BETTYE L. BEALE

Phone: 615-***-****

E-mail: ad2q83@r.postjobfree.com

WORK HISTORY

June 2010-

August 2015

HCA Patient Account Services - Revenue Integrity/Revenue Integrity Analyst-Work from Home for Parallon Atlanta SSC

Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, and eRequest

Medical necessity, Correct Coding Initiative, Outpatient Code Editor (OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertise’s

Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record

Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership

Performs assigned SAD’s Quarterly audits and Focus audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the RIAS systems

Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues

Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls per

HCA Requirements

Perform other related functions as assigned

November 2008-

May 2010

HCA Patient Account Services - Revenue Integrity/Revenue Analyst @ Las Palmas Hospital El Paso, TX

Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRT

Medical necessity, Correct Coding Initiative, Outpatient Code Editor (OCE), Inpatient Code Editor, Self Administered and other claims requiring clinical expertise’s

Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record

Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership

Performs assigned audits by researching documentation, analyzing information, and makes

recommendations to improve flow of claim and enters all corrections into the systems

Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues

Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls per

HCA Requirements

Perform other related functions as assigned

November 2008-

June 2019

Physician Office Services – AR/AP Manager - Credentialing Coordinator (Part-time) – Las Cruces, NM

Responsible for all credentialing and contract update for physician

Managed and implemented Cortex EDI billing and AR systems from start-up for medical office

OCTOBER 2007-

AUGUST 2008

Aegis Science Cooperation - Nashville, TN - Accounts Receivable Manager. (Managed 7-10 employees)

Managed AR policies and procedures, managed daily activities related to the AR function for 3rd Party Pain Comp billing, charge posting, analyze trends in insurance denials and worked with insurance companies to resolve denials/rejects. Screening, interviewing, and hiring new employees, arranged for training of new employees, reviewed each staff member’s productivity, performed annual evaluations, counseled staff with disciplinary and productivity issues, conduct monthly staff meetings, analyze statistics, compile, reconcile, and distribute monthly reports. Other duties included – overseeing insurance credentialing for non-par payers. Managed the implementation of Intergy and Practice analytics systems from start-up for the AR department.

DECEMBER 2005-

OCTOBER 2007

Revenue Cycle Solution Project Manager – Perot Systems-Advanced Receivables Strategy, Inc. Worked as a team member with implementation of eContracts and ePrime for ARS. Managed TennCare collections/billing, patient accounting, collections and appealed aged TennCare accounts, electronically, when possible. Billed and collected hospital patient accounts including inpatient acute care, comprehensive outpatient rehabilitation facility services, skilled nursing facility services and outpatient psychiatric services. Patient accounting for DC Medicaid - billed, collected and appealed aged Medicaid accounts.

JUNE 2003-

JUNE 2005

OB-GYN Clinic Murfreesboro, TN- Practice Manager/ Audit Nurse (Managed 10-15 employees)

Managed all daily activities related to the practice. Audit Medical records, appeal denials, hired and trained all employees, managed customer services, scheduled surgeries, precerted surgeries, verified insurance benefits, daily posting of remits (EOB’s), analyzing and reconciliation of patient and insurance receipts, interpreting EOB’s and account information, resolving outstanding patient accounts through direct contact with the patient by telephone and in person, obtaining payment on balances and establishing appropriate payment plans, Medicare, TN Care, and private insurance billing and coding, coordinated all billing activities and collection coordination, coordination of posting payments and keying adjustments and identifying additional documentation needs, reconciling receipts summaries, researching credits on A/R accounts, working with third party payers to resolve balances. Responsible for all credentialing and contract update for all providers. Developed a reporting system for collections. And many other duties as needed.

OCTOBER 1998

DECEMBER 2003

HCA Patient Account Services, Nashville, TN – TN Care/Medicaid Collection/Billing Manager.

(Managed 26 employees)

Collections Manager Duties

Screen, interview, and hire new employees

Arrange for the training of new employees

Receive and review statistical documents from Information Services and provide that information to the appropriate Collector/Patient Account Representative

Assure productivity of each staff member

Review each staff member’s productivity on a monthly basis and perform annual evaluations

Counsel staff with disciplinary and productivity issues

Work as a liaison between the Collections services staff and other PAS staff

Resolve issues escalated by patients and/or Collections staff

Conduct monthly staff meetings

Billing Manager Duties

Ensures that third party billing is submitted correctly and that appropriate follow-up is performed

Assures that denials are corrected and filed

Assures compliance with billing policies and procedures

Assists the Billing Director in establishing and monitoring productivity standards, quality improvement and direct staff in meeting department goals

Assists the Billing Director in preparing timely month-end closing activities

Screen, interview, and hire new employees

Arrange for the training of new employees

Counsel staff with disciplinary and productivity issues

Work as a liaison between the Billing services staff and other Patient Account Services staff

Resolve issues escalated by patients and/or Billing staff

Conduct monthly staff meetings

HCA Patient Account Services, Nashville, TN. - Clinical Appeals/Revenue Integrity/Auditing Nurse Manager – (Managed 16 employees)

Appeals Manager Duties

Analyze trends in insurance denials and work with insurance companies to resolve underlying reasons for denials

Manage recurring coding or clinical documentation issues and correct the underlying causes for errors.

