Anna Marie Lane

Director RCM/Credentialing and Contract Supervisor

Huntington Beach, CA 92646

ad31g4@r.postjobfree.com

+1-949-***-****

Administrative & Business Operations

Director of Revenue Cycle Management with over 29 years of Financial Analytics and Best Practice Management. Revenue Cycle Management, Credentialing and contracting leadership, Fee schedule management, Dispute Resolution, High Level Appeals, Risk and Compliance educated. Conflict resolution skills while maintaining HIPAA confidentiality and professionalism. Well-organized and analytical team leader with strong critical-thinking capabilities to manage day-to-day operations and strategic growth.

Authorized to work in the US for any employer

Work Experience

Director of Revenue Cycle Management

ACLA Medical Solutions, LLC - Huntington Beach, CA August 2021 to Present

Director of RCM for Multi-Specialty including BH, Laboratory, Telemedicine, DME,Derand MAT Treatment. Executes and creates SOP's, Job Aids, workflows, training, management and structure to 37 teammates. Maintains multiple EHR and PM software's daily. Creates Financial forecasting and projections, Credentialing and Contracting, Fee negotiations and Contract maintenance. High level appeals and disputes. Develops process and outcome solutions.

Director of RCM/Credentialing and Contract Management Arise Vascular Vascular - Austin, TX

April 2018 to August 2021

Director of Revenue Cycle Management . Utilization and Scheduling executive. Expertly planned, coordinated and directed all operations of the agency. Compliance management with other health related agencies and organizations. Actively maintained up-to-date knowledge of applicable CMS,Medicaid and Commercial Billing Guidelines.

Gap analysis high level overview of current state and executed Billing department to best predicative management to set and reach goals.Identified trends and revenue performance Execute plan of actions for additional new policies and training consistently. Revised policies and procedures in various states to modify billing expectations. Observed strict confidentiality and safeguarded all patient-related information. Executed written practice and employee policies and well as employee SOP and job aids. Provided administrative and clinical leadership to Medical Physicians and medical support team to help improve annual revenue. Credential and Contracted and negotiated all Fee Schedules. Directed Appeals Department. Educated team and maintained cross training to Administrative Team. Analytical and critical team building.

Revenue Cycle Management Supervisor

Balboa Horizons Recovery Services - Costa Mesa, CA December 2015 to September 2019

Director of RCM for all Levels of Care, Ancillary and Physician Services. In and Outpatient facility and professional services.

Certified Coder. Translating medical procedures into codes that can be received as rendered services by payers, other medical coders and other medical facilities. Coordinating insurance reimbursement of care related to VOB Reports Communicating with insurance companies to follow-up on claims and collect on outstanding AR Reports. Research and continued follow-up on insurance payment denials and/or inquiries made on clients claims. Retrieve and review EOB and initiate appeals as necessary. Maintain general knowledge of International Classification of Diseases (ICD-10), Current Procedural Technology (CPT)(HCPCS) and modifiers related to behavioral health billing codes. Maintain knowledge of clinician (Health Care Financing Administration - HCFA 1500) and clinic (Universal Billing - UB-04) billing claim forms.

Reviewing documents such as intake assessments, doctor evaluations, progress notes, etc. to see if the client will meet the necessary medical criteria to obtain authorization for treatment. Building relationships with insurance companies to obtain initial and concurrent in the vital billing process for levels of care such as Detox, Residential, Partial Hospitalization, Intensive Outpatient, and Outpatient. Utilization Review in a behavioral health/substance abuse setting Google Sheets and Excel Data Management

Verification of Benefits

Executive / Super Administrator of KIPU, Availity, Navinet, Multiple Commercial and Government Portals along and various credentialing portals for entire entity. Experience with several PM and EHR portals.

Attention to detail and accuracy, exceptional organizational and problem solving skills with the ability to work without supervision.

Medical terminology with focus in Substance Abuse experience. Director of RCM /Pharmacogenomics / Toxicology Credentialing and Contract Manager

Exceltox Laboratories, LLC. - Irvine, CA

February 2011 to January 2015

Conflict resolution, Personal and professional integrity, Government relations knowledge, Patient- oriented customer service, Motivation techniques specialist, Staffing management, Payroll and HR Management and Training, Compliance and Policy HIPAA Management, Accounts Receivable. New Business Development in all states of USA.

Revenue Cycle Management Supervisor

Newport Center Medical Group - Newport Beach, CA

March 2004 to March 2011

ASC Surgery and Injections, Pain Management, Laboratory Biller / Collections / AR and Appeal Senior Specialist.

