Accounts Receivable Team Lead
Resume:
Catherine Doniel Gaston
Madison, TN 37115
Education: Branell Institute
Certificate in Computer Accounting 1991
Hunters Lane Comprehensive High School
Honors Diploma 1987
Experience: HCA Physician Services
Accounts Receivable Team Lead July 2009 to Present
Maintains knowledge of commercial, Medicaid and Medicare guidelines for correct reimbursement for Physicians charges for all insurances along with all Anesthesia and RHC rules and regulations for billing and payment.
Manage Team Members for productivity and accuracy on all claims worked
Reporting to Manager and Director on any trends found or issues that may arise from a specific insurance company
Tracks, logs and helps resolve all denial activity on EOB’s to help Practice lower the denial rate, as well as working and reviewing of all appeals
Timely follow up on unpaid/unbilled claims
Posts payments from unapplied cash and adjustments for all payers due to contractual write offs and/or patient responsibility
Runs daily reports to ensure all claims are being worked by age and high dollar
Works directly with Payers for help resolve issue regarding billing and payments.
Accounts Receivable Representative July 2008 to July 2009
Maintains knowledge of commercial, Medicaid and Medicare guidelines for correct reimbursement for Physicians charges for the states of Florida, South Carolina and Virginia
Prints, verifies for accuracy and mails Federal billing forms
Posts payments from unapplied cash and adjustments for all payers due to contractual write offs and/or patient responsibility
Tracks, logs and helps resolve all denial activity on EOB’s to help Practice lower the denial rate
Timely follow up on unpaid/unbilled claims
Elk Valley Health Services
Billing and Collections Specialist Team Lead Sept 2003 to July 2008
Maintains knowledge of commercial, TennCare and waiver guidelines for correct reimbursement
Prints, verifies for accuracy and mails Federal billing forms
Maintain financial records
Participates in billing audits for TennCare and commercial payers with Private Duty Nursing and Intermittent visits
Helps post payments and adjustments for all payers
Tracks daily, monthly cash and denial activities in Excel
Timely follow up on unpaid/unbilled claims
Refunding insurances when overpayment is received
Conducts data analysis to provide clear and accurate reports
Supervises 3 employees
Primary contact for Provider Representatives for all insurances for any contract issues and fee schedule disputes
Assists with fee negotiations with individuals and group contracts
Continuous Care Services
Collections Nov 2005 to March 2006 (Part time 5pm – 8pm)
Bill online with Missouri Medicaid for home health services
Keep excel spreadsheet of all information for daytime biller to call and research errors
Do any follow up needed online along with any rebilling
Vanderbilt Home Care Services
Account Reimbursement Specialist May 1996 to Sept 2003
Maintains knowledge of Medicare IPS and PPS, TennCare and Commercial guidelines for correct reimbursement
Electronically submit claims to Medicare using the HCMS software
Coordinate billing activities for all audits
Participates in billing audits for Medicare and commercial payers
Maintain financial records
Verifies Medicare HIC# in DDE database
Posts payments and adjustments for Medicare payers
Tracks daily, monthly cash and denial activities in Excel
Timely follow up on unpaid/unbilled claims
Conducts data analysis to provide clear and accurate reports
Run financial reports
Prints, verifies for accuracy and mails Federal billing forms
Charge capture for patients billing records
Century Home Health Care
Billing Representative April 1995 to May 1996
Office Manager April 1994 to April 1995 (office closed/downsizing)
Data Entry Clerk Sept 1993 to April 1994
Data entry of certifications and recertification’s for physician approval
Mails/delivers and tracks Physician orders
Participates in billing audits for Medicare, TennCare and commercial payers
Prints, verifies for accuracy and mails Federal billing forms
Maintain financial records as well as personnel records
Maintains accurate information for completion of the Joint Annual Report
Charge capture for patients billing records
Conducts data analysis to provide clear and accurate reports
Run financial reports
Processes payroll
Supervised 1 to 3 employees
Works directly with Corporate Office in managing financial reports for accuracy
ComData Corporation
Credit Card Security Specialist Sept 1987 to Sept 1993
Processes and verifies credit card transactions, cash advances and fuel card transactions for accuracy for the trucking industry and gaming locations. Indication and cancellation of fraudulent transactions and works directly with federal and local authorities from each gaming and truck stop location in the apprehension of persons passing fraudulent transactions on credit cards or fuel cards and appears in court for conviction when needed. Answers multi-line switchboard, directs calls to appropriate departments and answers incoming Call Center calls if needed due to illnesses and high Que volumes.
Knowledge of the following Billing Programs and Software:
McKesson, Vividnet, CareKeeper, 3M, HCIS, DDE, Haven, Emdeon, Relay Health, Change Healthcare, OSM Core, eClinicalWorks, Artiva, OnBase, Outlook, Excel, Word, Powerpoint, Visio, Cactus, Host, WebEx, Cerner & PSC Request Portal (Remedy ticket system)
References available upon request
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