Project Management Manager

Samantha Moulton

*****************@*****.*** 617-***-****

Goal- oriented Analyst looking for an opportunity to utilize my attention to detail, problem solving, trend forecasting, information gathering, statistical analysis and leadership abilities to find creative solutions that lead to more effective business.

Skills:

Understanding of project life cycles and project management

Knowledge of Medical Terminology, CPT, HCPCS, ICD-9, ICD 10, Modifiers

Effectively manages time, prioritize work, multi-task across many assignments

Ability to articulate a variety of departmental and organizational goals

Demonstrates organization, verbal, written and inter-personal skills and flexible

Problem solver with ability to quickly take action to achieve goals

Handle multiple projects with aggressive timelines

Proven track record of producing quality deliverables on time demonstrating a solid work ethic

Energetic organizational skills and ability to work independently

Flexibility in schedule and in adjustment to assignments

Function in stressful situation in a calm manner

Work in a fast-paced environment independently. Self-starter and motivated

Robust technology and computer skills

Presentations in front of a large diverse groups

Staff training and development -creating manuals and step by step guides

Technical Skills: Siemens Soarian Financials, Epic EHR, IDX, Allscripts, Athena EHR, Meditech, Zoom, Sharepoint, Teams, Microsoft Office to include but not limited to; Power Point, Excel, Word, Outlook, one note.

Professional Experience

Charge Master Analyst

Lowell General Hospital Tyngsboro, MA 1/6/2020- Present

Project driven position with daily expected standing assignments.

Prepare and coordinate Epic go live for all of LGH, Tufts Medical center and MWH

Update and maintain chargemaster and yearly code changes.

Analyze price transparency for new state guidelines and submit quarterly report to CHIA..

Oversee late charges, posted charges, billing questions, denial issues, and staff/department questions.

Work independently organizing meetings with department leadership.

Maintain Epic Work Queues while utilizing LCD/NCD/CCI guidelines.

Responsibilities are independent while working closely with management. Analyze/trend data to improve financial revenue. Monitor changes that need to be made and provide a strategy to facilitate. Provide solutions, enhance system edits, guarantee logical avenues for increasing revenue. Experience with TEAMS and SKYPE. Project manager lead. Full time remote position.

Revenue Integrity Analyst

Lahey Hospital Burlington, MA 11/14/16-1/6/2020

Primary point of contact for service line directors, managers, finance directors, clinical support staff, physicians, allied health care providers, hospital colleagues regarding matters that relate to aspects of professional/ hospital revenue modality specific billing processes and/or workflows.

Responsibilities are performed independently within established department policies and procedures.

Responsible for improving revenue cycle workflow, efficiency, accuracy, reimbursement, overall revenue control through operational and system enhancements and/or modifications.

Accountable for developing an environment of customer service, continued learning and increased communication within revenue cycle and hospital departments.

In charge of coordinating revenue cycle policies, practices, identifying issues, trends, and provide solutions. Google Proficient, Knowledge of CPT, HCPCS, and ICD-10 coding principles, ability analyze and interpret financial reports, maintain strict adherence to the Lahey Health Confidentiality policy and perform all other duties as needed or directed to meet the needs of the department. Advanced to project manager lead and became a superuser for Epic roll out. Partly remote.

Charge Master Analyst 05/2013-11/14/2016

UMass Memorial Hospital Worcester, MA

Charge Master Analyst for Radiation Oncology, Hematology Oncology, Cancer Center of Excellence Marlborough, Gynecology Oncology, and Oncology Infusion.

Develops and executes training programs for clinical staff for facility revenue maximization with regulatory and contractual guidelines.

Proficiency in researching, reading and understanding third party regulations and compliance regulations. Strong clinical background experience with excellent organizational and communication skills.

Exceptional interpersonal skills for interacting with physicians, clinicians, clinical department’s compliance and administrative staff.

Strong familiarity with industry standard coding and billing methodologies.

Works under minimal supervision while off site and in the office. Report to department directors, vice president and president of hospital monthly with audit results for each clinic. Work with departments to transition to E-billing which includes working hand and hand with nurses/staff educating them on billing rules as well as payer guidelines. Creates monthly reporting for leadership and service areas.

