Revenue Cycle Team Members
Resume:
Charles Schmock
*********@*****.***
Waunakee, WI 53597
Authorized to work in the US for any employer
Patient Reimbursement Coordinator (Enteral)
UW Health Care Direct
Summary
I performed the initial patient financial and insurance verification and follow-up. I served as a communication liaison between team members, third party payers, patients, and billing for all financial arrangements. I Worked closely with referral sources and patients regarding their financial responsibilities. Also responsible for document management of patient information and ensuring that the claims produced for billing are accurate.
Communicate eƯectively with referral sources regarding patient financial responsibilities and insurance coverage for nutrition services.
Communicate with patients regarding financial responsibility both verbally and in writing.
Performs price negotiations, when applicable, in the best interest of the patient with respect to UWHCD business (including self-pay arrangements), seeking management approval when applicable.
Maintained knowledge of reimbursement principles and pricing parameters.
An understanding of Wisconsin Medicaid and Medicare coverage principles and requirements for covered and non-covered therapies.
Understands formula and related DME and supply pricing, as it relates to enteral therapy.
Verbally communicate to patient information (including but not limited to insurance and authorization status) to team members in a timely manner.
Promptly document all patient information including insurance and authorization information in accordance with company policy and procedures.
Remain up to date on contract, network, and fee schedule information.
Obtained authorization extensions on existing patients in a timely and accurate manner.
Performs ongoing verification of patient insurance, as needed.
Collaborated eƯectively with Reimbursement to troubleshoot patient specific A/R issues.
Performed critical evaluation of vended patient cases and keept management apprised of any trends or issues, as applicable.
Served as a back-up support to the enteral POC in managing supply orders and problem-solving delivery challenges.
Managed over 25 Healthcare Insurance portals, via Brightree, Epic…etc Independent Healthcare & Revenue Cycle Billing Consultant (Remote) The Charles Group LLC. - Waunakee, WI April 2019 to Present I work as a Healthcare Revenue Cycle consultant whom specialized in
Turnarounds
Interim Leadership
CDM initialization, implementation, maintenance, compliance, reporting
Leadership Development
Performance Transformation
Implementation of Healthcare Software i.e.: (Epic)
Workflows
Full Revenue Cycle Training
Consultation and Strategic Execution
Revenue Integrity Coordinator/ Chargemaster Analyst Unitypoint Health - Meriter Hospital/ Meriter Medical Group - Madison, WI 2015 to April 2019
Acted as a business partner for operational leadership focusing on revenue cycle performance within assigned areas and responsible for overall business processes and standard operating procedures.
Managed /Supervised Revenue Cycle team of 10 (FTE) hired, disciplined, audited, completed yearly personal reviews, lesson plans and training for suggested improvements.
Revenue cycle team included following departments: Patient Access (Scheduling and Registration), Financial Clearance, Patient Financial Coordination, Accounts Receivable, Denials Management, Charge Description Master (CDM) Maintenance, Charge Capture, and Revenue Integrity, Payor Audits or other duties as assigned.
Developed, tested, and programmed all functionalities for all versions of Epic for specific departments. Served as back up for each position in case of absence.
Actively worked to align teams, processes and supporting technologies (e.g., Epic) to achieve optimal revenue cycle outcomes by identifying opportunities, analyzing options and providing recommendations to upper management. Responsible for strategically planning and implementing changes.
Accountable for the overall process and policy documentation, including close coordination, communication with Department supervisors, and Revenue Cycle Coordinators in assigned areas.
Supported supervisors and other departmental leadership to ensure that work queues are appropriately managed and any applicable Service Level Agreements (SLA) obligations are fulfilled. Monitor the eƯiciency and eƯectiveness of new processes and systems, as well as ensuring the timeliness and quality of projects.
Identify any reporting needs for an assigned area and evaluated current reporting options. For identified gaps, responsible for the development and maintenance of standard reports, reporting templates or other tools
Supported leadership in the analysis of process improvement options and worked with counterparts to provide recommendations to operational upper leadership.
