KARNIE LEE

**** *** *** *** *****

Bronx, New York 10469

732-***-****

ad3vzi@r.postjobfree.com

OBJECTIVE: To be a team player in an efficient, excellent and cost effective Organization, utilizing the knowledge and skills already acquired.

SUMMARY OF QUALIFICATIONS:

Thorough knowledge of medical billing, Medicare and Medicaid billing guidelines

Insurance industry experience in the area of claim resolution, over payments and underpayments

Understanding of medical coding procedures and medical terminology

Basic accounting skills including experience in Excel and Access

Experience with insurance contract negotiating

Knowledge of UB92s, HCFA 1500s, and EOBs

Over 20 years of experience at both NY Presbyterian and NYU Langone Hospitals with bed capacity of 1,205 between both facilities

Strong analytical skills

EDUCATION:

1989 City College of New York, NY

Bachelor’s of Arts Degree in Economics and Management

Certificate of Finance

EXPERIENCE:

02/16 – Present EDI and Revenue Cycle Manager

Acacia Network, Inc.

Bronx, NY

Retrieve, convert, upload and post ERAs for commercial and government insurance (Medicaid) using Emdeon, PaySpan, PNC, NextGen Dental, NextGen 5, Fidelis Mailbox, EmedNY, Smart, ADL, Basics, FundEZ, and AIRS software.

Create Medicaid and Managed Care ERA denial spreadsheets for staff to work

Create spreadsheets to document daily, weekly, monthly and yearly totals.

Develop procedures manual.

08/13 – 02/16 Special Projects Manager

Brookdale Hospital Medical Center

Brooklyn, NY

Provide itemized bill for medical services to patients and insurance providers.

Retrieve and submit medical records for out-of-state Medicaid patients, as required.

Provide medical records in support of medical necessity denial appeal requests.

Set up payment plans for financially distressed patients.

Collect co-pays, co-insurance and deductibles and/or provide financial assistance education to patients and their families.

Responsible for accurately resolving Medicaid, Medicare and private insurance credit balances.

Update vendor closeout reports, remittance lists and invoices.

Generate reports detailing IPRO, RAC and Lack of Medical Necessity Denials.

01/11- 8/13 Manager

Help In Home Agency, Inc.

Long Branch, NJ

Prepare journal entries associated with monthly payroll and enter in to accounting system.

Responsible for quarterly payroll tax preparation.

Maintain financial statistics.

Handle customer enquiries and provide support.

Responsible for scheduling of appointments of aides with clients.

Process accounts payable/receivable.

Prepare and distribute client’s invoice and handle billing claims.

04/09 - 09/10 Rusk Business Office Supervisor

NYU Langone Medical Center – Rusk Institute

New York, NY

Responsible for hiring, coaching, conducting, performance appraisals and disciplining of staff. Supervised the activities of up to 8.5 subordinate staff.

Provided guidance and leadership for staff to ensure employees are achieving customer satisfaction through effective communication, problem-solving, professional phone etiquette, and efficient processes.

Responsible for resolving patient/customer complaints by identifying problems and coordinating appropriate corrective action.

Additional duties included implementing proper intake procedures, performing patient registrations, insurance benefits verifications, co-pay collections, and charge posting.

Input charges for clinical areas for billing purposes.

10/06 – 04/09 Financial Services Supervisor

NYU Hospital for Joint Diseases

New York, NY

Supervised up to 24 employees within the Therapy, Clinic and Radiology departments. Other duties included compiling monthly statistical data including time of service, staff attendance and timesheets.

Responsible for verifying patient insurance coverage, pre-certifications and authorizations.

Provided on-site customer service and handled billing inquiries. Also maximized reimbursements by ensuring accurate diagnostic and procedure coding.

Provided ongoing training to staff on intricacies of insurance submissions, codes and intake procedures to minimize rejections.

Worked collaboratively with patient accounts department to ensure accurate billing and resolve claim denials.

Responsible for billing clinical charges and ensuring any corrective action in regards to general billing for various accounts.

04/04 – 10/06 Senior Financial Services Associate

NYU Hospital for Joint Diseases

The Orthopaedic and Sports Therapy Center

New York, NY

Interviewed physical and sports therapy patients regarding demographic and insurance coverage and accurately entered this information into Hospital’s database.

Verified insurance coverage and obtained appropriate authorization.

Counseled patients regarding financial responsibilities and collected time of service payments, issued receipts, and prepared cash settlement records.

Also filled vacancies due to cancellations. Reviewed and prepared next day cases and schedules for physical therapists.

Performed other tasks related to registration of patients requiring sports physical therapy services at the The Orthopaedic and Sports Therapy Center.

Billed accounts when appropriate.

09/01/ - 04/04 Senior Financial Services Associate

NYU Medical Center

New York, NY

Researched patient accounts to identify and rectify billing issues concerning patient or insurance responsibility.

Reviewed patient accounts receivable in accordance with general credit policy and coordinate appropriate reimbursement.

Maintained liaison with other areas of financial service department to advise patients regarding financial coverage, to refer accounts and determine collection progress.

Performed extensive customer service via telephone and face-to-face interviews.

Assisted discharging patients with inquiries and provide itemized bills upon patient request.

Also rebilled accounts with appropriate correction when necessary.

11/89 – 08/01 Technical Support/Patient Representative

Columbia Presbyterian Hospital

New York, NY

Acted in-lieu of Supervisor or Manager of Medicaid Eligibility Unit in their absence.

Assisted in computer training for proper financial coding of cases.

Responsible for maintenance of office equipment as well as processing accounts, verifications, invoices and executing transaction, fact-finding information pursuant to determining eligibility of a accounts for Patient Financial Services.

Acted as liaison between patients, Presbyterian’s City On-Site Medicaid Office, Third Party Insurance, and other departments within Patient Financial Services.

Also responsible for billing Medicaid and commercial Insurance and referring cases to appropriate agencies and compiling necessary statistics.

AFFILIATIONS: Montserrat Cultural Connection Inc. (Non-Profit Organization)

1998 - Present Vice- President

SKILLS: Software: Adobe Illustrator, Photoshop, QuarkXPress, Pages, Keynote, Microsoft Office, HIS, Eagle, Epass.

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