Shan Torti

903-***-****

Revenue Cycle / Collections/ Billing Remote worker

Experience and due diligence are what makes me valuable to your company. I have letters of recommendation on the high volume, high dollar account balance collections. Invoicing patients, and accounts receivable follow up and balancing. Reconcile month end closing and reporting, bank account activity and bank account balancing to client database. Posting payments. 13 years of accounts receivable collections for Physicians and hospitals. Experienced in appeals, refunds, payment disputes, credit balances, incoming patient and insurance calls, resolving issues, benefits verification, month end closing and reporting, point of contact for clients. All insurances including Managed care, Third party, all secondary payors, Medicare, Medicaid, Advantage plans, Commercial, IPAs, Capitation, Workers Compensation, Tricare, Veterans Administration, personal injury attorney cases. Previous specialties include: Physician, Inpatient and Outpatient hospital, Emergency, Surgical, Medical and Cosmetic Dermatology, Radiation Oncology, Pain and Rehabilitation, DME, HME, Genetics, Opioid therapy, Orthopedic, injection procedures, occupational, and personal injury, I have Letters of Recommendation available from previous employers.

Work Experience

Revenue Cycle Recovery Analyst II/ Epic Mar 2021 - CloudMed Solutions an R1 Company – Remote

EPIC Resolute HB, EHR- Hospital account management for the accounts receivable department working independently in a fast-paced environment

Identify trends and analyze unpaid and underpaid claims

Research, appeal, and resolve claim rejections, underpayments, and denials, drafting appeals and letters to insurance companies proving medical necessity, eligibility, coordination of benefits, third party liability

Aging reports and follow-up of client accounts.

Develop and maintain positive relationships with clinical personel, and insurance companies

Utilize analytical and critical thinking skills to problem solve

Analyze and translate workflows, ensure projects are completed timely,

collaborate with teams, document, and maintain quality, demonstrate translate a history of resolving challenging issues

Followed up with clearinghouse and practice mangers for any claim issues or rejections, processes, or any other benefit discrepancies.

inpatient, outpatient, ambulatory, surgery, and physician claims

answering client, patient and insurance calls.

Prompt follow up to all inquiries and requests for information, refunds, credit balances, overpayments.

Root cause analysis, copays, deductibles, correcting coding, modifiers, and place of service on corrected claims.

Drafting appeals and letters to insurance companies proving medical necessity, eligibility, coordination of benefits, third party liability.

Using available resources appropriately, including training materials, shared drive, team meeting notes, payor portals and provider manuals, making proper notations in software system on all accounts, handling rush cases appropriately, completing initial reviews and validations as assigned.

Follow up on all appeals, claims, letters, or other documentation within 30 days or less of the submission, follow up on all payments at the time an overturn is received.

Ensure that assigned accounts are followed up on timely matter.

strong problem-solving, communication, and teamwork skills, detail-oriented.

Month end closing, balancing to bank accounts, and reporting.

Senior Revenue Cycle Manager- Call Center

U.S. Dermatology Partners - Tyler, TX Dec 2019 to Mar 2021

Follow up of outstanding balances of claims, working denials, submitting appeals for medical claims to ensure payment of charges.

Corrected claims, maintenance of patient accounts, posting payments, and verifying insurance coverage.

Escalate unresolved issues to management.

Improved Accounts Receivable processes.

communicating to clinics and hospitals as Point of Contact, Complete Initial Reviews and Validations as assigned.

incoming patient calls, taking credit card payments, Maintain the worklist through daily audits and the open task report.

Balances adjustments and qualifying patients for financial assistance and arranging payment plans.

health insurance verification and benefits

Trained new staff, maintained internal documentation.

Month end reporting, refunds, credit balances, overpayments, duties include all aspects of medical office.

