy Terminology

•Chart Control, Access, and Storage

•DME Credentialing, Billing including Medicare.

•Managed Care Credentialing and guidelines

•Managed Care Regulations/JCAHO Guidelines

•Obtained and kept CPC certification from 2006 to 2008.

•Current on HIM Technologies

Work Experience –

Regenerative Orthopaedics & Spine Institute – January 2023- Present

RCM Manager/Credentialing Manager

Managed all credentialing, including hospitals, ASC, Government, WC, and Commercial payers at quickly growing Orthopaedic organization with two clinic locations currently, soon to be four, which provide clinic services, in house Physiatry procedures, MRI, and physical therapy and one standalone physical therapy location. I also assisted in the credentialing for Certified Surgical Assistants and new M. D’s and AHP’s for the ASC.

Worked with The Piedmont Clinic, as part of the credentialing process to add our new M.D. providers to their CIN. Created and developed relationships with Piedmont Clinic, numerous hospitals, and ASCs for credentialing and physician compliance within the Metro Atlanta area.

Practice had eleven providers when I started in January, Practice providers have increased by 45%, in the last ten months, I have credentialed seven new providers including M.D.’s, AHP’s, Certified Surgical Assistants, and Physical Therapists.

The credentialing process also includes recredentialing current providers, creating and updating CAQH, revalidation of government and commercial payers.

Identified, created, and updated an extensive managed care plan list so staff and providers will know which payers we participate with

in accordance with the No Surprises Act.

Managed daily deposits for all locations and departments.

Posted and allocated attorney payments for MVA’s

Researched, negotiated, and implemented a new medical records/disability form platform which has automated our Health Information Management processes. Saving the practice overhead for 1.5 FTE’s

Created training programs for new and existing administrative staff members, including managers, on Athena One, including the implementation of new workflows for appointment schedulers, front desk staff, MRI scheduling staff and new administrative managers and staff. This includes training staff on how to use our EHR and insurance portals to verify insurance and to ensure that they understand how to read the patient’s insurance cards and so that they choose the correct plans when scheduling new and existing patients. This includes verifying eligibility and benefits, as well as referrals and preauthorization.

Presented Lunch and Learn and instructed staff when we received upgrades for Athena One so that that we use our practice management system to its full capacity.

Training also includes showing staff the work flows from the time the phone rings and/or we receive a new patient referral, through to front desk check and check out so staff understands how verifying eligibility and benefits and choosing the correct insurances, and entering them correctly in the system, and how to collect patient copays, deductibles, and coinsurances affect the flow of practice revenue. Used training to ensure effective communication of the staff with our patients when collecting monies effectively while being polite and calm.

Worked with Billing Supervisor on training of billing staff and helped create a system to track their production on a daily basis.

Oversaw revenue cycle management department using Athena One and Microsoft 365 including Excel, PowerPoint, Word, Teams, and other applications.

Worked on and created special projects as needed.

Spine and Orthopedic Center- June 2021-January 2023

Practice Administrator

Oversaw small physiatry practice with one physician and seven employees.

Brought outsourced billing in house within first month at practice due to large loss of revenue. Implemented workflows and KPI’s to streamline the billing process, ensuring billing team sends out clean claims and payments are reimbursed correctly by loading fee schedules into EMR system. Assisted billing staff with appeals and any questions regarding claims. Increased practice revenue 65% within the first year at the practice.

Credentialed physician includes filling out necessary documentation so that the practice is now part of the Piedmont Clinic CIN.

Keep all credentialing, contracting, and licensing current including CAQH.

Developed billing measures to assist with monthly and weekly billing revenue cycle to keep physician updated.

Review all collections accounts and determine whether to turn patient accounts over to collections.

Since this is an exceedingly small practice I also assisted in medical assisting, working the C-arm while assisting in procedures such as epidurals and RFA’s, applied physical therapy modalities to patients. This had been invaluable to help me understand the back end of the practice which has served me immensely in streamlining and implementing new processes in the practice.

Used QuickBooks for Accounts Payable, responsible for daily opening of mail and making daily bank deposits.

Implemented workflow at front desk for balancing out the cash drawer and ensure front desk deposit is created daily.