Maintained process and policy documentation, appropriately coordinating with Specialty Department Directors and Senior Analysts in assigned areas. Supported workflows and tools, including management of work queues and reports, basic system maintenance (or maintenance requests), documentation of workflows, training and data analysis.
Daily coordination with Informaticists or other appropriate teams to document and provide training of Epic or other system changes.
Primary Epic trainer for end users within supporting business areas
Acted as an AƯiliate Liaison and represented Meriter in diƯerent UPH / UW contexts and groups.
Led special projects as primary Project Manager for any assigned performance improvement initiatives or work plans to include Epic Implementations.
Acted as an escalation point for specific patient concerns or review of accounts.
Solely responsible for reviewing and maintaining CDM, assigning new charge codes (ICD10), HCPCS codes, supply codes.
Ensuring all data elements are accurate and comply with all payor requirements
Maintained both Hospital and Clinic master fee schedules for CDM, constant monitoring for changes in Medicare and Medicaid regulations to assure the appropriateness and the impact in hospital reimbursement
Solely made fee recommendations for both the Hospital and Clinics based on comparison of a relative value system, national benchmarks, and community standards. Ensure fee that covered our costs, are consistent, defendable and are within community standards
Bi-weekly meetings with specialty departments in Hospital, free standing clinics, and Health-Psych departments to assure changes are appropriately communicated to aƯected departments and modifications made in related ancillary systems throughout
Research and resolution of missing charges, undercharges, and erroneous charges. This included corrections and re-billing of charges, feedback and education to the medical unit staƯ, process and procedure review to prevent repetition of the problems.
Completed price analysis of all ICD10 codes relating to both Hospital and professional charges via Medicare fee schedule, entered and published into chargemaster, uploaded into Epic and daily management of new and ever changing procedures
Worked solely as the Liaison between physicians and administration in communications regarding new medical procedures, providing physician's resources and being their conduit to administration to strengthen the relationships throughout the hospital and medical group.
Maintained an open line of communication with clinic physicians, in hopes to maintain and grow their patient referral base.
Prepare invoices for all outside vendors to include all air and ground ambulance charges, specific to payor contracts; Medicare /Medicaid
Priced, entered and billed all DME third party contracts. Financial Coordinator / Certified Application Counselor Unitypoint Health - Meriter Hospital / Merifter Medical Group- Madison, WI2009 to 2015
Trained in calculating Hospital in-patient estimates, FINA assistance; collecting monies, posting all payments, keeping and reconciling cash drawers, making deposits- writing workflows for all mentioned and sole trainer
Implemented Epic billing-collection processes self-pay and insurance follow-up for Meriter Medical Group
Reviewed 30-50 accounts daily for accurate billing. Updated correct insurance information via patient call, calling insurance companies, reviewing online software. Updating account information, resubmitting claims to Insurance company, clearing house
Proficient knowledge in claims, benefit, enrollment, and provider
Oversaw processes and work distribution via work queues to ensure adequate staƯing numbers for production
Created workflows and made adjustments as necessary
Monthly collections reconciliation for three respective agencies, financial analysis of departments.
Promoted to Supervisor of MMG, managed 8 FTE's. Hired, fired, trained, performed yearly reviews, identified and resolved staƯ concerns, taught and implemented new strategies in order to bring successes to staƯ.
Hiring of Billing department via interviews. Trained Epic workflows to Billers and Customer service departments in order to learn and fulfill a high level service agreement to Meriter
Reviewed and audited phone sessions for customer service representatives, made informative suggestions and teaching and training weekly
Daily- weekly audits and phone monitoring follow up plans MMG; Outbound- Inbound phone calls to patients/billing questions. Resource for all outlying clinics self-pay policy and procedures, referrals.
Proficient in claims, benefit, enrollment, provider knowledge and understanding
Prepared, analyzed and interpreted quality and quantitative Epic clarity reports for review and shared with fellow management in order to document and improve Meriter's overall performance
Daily Dashboard review of work queues for company matrix, productivity standards and operating budget requirements
Implemented Epic billing-collection processes self-pay and insurance follow-up for Meriter Medical Group
Developed Bankruptcy, Probate workflows, implemented policies into Epic.
