ad2xei@r.postjobfree.com

Deborah D. Allen

Charge Capture Analyst

Aiken, SC p. 941-***-****

More than fifteen years of management, financial, customer service experience and have spent the last eight years within the Revenue Cycle, exemplifying accurate auditing proficiency, leadership abilities and professionalism. Excellent interpersonal skills, very motivated and require minimal supervision. Ability to interact effectively with senior management and peers. Seeking new

(Remote) challenges.

Proven ability to effectively audit and reconcile departmental charge errors, identify trends and develop root cause analytics for improvement initiatives.

Extensive background in customer-oriented service operations and business development, including cost control, sales, marketing, promotions, and life safety coordination's Excellent written and communication skills, ability to maintain positive relations with clinical departments, outside agencies, staff and customers in high-volume, fast-paced environments Proven ability to process member/provider appeals accurately and timely within the policy guidelines. Able to comply with applicable mandated State and/or Federal legislative or regulatory requirements Summary

Computer and Internet proficient

Revenue Enhancement

Auditor

Research Analysis

Process Improvements

Customer & Staff Relations

Strategic Planning

Relationship Building

Team Leadership

Competitive Intelligence

Training and development coordinator

Microsoft Office Proficient

Competencies

-

Research and investigate all aspects of the member and provider appeals and grievances, NCDOI, Congressional and/or Department of Justice complaints to ensure compliance with medical necessity criteria, Corporate Medical Policy (CMP), member and provider contract provisions, State and/or Federal requirements, BCBSA guidelines and/or other mandated requirements (e.g. Thomas Love Settlement), NCQA Standards, Current Procedural Terminology )CPT), ICD-9, and Healthcare Common Procedure Coding System guidelines (HCPCS), as applicable. Identify, collect, and analyze appropriate documentation from multiple internal systems including claims, customer contract management, benefit booklets, UM systems, coding claim edits, etc. and external sources including pharmaceutical companies, attorneys, providers, Medicare, PBM's, etc. Coordinate and draft responses to NCDOI, Congressional and/or DOJ complaints with all Enterprise Departments to ensure timely and accurate resolution. Consult and confer with medical directors and other clinical staff to ensure the appropriate decision has been made and the approved outcomes are implemented. Review, analyze and make determinations on provider requests for increased payments related to coding and/or bundling issues. Communicate findings of analysis and documentation to appropriate committee, benefit administrators and BCBSNC leadership, as necessary. Work experience

2023 Current Member / Provider Appeals Associate - Remote Blue Cross Blue Shield - Winston-Salem, NC

-

-

Initiate claim adjustments on individual cases when necessary and follow and track until completion.

Provide written documentation of case determinations to appellants and/or all involved parties (including but not limited to physicians, attorneys, senators/legislators, employer groups, etc.) in a timely manner as required by regulatory mandates and legislation.

Identify trends and high-risk issues to mitigate risk of potential legal actions and/or NCOI focused audits and penalties.

Communicate findings to the Legal department, Corporate Communications, Special Investigations, and Healthcare Senior Management. Make recommendations to address future exposure.

Audit appeal and grievance files as required by Federal and/or State regulatory agencies and provide feedback, education and training to individual employees to ensure compliance with mandates.

Audit and oversight of entities where delegation of member and provider appeals exists.

Identify and take corrective action on appeals or grievances that result from noncompliance of contract provisions, appeal or grievance guidelines, provider contract violations and/or medical policies.

Stays current with press releases, emails, and other forms of communications relaying initiatives, contracting issues, as well as Plan wide concerns. Demonstrates high degree of appropriate knowledge of all areas of the plan. Identify and create action plans to educate internal departments on benefit misinterpretation and/or claim payment system errors. Answer member/provider questions via incoming telephone calls in a professional quality driven manner.

May handle complaints/grievances as defined by the federal government. Responsible for ensuring the accuracy and facilitating proper charge capture and coding accuracy associated with hospital and professional fee charges. Reconciles daily charges, works edits and errors within the charging systems trending data for collaboration of root cause analytics and performance improvement initiatives. Maintains the integrity of revenue capture, coding, and billing compliance. Interacted effectively with groups of customers or organization employees Presented a pleasant, professional demeanor at all times Handled sensitive and confidential information according to internal policies; to problem- solve in a high profile area.

Identifies, investigates, and assists in the resolution of issues delaying timely charge entry. Monitor and trends errors and gaps for performance improvement initiatives working collaboratively within Revenue Integrity and with leadership and clinical team members for root cause analysis and resolution.

Effectively communicates and educates clinicians/physicians, billing, coding and AU Health associates on accurate charge capture impacted by coding, reimbursement and/or payor policy for compliant billing.

Resolve all appropriate real-time edits for hospital and professional fee charges produce due to billing edits, suspense and late charges reporting. The edits and errors entail charges due to missing data elements, inappropriate modifiers, revenue codes or coding based on Payor rules, location charges due to Payor Contracts or other specialty coding rules. Monitor and reports late charges. Works closely with revenue departments to minimize late charges not to exceed industry benchmarks.

Collect and summarize data by performing daily data input Works independently to coordinate information and workflow of charge management hospital/professional practice area and works with charge management team to assure completion of all charges capture within corporate and department goals Cross trained to perform all service line charge management hospital/professional practice and analysis functions

Ensures prompt and accurate execution of duties and distribution of reports Assist support staff, coding, patient financial services and nursing in appropriate documents to support charging hospital/professional practice Retrieves and prepares information for analysis from data systems for quality, cost and utilization reports

Audits and analyzes all medical record charts for appropriate documentation and charge capture hospital/professional practice Initiates and performs research to analyze charts

2019 2022 Revenue Charge Capture Analyst

Augusta University Health Systems - Augusta GA

2015 2018 Revenue Charge Analyst II

Orlando Health - Orlando, FL

Collects and provides statistical data and generates report to Manager Maintain current knowledge of Medical Terminology

Maintain charge management hospital/professional practice training Maintain current Affinity/GE Centricity training

Participate in QA studies

Attends departmental meetings as required

Demonstrates exemplary customer service to include resolution and process improvement skills

Demonstrates self-motivation and self-direction

Maintains open communication with departments and processes Assumes the responsibility for professional growth and development

-

-

-

-

-

Salt Lake City, UT

Norcross, GA

Pittsburgh, PA

Deerfield Beach, FL

Pittsburgh, PA

Education

2023 Current Certified Professional Coder

AAPC - Current Studies

2017 2018 Medical Billing And Coding

Ashworth College

2013 2015 Associate of Science

Art Institute of Pittsburgh

2008 2008 Certified Business Manager

Professional Development Center

2003 - 2004 Digital Design Diploma

Art Institute of Pittsburgh

Microsoft Office Suites

Word - Excel - Outlook - Power Point - One Note

Hospital Systems

Powerchart - Health Quest - Avadyne - IDX - Cool - SSI - FinThrive - Cerner - Quadax - Med-Metrix - Affinity - Sovera - Sunrise XA - Provation Multicare - SIS - OB TraceviewV- Vitalware - Web MD - Meditech - Medibuy Insurance Systems

Prime Therapeutic - Macess - Amisys - Cotiviti - Cover My Meds - RightFax Payroll Systems

Kronos - Reynolds - Citrix

Technologies

Upon Request...

References

Contact this candidate