Oversee all H.R. processes including one on one interviews, reviews, taking disciplinary action when necessary.

Responsible for bi-weekly payroll using ADP.

Marketing to other practices and attorneys to increase patient growth.

Ortho Atlanta/Piedmont Orthopedics by Ortho Atlanta March 2019-September 2020

Practice Administrator

Oversaw large Orthopedic practice with eight physicians and forty-two employees including Urgent Care Center •

Participated in the development of annual operating and capital budgets for the location.

Ensure appropriate resources and supplies are available for staff to fulfill their job responsibilities.

Expertly address concern of patients, visitors, staff, and physicians in a calm manner, investigating thoroughly and assisting with resolution daily. This includes medical records issues as well as patient collection issues.

Reviewed daily transactions by staff to ensure that they are trained properly. Created and reviewed monthly reports. Managed variances. Review daily deposits •

Direct and facilitate continuous quality improvement initiatives for patient-focused care.

Lead and support cost reduction efforts within the practice location

Conduct regularly scheduled staff meetings as well as location meetings with physicians for communication and process improvement.

Coordinate all required training, upon hire and annually.

Provide management support to ancillary services and clinic location.

Assist with marketing plans/efforts and with community activities.

Monitor hours worked and approved timesheets.

Work with H.R -. directing the personnel activities of recruitment, hiring, and addressing disciplinary issues, terminations.

Ensure that all staff are held accountable. Implemented one on one interviews with staff and annual reviews. Oversaw and directed forty-two employees and seven AHP’s.

Assist ancillary services, including physical therapy and all location staff during transition from Ortho Atlanta to Piedmont Orthopedics by Ortho Atlanta.

Assisted Ambulatory Surgical Center in Fayetteville in answering questions and helping administrative staff and new director with issues and helped them to implement processes until a new business manager was hired. This includes setting up processes to obtain and ensure that all operative notes are entered into both Athena and Vision systems. Also helped to answer any questions that they had until new business manager came on board. This included answering questions regarding Revenue Cycle.

Assisted Regional Director in overseeing the Peachtree City and Newnan offices until new administrator was hired. • Trained clinical supervisor in leadership, team building, and billing and collections skills while also implementing systems and processes to make the practice run more efficiently.

Have filled in check in and check out when clinic supervisor was unavailable.

Oversee staffing and operations of Ortho Quick Urgent Care Center in the Fayetteville office.

Develop monthly staff schedule and Physician clinic schedules, including weekly rotation of orthopedic medical assistants throughout all three locations of the Fayette/Coweta market.

Oversee large, dedicated phone center for all three locations Fayetteville, Newnan, Peachtree City. •

Implemented guidelines for health and safety of our patients and staff according to CDC guidelines for our clinic which was inside a hospital during Covid 19.

Regenerative Orthopaedics & Spine Institute Mar 2016 – May 2017

Practice Administrator

Managed all aspects of Practice administration of startup Orthopedic Spine surgery practice including:

Accounts Payables -Proficient in QuickBooks

Human Resources- Managed all aspects of H.R. including Finding and hiring applicants and onboarding new staff. Formal write ups and firing, if necessary. All paperwork associated with hiring, including I-9.

When I joined practice in March 2016 there were eight employees, one physician and one mid-level since it was a startup. In one year, we grew exponentially, and I had to hire ten employees. Supervised all eighteen employees when I left in May 2017.

Payroll- Managed all aspects of payroll using Paychex, Benefit Mall, Pay Focus Pro and Time Focus Pro for time tracking.

Oversaw AR of $1.9 million per month. Decreased AR of 91+ by 25%. Increased gross practice revenue by 60%. When I started in 2016, along with all my other duties as administrator I had to dig into AR to get it under control until I hired staff to work it. Built a team of account representatives of five people for two physicians and one nurse practitioner.

Payor Mix was, in order, Blue Cross Blue Shield, United Healthcare, Medicare, Workers Compensation, Medicare Replacement Plans, Cigna, all other large and small commercial plans, Corporate Billing for MVA’s, and Medicaid only as secondary. No ACA plans.

