Customer Service Representative
Resume:
Cynthia Adams, BS, MBA
919-***-**** *******.*********@*****.***
PROFILE
Experienced business professional with 20 years of expertise in robust health services and diverse medical practices leading key elements of quality thru billing coding, claims and financial counseling. Reverent to timely and accurate data and processes supporting business and clinical operations as well as regulatory requirements. Compassionate team member and knowledgeable leader dedicated to service excellence
SKILLS SUMMARY
Accounting
Authorizations and Denials
Billing Budgeting, Forecasting
Build Clinical Trials Spreadsheets
Coding
EPIC, STAR, Cerner, Mosaiq
Financial Counseling
Healthcare Privacy & Safety
Internal & External Audits
Operational Goals & Metrics
Regulatory Compliance
Service Excellence
Word, Excel, PowerPoint
PROFESSIONAL EXPERIENCE
UNC REX Healthcare, Raleigh, NC 2000 to 2023
Revenue Manager 2022-2023
Create an annual budget for Billing Department and summarize the financials plans monthly.
Perform variance analysis monthly, monitor department financial performance against the actual budget and the forecasted monthly and annual amount.
Accounts Receiving and Accounts Payable
Manage the Revenue, Coding, and Authorization teams
Operations Manager Radiation/Oncology Facility, REX Cancer Research 2020 to 2022
Develop and consolidate financial plans for Radiation and Oncology Clinic
Create an annual budget for both clinics and summarize the financials plans monthly
Perform variance analysis monthly, monitor facility financial performance against the actual budget and the forecasted monthly and annual amount.
Meet internal and external customer needs.
Accounts Receiving and Accounts Payable
Financial Analyst, REX Cancer Research 2017 to 2020
Manage financial analysis requirements to meet the daily, monthly, and quarterly operations
Provide updates on financial status for assigned projects and client financial reporting needs
Monitor variances, compare and analyze plans and forecasts with actual results
Assist month-end closing activities, review contract payment schedules and monitors cash flow
Support internal and external audit, support initiatives to drive improved margins
Oversee all internal and external audits for clinical trials
Patient Financial Navigator, REX Hematology Oncology 2008 to 2017
Supported oncology patients in securing assistance to offset chemotherapy costs.
oInitiated and coordinated pre-certification and prior authorization for patients with their insurance carrier, provide financial counseling, collaborate for timely claim, account f/u
oVerified patient benefits to ensure appropriate coverage for treatment regimen ordered. Reviewed out of pocket costs and discuss options for payment or assistance
oPayment request from foundations to assist out of pocket expenses, ensure posting is accounted to correct account.
oConsult with insurance company to price out costly medications. Enrolled patients in the assistance programs and complete follow-up
oEnrolled uninsured patients in any free drug programs that apply to their regimen
oPerform monthly audits on accounts in regard to free drugs and revenues from pharmaceutical companies
oCompleted program application process, requested drugs from companies, documented and credit patient’s account based on drugs received
Completed authorizations from insurance company for chemotherapy regimens
Provided referrals to Social Work team per patient need and circumstances
Researched grants, scholarship, copay assistance cards, and free drug programs that will assist patients in paying for their out-of-pocket deductible, copay, and or coinsurance
Intake Specialist, REX Hematology Oncology 2000 to 2008
Supported oncology patients, service practices, and coworkers in provision patient intake:
oFacilitated accurate and timely account pre-registration, insurance real-time eligibility checks and verification. Approval, pre-authorization and prior-approval- before date of service for scheduled and pre-registered accounts
oSupported accurate collection and data entry of pertinent information via phone or forms.
oProcessed account transactions, Met departmental target for overall accuracy rate for all processed accounts. Ensured ADT information is current and accurate to ensure patient safety, charging, coding, insurance processing, and billing accuracy
Operated within compliance with all governmental, regulatory, and contractual requirements
oHIPPA, CMS, Joint Commission, Rex Policy & Procedure
Hospice of Wake County, Raleigh, NC 1998 to 2000
Medical Records Specialist
Supported Medical Records Service Need
oProcured data and records from outside facilities and referring services. Prepared charts to standard and organize for Physician and care team review
oAudited charts daily to ensure record completeness and accuracy. Prepared, maintained and disseminated timely health information and medical reports as requested
oSupported phone requests and transmission of medical information as appropriate
oEnsured safety, compliance, security and confidentiality: HIPAA, CMS, etc
EDUCATION
Master of Business Administration 2019
Western Governors University-Salt Lake City, Utah
Bachelor of Science-Accounting & Business Administration 2015
North Carolina Wesleyan College – Raleigh, NC
Associate of Arts- Business Management 2013
Wake Technical Community College– Raleigh, NC
ADDITIONAL EDUCATION &CERTIFICATIONS
Clinical Trial Billing Compliance
Human Subjects: Biomedical Research
Conflicts of Interest
UNC Health System Orientation for New Clinical Trial Research Personnel:
~Recruitment, Budgeting & Accounting of Funds
~Preparing NIH Grant Budgets, Billing Coverage Analysis
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