Perform Q/A for Clinical Appeals function

Screen, interview, and hire new employees

Arrange for training of new employees

Review each staff member’s productivity on a monthly basis and performing annual evaluations

Counsel staff with disciplinary and productivity issues

Work as a liaison between the Clinical Appeals staff and other Patient Account Services staff

Resolve issues escalated by Clinical Appeals staff

Conduct monthly staff meetings

Auditing Manager Duties

Assist with the processing of payroll for his/her direct reports by maintaining employee edit requests, PTO requests, etc.

Maintain accurate attendance records for employees

Maintain QA statistics as needed and reports results to the Regional Revenue Integrity Manager

Assist with or performs employee evaluations with input from Regional Revenue Integrity Manager

Directly oversee the daily activities of the RI Analyst to ensure department standards are met

Continually educate staff of any changes pertinent to their roles

When appropriate, relieve staff members during employee sick/vacation time

Work closely and professionally with nursing and ancillary departments in an effort to maintain a teamwork approach

Excel in all functions performed by Revenue Integrity Manager

Responsibilities to ensure adequate staffing and problem-solving

Schedule and assist with evaluation processes; helps resolve employee concerns

Assist Regional Revenue Integrity Manager to ensure all personnel and department policies and procedures are followed

Informs Regional Revenue Integrity Manager of all issues

Supervise and maintain effectiveness of workflow and staff responsibilities

Recommends sufficient number of qualified/competent staff

Actively seeks ways to control costs without compromising patient safety, quality of care of the services delivered

Attends in-service presentations, and complete mandatory education week including, but not limited to, infection control, patient safety, quality improvements, MSDS and OSHA Standards

Demonstrates knowledge of occurrence reporting system and utilizes system to report potential patient safety issues

HCA Nashville Memorial Hospital, Nashville, TN. - Patient Account Representative, HMO/PPO Collector/Appeals Representative - Review managed care insurance claims denials for possible appeal, review medical record for clinical information to support an appeal, resolution of bad debt claims, customer service, prompt pay discounts, analyze remits for correct payment per contract, and direct communication with insurance company and patients regarding payment of hospital bills.

AUGUST 1996-

OCTOBER 1998

Baptist Hospital, Nashville, TN. - Claims Resolution Specialist, HMO/PPO Collector/Private Pay Collector-Direct communication with insurance company and patients regarding payment of hospital bills, developed training manual for patient representatives, trained patient reps, verified and processed charity applications.

JUNE 1994-

MARCH 1996

Millennium Medical Trust, Nashville, TN. - Billing/Collection Coordinator

Managed accounts receivable/payment, insurance billing and follow-up for a solo physician clinic, and direct communication with patients regarding bills.

JANUARY 1993

JULY 1993

Middle Tennessee Medical Center, Murfreesboro, TN. - Quality Care Review Nurse

Audited and Reviewed Home Health patient’s charts to meet Medicare Guidelines before billing, billed Medicare/Medicaid and third party claims.

SEPTEMBER 1984-

JANUARY 1993

Concord Psychiatric Clinic, Knoxville, TN. – Psychiatric Nurse/Clinical Director (Managed 20 employees)

Audited Medical records, appealed denials, maintained all accounts receivable, account payable, payroll, general ledger, franchise taxes, hired and trained all employees, managed customer services, assisted the physician, billed all insurance claims, CPT/ICD-9 coding, data entry, bookkeeping, self-pay and insurance follow-up. And other duties as needed.

SEPTEMBER 1984-

NOVEMBER 1985

University of Tennessee Memorial Hospital, Knoxville, TN. - Staff Nurse/Medical Surgical - Patient care for Medical Surgical steps down Unit.

EDUCATION

Middle Tennessee State University, BSN, 5/6/2006

Meharry Medical College School of Dentistry

Tennessee State University, Nashville, TN. - Nursing/Chemistry, AD in Nursing, 8/11/84

Eastern Michigan University, Ypsilanti, MI. - Chemistry/Pre-Med

Meharry Medical College, Nashville, TN. - Summer Biomedical Program

Tennessee State University, Nashville, TN. - Chemistry/Pre-Med

Alabama A&M University, Normal, AL. - Chemistry/Pre-Med

SYSTEMS USED

Intergy by Sage

Practice Analytics Reporting by Sage

Patient Accounting (HOST)

RDARS

Revenue Integrity Audit System (RIAS)

Collections

Meditech

Patient Care Inquiry (PCI)

MSM (Medqual)

Voicert

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Power Point

Microsoft Outlook

Clear Access

Med Informatix

ePremis

Affinity

Medisoft

Passport

CDM Viewer

MSC (DET/RMT/CRT)

SSD Etran

Kronos

Onbase DEI

Revenue Cycle Pro

CLUB AFFILIATIONS

Toastmaster International

CTM (Competent Toastmaster)

CL (Competent Leader)

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