Managed all aspects of adding a second practice location within the first year of startup. Including any credentialing changes so that billing would go smoothly when second location opened. all payers, including appointment and reappointment to two separate hospitals.

Quantrex HealthCare Business Consultants Jun 2006 – Sept 2018

Healthcare Consultant (RCM Specialist with expertise focused on Revenue Cycle Management and Medical Office Administration) • Worked as a freelance consultant for firm. Engagements included, doing all medical coding and billing for large cardiology practice both on and off-site for 1.5 years.

Simultaneously developed and presented processes to multiple practices, with multiple specialties, and medical billing companies to streamline and increase their collections ratio.

Trained staff on how to appeal claims, including presentation of additional documentation to collect previously written off “bad debt.”

Assisted with several start up practices with set up and mapping of Medical Information Systems. Served as liaison between software vendor and office manager to ensure a smooth start up.

Trained practice management and billing managers on how to file and collect insurance claims and to ensure 100% collection of copays and patient balances, including self-pay patients, without damaging the patient/doctor relationships while maintaining full compliance.

This position gave me invaluable experience that allows me to go into various multi-specialty practices and immediately focus on resolving issues and problems by analyzing reports and data. As part of this work, I have developed the ability to learn all aspects of Medical Information Systems (software) necessary to do my job, within 24-48 hours, through research and study, so that I can assist the practices in the collection of revenue as quickly as possible.

Helped oversee and run two large Central Billing Offices for clients in cardiology and orthopedic specialties. This included the development and monitoring of new KPI’s for presentation and review to owner physicians, including payer mix, A/R, collections, adjustments, bad debt write offs, estimated collections, auditing for coding compliance appeal success rates and other parameters. • Maintained extensive knowledge of revenue cycle and all regulatory, compliance, and legal requirements.

Unalisys LLC Nov 2009 – Apr 2011

Medical Resolutions Department-

Worked for national company in department that collects accounts receivables for companies, multi-state, multi-specialty billing clients.

Worked to ensure accurate billing and resolve claims denials and medical-necessity issues.

Filed appeals for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims. Filed liens for Workers Compensation client in California on EDEX system.

Review medical documentation and consult with healthcare providers when documentation is inadequate/unclear for coding purposes. Transferred to SMAC (Smartfund Medical Acceptance Company) when company closed the medical billing division. SMAC is a collections agency for patient balances.

Worked in the insurance department of SMAC resolving any issues that arose due to incorrect insurance claims filings or not any filings at all.

Also answered calls from any Spanish speaking patients that called regarding their bills and did overall collections for this division. Translated all documents from English to Spanish which were necessary to conduct business with Spanish-speaking clients. • Worked extra hours from home in the evenings to help cover Spanish calls. Left in April of 2011 since company went out of business.

Maximized reimbursement by ensuring accurate ICD-9-CM, CPT, and HCPCS coding and conducting regular quality audits of providers’ selected codes compared to chart documentation.

Provided ongoing training to staff on intricacies of insurance submissions, codes to assist new collectors, with no medical experience to learn the particulars of medical billing and collections.

Clínica Médica Nuestra Sra. De Guadalupe LLC 2001 – 2009 Interim/Temporary Practice Administrator

Worked as a temporary practice administrator and on an on-call basis for family practice clinic catering to the Latino immigrant community.

Developed/implemented policies and procedures with “checks and balances” for clinic that works on a cash only basis (no insurance accepted) efficiently decreasing revenue losses by 98% monthly net revenue was $300,000 with one provider per location. • Researched and analyzed Latino-immigrant population preferences and developed programs to increase patient flow and maximize revenue. Managed a team of six employees with two clinics in the Metro Atlanta area.

Oversaw inventory of all medical supplies/drugs and negotiated prices with vendors to decrease practice overhead. Ensured that all equipment at facilities were calibrated and met standards required. Ordered new equipment for second office and oversaw inventory.

Ash Morrow Medical Center Inc. 1998 – 2011 Medical Consultant/Self Employed

Trained staff in computer systems to ensure peak performance.

Developed marketing strategies targeting the Latino community to increase new patient flow.

Researched practice procedures and implemented new policies and protocols to solve problems in front office and billing department.