Extensive analyses and data manipulation. manage multiple projects and assignments and within scheduled deadlines. Attended training workshops for ICD10 as well as completing modules in order to receive certification for ICD-10. Worked with various systems such as MedAssets, Soarian, Allscripts, and Medaptus. Promoted Lead analyst in 2014 to 2016.

Billing Coordinator/ Referral Specialist- Promoted to Lead Referral Coordinator 05/2010-05/2013

Boston Children's Hospital Waltham, MA

Responsible for ensuring all required demographic, insurance, referral/authorization, clinical, data is collected, verified, and communicated appropriately.

Excellent oral and written communication skills to interact with all levels of personnel both within and outside the office.

Applies experienced based skills/knowledge in the completion of more complex tasks/assignments and assumes designated leadership responsibilities in absence of Supervisor.

Prepares and submits accurate insurance claims to payer within proper timeframes. Handles payer scrubber and denial reports in an effective and timely manner.

Ensures prompt resolution of outstanding insurance claims. Monitors and identifies trends, denials, issues impacting account resolution or workload and refers as appropriate. Identifies, recommends and participates in process improvement opportunities.

Provide exceptional service that supports departmental and hospital operations. Contributes to the departmental training program of new employees and provides on-going support and assistance to existing staff. QCC point person for Ophthalmology Foundation.

Organizes scheduling and work flow for three employees daily. Strong organizational and interpersonal skills; attention to detail. Worked with various systems such as, Epic, Athena, SRS, and Power Chart, Navi-Net, Virtual Gateway, BMC website, NEHEN, Health-Trio, etc.

Intake Coordinator

Spaulding Rehabilitation Charlestown MA 12/2009-5/2010

Patient demographic and insurance information is entered into the 4Next system electronically via 4Next or manually for non-partners facilities including those facilities that utilize E-Discharge.

Insurance information is verified and documented in the Manage Referral site not section in 4Next. The patient is clinically accepted by liaison staff. If the patient is covered by a Managed Care payer's authorization is obtained. Experience with NEHEN, FISS, HIS, 4 NEXT, Virtual Gateway, E-discharge and Emdeon.

Charge Master Analyst II

05/2009 - 12/2009

Partner's Healthcare Charlestown, MA

Reporting to the Corporate Manager of the Charge-master Group. I was part of a high-profile group who are responsible for the ongoing maintenance and development of the Charge-master database for a defined number of hospital cost centers.

Project management emphasis, strong interpersonal and communication skills combined with superb analytic and organizational skills and the ability to meet deadlines while influencing but not directly managing the work of others.

Experience with Sovera, PeopleSoft, BICS, IDX RAD, LMR, E-room, RAC Database and Med-Assets.

Billing Representative

Partner's Healthcare Charlestown, MA 02/2008-5/2009

Responsible for preparing and posting payments, entered ancillary charges, verified insurance with outside vendors, confirmed pharmacy charges were billed correctly, ordered supplies, and faxed documents. Researched denials for Medicare, Medicaid, and other HMO's, Maintained denial spreadsheets and resubmitted claims. Experience with Keane Net Solutions, NEHEN, FISS System, and BICS. In addition, completed a Non-Paid 160 hour internship with North End Rehab and Brigham and Women's hospital.

Education and Training (In process of obtaining Bachelors Degree)

Associate of Science: Middlesex Community College – Business Management

2013

Bedford, MA

Associate of Science: Everest Institute – Medical Insurance Billing and Coding

Chelsea, MA

oPresidents List 4.0 GPA- Ambassador of class

2008

Volunteer

Lahey Cancer Walk Team Lead 2016-2020

Event Coordinator for Revenue Cycle at Lahey Hospital 2016-2020

Cradles to Crayons 2012-2018

Children’s Hospital NSTAR Walk 2010- 2013

Light The Night Walk for Leukemia 2007-2012

Why Me children with cancer 2013-2015

Certifications

HIPAA Certification

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