Anthony J. Bentivegna

Email: ad2tlq@r.postjobfree.com 619-***-****

Objective

I am seeking position in Healthcare Compliance or Revenue Cycle Operations, in industries such as pharmaceuticals, medical device,biotech and life sciences.

•Professional Strengths

• A solid background has led to a strong understanding of Healthcare compliance.

• Adept at managing cross-functional teams and implementing process improvement. Conducted quality assurance, auditing, and investigations.

• Experience working with therapeutic areas such as oncology and pharmacovigilance.

• A strong understanding of Healthcare compliance and FDA regulations.

• I seek to utililze these skills as a leader, leveraging my experience in managing cross-functional teams and implementing process improvements.

•Certified Compliance and Ethics Professional,Texas notary publicS

Professional Experience

Avita,LLC

Compliance Analyst, Legal Affair

October 2020-January 2024

Responsibilities:

Support the Legal Department in the areas of licensing, compliance, and permitting. The primary focus of my position is maintaining compliance of all required licensing/permits for the company.

Additionally, this position collaborates closely with various business units to ensure compliance of identified risk areas associated with licensing and permitting.

This role utilized my skills managing cross-functional teams and implementing process improvements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

•Obtaining and maintaining the required licenses, permits and governmental authorities which are necessary when we open new locations

•Coordinating the completion, receipt, and review of license and permit applications and renewal applications

•Ensuring compliance with applicable policies, administrative regulations, and statutes

•Communicating with Federal, State, and Commercial Insurance Payors.

•Provide advice with application of various licensing requirements to current and proposed operations.

•Maintaining records, compiling information, and ensuring timely submission of materials to state agencies to obtain and maintain entity and agent licenses promptly and efficiently.

•Conducting extensive research and analysis of a variety of licensing matters related to Pharmacy and Clinical Operations.

•Keeping all entities compliant in the states in which they are currently registered, including assumed name filings and maintenance.

•Setting up, maintaining, and assisting Company Stores with the Texas StateBoard of Pharmacy and Medicaid.

•Additional responsibilities include assisting the Finance Department with contract administration. PBM and Healthcare reimbursement issues

Revenue Cycle Manager

Conifer Health Solutions - Plano, TX

June 2020 to October 2020

SUMMARY

•Obtaining and maintaining the required licenses, permits and governmental authorities which are necessary when we open new locations

•Coordinating the completion, receipt, and review of license and permit applications and renewal applications

•Ensuring compliance with applicable policies, administrative regulations, and statutes

•Communicating with Federal, State, and Commercial Insurance Payors.

•Provide advice with application of various licensing requirements to current and proposed operations.

•Maintaining records, compiling information, and ensuring timely submission of materials to state agencies to obtain and maintain entity and agent licenses promptly and efficiently.

•Conducting extensive research and analysis of a variety of licensing matters related to Pharmacy and Clinical Operations.

•Keeping all entities compliant in the states in which they are currently registered, including assumed name filings and maintenance.

•Setting up, maintaining, and assisting Company Stores with the Texas StateBoard of Pharmacy and Medicaid.

•Additional responsibilities include assisting the Finance Department with contract administration. PBM and Healthcare reimbursement issues

•Responsible for all aspects of the day-to-day supervision and leadership of Patient Account Representatives, including but not limited to the Performance Management metrics of collections, productivity, quality and aging. Interview candidates and make hiring recommendations and decisions. Complete monthly quality evaluations. Monitor staff scheduling and adherence to time and attendance protocol. Responsible for all aspects of A/R Management, including but not limited to maintaining workload balance, ensuring maximum efficiency, eliminating rework, and reducing cost. Promptly identify issues and develop action plans to mitigate or resolve.

•Train, develop, motivate and assist subordinates in reaching new levels of skills, knowledge and attitude. Effectively maintain a work environment which stimulates and motivates the morale, engagement and growth of subordinates. Identify performance deficiencies and opportunities and implement action plans as needed.

•Review and respond timely to requests, including emails, telephone calls, issues, account research and resolution as needed by staff, management and clients. Timely completion of accounts referred to the Supervisory Desk by staff or management.