Revenue Cycle Account Manager - 2 separate companies

CareFirst Pain and Rehab, Red Leaf Ventures – Tyler, TX Dec 2014 to Dec 2019

Rize Medical Equipment DME & HME, Trinity Mobile, LLC Tyler, Texas

Collections for Orthopedic and Spine, sports medicine, pain rehabilitation, diagnostics, opioid therapy, injection procedures, behavioral health, physical medicine, DME & HME occupational, Physicians and surgeon’s compensation. commercial, Veterans Administration, Medicare, Medicaid, third party and attorney’s personal injury cases.

Duties included claims follow-up, denials, submitting appeals for medical claims to ensure payment of charges. Insurance calls incoming and outgoing, and patient calls.

Corrected claims, denials, credit balances, refunds, and overpayments.

DME & HME billing, payment posting, coding of medical equipment for billing insurance, collections for accounts receivable.

All month-end processes are carried out including Accounts Receivable aging reports.

Carrier /insurance analysis reports, rejections reports, patient payments report, and denial tracking reports

Maintenance of patient accounts, posting payments, verifying insurance coverage, incoming patient calls

Credits and balances adjustments, qualifying patients for financial assistance

Arranging payment plans.

Lead Revenue Cycle Account Manager

Radmax Solutions Ltd - Tyler, TX Jan 2009 to Dec 2014

Overseeing the staff of the revenue cycle department

Managed five Radiation Oncology clinics across the United States at any time depending on my departments need, including capitation and IPA accounts in California, also Nebraska, Oregon, and Texas

Trained new employees on our database and processes.

Overseeing month end balancing, closing and reporting for 25 clinics and hospitals.

Submitted appeals for medical necessity to ensure payment of cancer treatments

Worked denials, insurance verification. incoming patient calls and carrier calls.

Qualifying patients for financial assistance and taking payments from incoming patient and insurance calls

Loading contracts into the database

Creating and implementing policies that ensured the accuracy of patient billing information.

Analyzing contracts.

Credit card payment, refunds, credit balances, and adjustments.

Payment Posting Representative

Fresenius Nov 2005 – Jan 2010

Ensures payment, adjustment and denial transactions are accurately posted and reconciled according to department and company specifications and in compliance with regulatory requirements. Escalates more complex transactions and issues to Team Lead or supervisor as appropriate.

Receives the electronic deposit confirmation via email from the bank for the FVC center location, downloads the images of corresponding paper Explanation of Benefits (EOB's) and prints electronic Remittance Advice (RA) reports from the electronic data interchange vendor (Navicure).

Totals transactions on EOB's and RA's and verifies that balances total the respective deposit.

Creates a batch by payer and/or deposit date and totals each batch.

Applies the batched transactions to the appropriate accounts in the appropriate medical billing software application (Medical Manager or Imagine.

Verifies that the applied transactions reconcile to the batch totals.

Generates a payment application report and attaches to the batches posted for the day.

Posts the non-payment transactions (including adjustments and denials) to the appropriate accounts in the medical billing software application.

Closes all medical billing application batches on a daily basis.

Education

Completed courses in Accounting & business

Devry University - Dallas, TX

Skills

Root Cause Analysis

Aging reports, denial reports, month end reporting, billing reports

Month end balancing and closing

Physician billing

Hospital billing inpatient, outpatient, ambulatory, physician, skilled nursing, hospice

Experienced in Oncology, Pain and Rehab, Dermatology, DME, HME, Veterans, Cancer Treatment Facility’s, Dialysis, cardiology, gastroenterology, orthopedics, internal medicine, family medicine, anesthesiology, neurology

Employee Training

Insurance Appeals

Revenue cycle management

Charge entry

Third Party reimbursement

EMR systems and EHR systems

Financial assistance qualification

Managed care, Third party, Medicare, Medicaid, Advantage plans, Commercial, IPAs, Capitation, Workers Compensation, personal injury.

Contract Management – loading contracts

Databases: Epic, Oracle, Cerner, Allscripts, Sorian, HME (DME) Saas Software Brightree ResMed, Nautilus

Clearinghouse: Advanced MD, NextGen Healthcare HER, Emdeon, Availity, Optum

Customer service and monthly statements

Microsoft Office skills including: OneNote, Word, Excel, Outlook

Denials

medical billing

Collections

Contact this candidate