Analyzed computer data and corrected coding problems reducing claims rejections from insurance companies, Medicare, Medicaid, BCBS and Workers Compensation.

Researched, coordinated, and oversaw the purchase and implementation of medical computer software to increase productivity. • Used my medical software knowledge to troubleshoot Wallaby PCN, and Medical Manager systems, including software and hardware issues since the practice did not have a support contract.

Have interviewed and assisted in hiring of several employees including billing personnel and Latino support staff. •

Reviewed methods to increase the effective use of employees including the outsourcing of billing.

Advanced Orthopaedics & Sports Medicine LLC. 1993 – 1998 Billing and Collections Manager

During my tenure at this practice, it grew from a solo-physician surgical practice to become the largest and most prestigious Orthopaedics practice in South Atlanta during its prevue.

Started as collections clerk and was promoted to collections manager within the first six months of my employment. • When I left in 1998, I was responsible for the training of new practice administrators and was offered the position. • Decreased accounts receivables by 20% within my first month of employment by collecting $12,000.00 of denied claims with persistent follow-through and appeals with documentation review.

Coded both office and surgical procedures for maximum reimbursement.

Coordinated and participated in the credentialing of new physicians that joined the practice for managed care plans, Worker’s Compensation, Medicare, and Medicaid.

Developed and designed systems used to track the most used procedure codes for the practice which were then used as fee schedules to negotiate managed care contracts. Designed and developed spreadsheets used to track each surgeon’s production for the end of each month.

Managed a team of seven employees and was responsible for the entire billing and collections department, including hiring, reprimanding with write ups, and firing if necessary.

Responsible for maintenance of Wallaby and Medical Manager medical software, duties included running any reports that were needed for practice from both MIS which ran concurrently. Coordinated the hardware for these systems, including the relocation and support of SCO-Unix based terminals.

Handled all translations and interpretations for the entire practice from English to Spanish and vice-versa. • Developed/implemented policies/procedures and job descriptions for Front Office/Billing and Collections departments. • Worked as liaison between physicians and patients, including the resolution of any customer service issues that required a manager in connection with the business office.

Participated in the interviewing, hiring, and training of all business office personnel.

Oversaw a monthly revenue of 2.9 million at the end of my tenure, we had five surgeons.

Georgia Life and Health Insurance Company 1991 – 1993 Assistant to Claims Manager

Employed by insurance company headquartered in Hapeville, GA; products offered were life, health, and Medicare supplements insurance coverage.

Started in policy service department and was promoted to assistant to the claims manager.

Duties in Policy Service Dept. included posting of insurance premiums and handling all telephone calls regarding premiums and agent commissions.

As the assistant to the claims manager, I answered all correspondence directed to claims manager, requested, and collected refunds of insurance overpayments from Providers. Responsible for handling all correspondence from the State Insurance Commissioner’s Office, including resolving all issues within fifteen (15) working days per Georgia Law.

Assisted with claims processing/payment when adjustors were short-handed. Resolved all inquiries from policyholders regarding Medicare supplement claims.

Translated all claims, medical records, and correspondence from Spanish to English and vice-versa. •

Answered all calls in Spanish that came thru the switchboard and resolved the issue at hand.

Georgia Life and Health Insurance Company 1983 – 1990 Spanish Translator and Interpreter/Assistant to Claims Manager

Returned, to work off site, by insurance company to translate all medical records and claims from Spanish to English, primarily for Mexico, Central and South America.

Managed all calls which needed interpreting via the telephone.

Certification in Hot Topics in Medical Biling and Collections.

Certified Professional Coding Certification 2006 – 2008 • FDCPA (Fair Debt Collection Practices Act) Certification 2009, 2010 & 2011

HIPAA Certification 2009- current • Certification as a Super User in Athena Health Medical Information Systems 2016 •

MACRA/MIPS-Seminar “What to expect and how to prepare” 2016 • Teaching leadership by using Emotional Intelligence 2017

Related Courses:

Health Data Classification Systems I (ICD-9 /ICD-10, CPT and HCPCS), Medical Terminology, Health Information Systems, Human Anatomy, Intercultural Communication, Health Statistics, Quality Assurance/Health Care, Advanced Coding and Reimbursement, RCM Analytics

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