•Effectively communicate and interact with subordinates, management and clients. Conduct, attend and participate in meetings, conference calls and training sessions, including Management Meetings, Team Meetings, as well as one-on-one monthly meetings with subordinates to provide consistent performance feedback. Complete the mid-year and year end Performance Management review.

Compliance Analyst

Tenet Healthcare - Dallas, TX

October 2020 to December 2020

Contract to Hire Position At the time a reductions in force occurred. I continued to apply to open positions and was hired as a Revenue Cycle manage at Conifer Health Solutions, A subsidiary of Tenet Health.

Medical Practice Solutions LLC

Compliance Manager

July 2017 –October 2019

RESPONSIBILITIES:

·Assure compliance with applicable Federal and State rules and regulations.

·Responsible for monitoring business units with audits to minimize potential exposures.

·Provide training for all new and existing employees.

·Offer daily support and guidance on Compliance related issues.

·Document and respond to all hotline inquiries and create a corrective action plan.

·Create and maintain an annual compliance audit and plan.

·Reporting on the compliance audit to senior management on a quarterly basis.

·Create and maintain Sop’s for training and corrective action.

·Act an assistant to Corporate Counsel with internal investigations and legal research.

·Ensure that all policies are current and enforced for Federal and State HIPAA requirements.

McKesson Business Performance Services

Revenue Cycle Supervisor

February 2016 to June 2017

RESPONSIBILITIES:

·Assure compliance with applicable industry rules and regulations

·Responsible for managing the Revenue Cycle Outsourcing business including financial outcomes (e.g., operating income/expense controls), customer satisfaction and employee satisfaction as per individual contracts.

·This also includes Business Office/Patient Access/Physician Office functions, which encompass all functions of First/Third Party Claims Operations, manage registration, admitting, insurance verification, customer service, and managed care contracts.

·Oversee performance and contract compliance. Facilitate problem resolution between hospital and he Business Office. Physician departments and the Business Office.

Biocept Inc.

Manager of Appeals and Reimbursement

June 2015 to January 2016

RESPONSIBILITIES:

·Maximize collections by managing submission and reimbursement of claims and appeals performed by the outside billing service and/or billing staff

·Responsible for full cycle billing and accounts receivable for non-commercial revenue

·Presentation of billing and collection data for monthly financial reporting and as needed for Board of Directors meetings

·Assure compliance with applicable industry rules and regulations

·Build and maintain relationships with the outside billing service and direct bill customers

·Process and post cash receipts in ERP system

·Maintain sales journal and prepare general ledger reconciliations for accounts receivable and revenue accounts

·Review commission reports for payroll

·Responsible for processing and reconciling the month end reports provided by outside billing service

·Is facile with Laboratory Information Systems to ensure timely research of client questions

·Analysis of collections experience to identify opportunities to improve billing

·Maintains current knowledge of Federal and State legislation pertaining to all billing related matters.

Pathway Genomics Corporation

Appeals & Reimbursement Manager

July 2014 to January 2015

·Responsible for managing the accounts receivable, collections, and related customer service functions to increase cash flow and reduce outstanding accounts.

·Implement and monitor the follow-up of all accounts receivable and collection processes, including reimbursements, cash flow of all third party payers – this includes Medicare, Medicaid and other government programs, as well as commercial and managed care

·Establish protocols and policies and procedures for documenting all patient accounts and client reporting

·Proficient in the understanding of various reimbursement methodologies with knowledge of all payer billing requirements

·Establish and oversee a strong quality review program to ensure consistency and high quality for turnaround time of all accounts worked; accurate and clarified documentation and correspondence; and to identify additional staff training and process improvement needs

·Foster strong and effective relationships with clients, Sales, and contracted partnerships in order to exchange information and resolve issues of financial impact

·Sets, achieves, and maintains department cash goals and client objectives

·Regularly assess practices with department and the Company to identify areas of significant opportunities for improved financial gain and services or product lines

·Develop staffing models for department and maintains department profitability in staffing levels

·Initiates and participates in focused review of pricing, coding, departmental charge structure and standardization

·Recruits, hires, and effectively develops department staff

·Consistently trains, motivates, and evaluates department staff to achieve optimum results for client and corporate objectives.