Electronic claims transmission and hard copy billing. Handle all RCM collections, denials and appeals for multiple physicians. Executed professional documentation and policy executer for high level RCM protocol. Analytical and critical review of current process and workflows. Credentialing coordinator Supervising several medical offices to maintain accurate and precise clerical and M.D. support.

Medical Biller/ Front Office Manager / Internal Medicine / Cardiology Pacific Crest Medical - Laguna Beach, CA

February 2000 to March 2004

PPO, HMO, EPO, MEDICARE, WORKERS COMPENSATION Billing / Collections/ ICD9, CPT Coding, Medisoft, Tiger, Gateway and E Clinical Software. Referral coordinator / Authorizations.

Front Office Clerical, Heavy phones, Scheduling, Medical Records, Laboratory Triage. Credentialing, Contract and Fee Negotiation Management. Front/Back Office Medical Manager

TLC Pediatrics - San Juan Capistrano, CA

August 1997 to February 2000

San Juan Capistrano, CA.

Front Office Reception / Pediatrics.

Heavy phones, faxing, referral coordinating, scheduling, triage. Medical Records.

Data entry.

Pharmacy Technician

Savon Pharmacy - San Clemente, CA

June 1993 to August 1997

Certified Pharmacy Technician

Insurance Billing, medication authorization, TARS, managed inventory, ordering supplies, heavy phones, customer service data entry and specialty certified to compound drug assistant . Education

Bachelor of Arts in Business Administration

California University State Long Beach - Long Beach, CA September 1993 to June 1998

Skills

• Billing (10+ years)

• Cardiology (4 years)

• Claims Processing (10+ years)

• Coding (10+ years)

• Credentialing and Contracting (10+ years)

• Management (10+ years)

• Human Resources (7 years)

• Excel (10+ years)

• Quickbooks

• Organizational Skills (10+ years)

• Word

• Accounts Payable (10+ years)

• Filing

• Inventory

• ICD-9

• Medical Collection

• CPT Coding

• Medical Billing (10+ years)

• ICD-10

• Intake Experience

• Behavioral Health

• Medical Coding (10+ years)

• Medical Office Experience

• Laboratory Experience

• Medical Records

• Revenue Management (10+ years)

• HIPAA (10+ years)

• EMR Systems (10+ years)

• Hospital Experience

• Clerical Experience

• Office Management (10+ years)

• Insurance Verification

• Medical Scheduling (10+ years)

• Medical Terminology (10+ years)

• Workers' Compensation

• Managed care (10+ years)

• Supervising experience (10+ years)

• Windows

• Financial concepts (10+ years)

• Operations management (10+ years)

• Management (10+ years)

• NCQA standards

• Project Management (10+ years)

• EDI (10+ years)

• Contracts (10+ years)

• Budgeting

• Medical management

• Analysis skills

• Quality management (10+ years)

• Process improvement (10+ years)

• Contract management (10+ years)

• Negotiation

• Business Development (10+ years)

• Employee Orientation

• Pain Management

• Credentialing Software (10+ years)

• Communication skills

• Customer service

• Research

• Microsoft Excel

• Data entry (10+ years)

• Microsoft Office (10+ years)

• Contracts (10+ years)

• Healthcare management

• Compliance Management (10+ years)

• Practice Management (10+ years)

• Triage (10+ years)

Certifications and Licenses

Certified Professional Coder (CPC)

March 2021 to March 2024

Medical coding certification exam issued by the American Academy of Professional Coders (AAPC). Pharmacy Technician License

Groups

Advancing the business of Healthcare (AAPC) MEMBER September 2008 to Present

Provides professional certification to physician-based medical coders and to elevate the standards of medical coding.

Additional Information

CAQH

NextGen

Eclinical

Mod Med (EMA)

MediSoft

Elation

Atlas

Human Resources

Kareo

SharedFiles

Box

EMR

Xifin

Office Ally

Medisoft

Gateway

Misys Tiger

EClinical

Monarch Healthcare

IPAs

CalOmpita

Medicare

CollaborateMD

KIPU

Revenue Management

Risk Management

Government, Commercial PPO,IPA,HMO,EPO and 3rd Party Appeals Level 3

Claims Resolution

Cardiology, Pain Management, Anesthesiology, Laboratory. ASC, Pulmonary, Ophthalmology, Mental Health and SUD billing experience

Exceled level of Credentialing, Contracts and Negotiations Certified Coding

Customer service

Data entry

Medical Terminology

ADP Payroll

Salary Based on advanced experience and precise skilled performance. Negotiations acceptable within reason and benefit compensation.

Contact this candidate