·Performs job duties in the most ethical, effective and professional manner

·Assist in internal audits to ensure compliance to Billing Policy and company requirements

Prometheus Laboratories Inc.

Compliance Specialist, Legal Affairs

2011-2014

·Spearheaded compliance projects and training efforts to field sales, as well as corporate office staff on behalf of senior management.

·Collaborated with the Compliance Officer in the preparation of annual compliance audit plan and implemented key departmental audits related to billing, sales and marketing.

·Performs internal audits of professional service agreements, ad-boards, promotional sponsorships, medical affairs, and Clinical Operations. Assumed responsibility and accountability for results.

·Reviewed and analyzed compliance monitoring reports or other related source documents for any gaps and patterns of compliance concerns.

·Project Lead in developing new software to aid the sales force as well as the back office function in preparation for Sunshine Act and State reports.

·Coordinated with the Compliance Officer in identifying potential compliance risks, and recommended a specific plan of action to support the audit objectives to foster a positive culture of Ethics and Compliance.

·Created new, comprehensive reporting system to keep senior management apprised of key issues affecting the compliance department.

·Directed follow-up meetings with department supervisors to recommend appropriate action in cases where audit trends occur.

·Developed training materials to be used company-wide for regulatory mandated continuing education; created written policy manual for ethics and compliance.

·A key person in analyzing department work flow, creating efficiencies by eliminating unnecessary and/or redundant functions, and reallocating human capital towards more focused goals.

·Managed the HIPAA and Code of Ethical Business Conduct training to all new employees.

·Periodically conducts investigations and interviews from inquiries received via the Ethics and Compliance Hotline.

·Periodically notarized documents for the company and personnel.

Prometheus Laboratories Inc Medical Accounts Appeals Specialist

2007 to 2011

·Generated periodic reports for department and management use regarding appeal outcomes.

·Developed framework for Oncology line of business; Created step-by-step guidelines and product documents to yield favorable reimbursement.

·Achieved an 88% success rate for provider appeals.

·Provided guidance and training for team members as a direct result of research analysis.

·Assessed billing documents and guidelines for compliance standards in the Procedures Committee.

·Maintained online database repository of commonly used documents for the billing department.

·Coordinated detailed research efforts to support other representatives involving complex payor issues.

·Served as a key resource for the Sales Force for guidance on billing related issues.

·Conducted conference calls with District Managers and Sales Representatives to provide strategies on intricate billing affairs.

·Interacted regularly with National Account Managers to evaluate potential impacts on Laboratory Pricing Agreements.

· Examined state regulations concerning balance billing and formulated a matrix for reference.

·Consistently reviewed correspondence to filter for potential Better Business Bureau complaints and regulatory statutes for correct balance billing compliance.

·Collaborated with management and cross- functional departments to highlight potential risks and monitor trends to maximize collection recoveries.

Employment History

Medical Practice Solutions LLC

Compliance Manager

July 2017 –October 2019

McKesson Business Performance Services February 2016-June 2017

Revenue Cycle Manager

Biocept Inc. June 2015-January 2016

Manager of Billing and Reimbursement

Pathway Genomics Corp. July 2014-January 2015

Appeals & Reimbursement Manager

PROMETHEUS LABORATORIES, INC. 2007-2014

Compliance Specialist, Legal Affairs

Medical Accounts Appeals Specialist

Education & Training

·SOCIETY OF CORPORATE COMPLIANCE AND ETHICS Certification CCEP 2012 and CCEP-I 2013

·DUTCHESS COMMUNITY COLLEGE, Poughkeepsie, NY 1988

oBusiness Administration Certificate Program

·INSURANCE INSTITUTE OF AMERICA AIC, Certificate in general insurance. 2007

oARM Associate in Risk Management

·NOTARY PUBLIC 2005 to present

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