Prepare Epic lesson plans; training material as per Epic updates; teach classes to all applicable end user Meriter staƯ. Work closely with IT staƯ to continually measure work flow standards.
Created Meriter (HCFA)Financial Assistance for Health Care Program for Meriter Medical Group.
Created and developed statement system for MMG with third party vendors/ IT department.
Serve as MMG's collections Liaison; Serve as attorney's witness and appear for court dates for all suit authorizations in suing patient's.
Versed in Medicare/ Medicaid managed care and all contracted insurances.
Set up Epic reporting for clinical analysis, process improvement for entire Medical Group Practices; member of the Meriter Medical Group Revenue Cycle Team.
Understanding of CPT codes and unique billing standards to include charge master to set fees as per AMA coding standards. Versed and trained in Cadence- registration, scheduling.
Implementation team member for pre-authorization-referral process for self-pay patients
State and Federal training, obtained Certified Application Counselor Status • Help to Implement POS Up Front collections for Medical Group clinics. Created and set up new policies and determined new procedures, created and implemented and trained new work-flows as per analysis and metrics, successful go-live.
Assessing patients' financial and insurance information in order to determine Medicaid, Marketplace, or other community programs as per Federal mandates. Member of Meriter implementation /Project Management team; Certified Resolute Professional Billing and self-pay, insurance follow-up. Business Development / Marketing / Public Relations Americollect, Inc Manitowoc, WI – Work From Home 2007-2009
Worked extensively with the sales and marketing team to grow company from 40-100+ employees through new business development within a two-year time line.
Solicited Health care; Utility; Government; Cellular; and Cable industries via cold calling, face to face walk-ins.
Answering, preparing, delivering R.F.P's (request for proposals) to perspective clients, scheduled follow up meetings.
Member of Collections process team, identified and researched company vision mission and values into a successful workflow and company slogan of Win-Win collections.
obtained ACA certification
Solely added over one million dollars of revenue to company.
Associate Marketing Team member, developed marketing strategies/products for immediate growth in industry.
Public Relations duties. Wrote monthly company press releases published in local chambers; Corporate Report Wisconsin; Health care magazines (The Voice), along with writing nomination letters, (Corporate Report Wisconsin Magazine, INC.500 fastest growing companies 2009. Nomination letter won "Small Business of the year award" for company in 2008. Co-wrote, published, and distributed company newsletters on a quarterly basis.
Attended all pertinent industry related organizational conferences throughout the state of Wisconsin. Member of Toast masters.
Attained continuing education credits for future growth.
Planned, promoted, marketed, and sponsored organizational conferences in excess of 100 plus attendees relating to industry.
Collection Agency Liaison / Physician Liaison
Dean Health System March 2002-2007
Extensive training in medical insurance, payment posting, accounts payable, accounts receivable, and bankruptcy.
Responsible for auditing patient accounts for updated insurance information. Claim denials, denial research to include correct CPT codes, obtaining new information and resubmitting claims.
Obtaining correct demographic information via patient phone calls outbound-inbound (25-40 Dailey) Made collection attempt, set up payment arrangements, no pay- send account to collections.
Dynamic customer service skills.
Promoted to Collections Liaison
Member of Dean /Epic implementation Team for Professional Billing Epic version 2002
Daily walk-ins, incoming and outgoing phone calls with patients, physicians, and lawyers.
Listening, obtaining specifics, researching, and providing solutions to their immediate concerns, providing timely answers.
Testing /programming/ preparing workflows/ billing processes/ setting fees as per Medicare fee schedule/ statement process's
Working hand in hand with agencies to reconcile accounts daily for balancing at month end.
Review accounts concerning settlement oƯers in direct relation with the respective collecting agency.
Preparing supporting documentation and attending monthly trials as a witness concerning accounts in direct relation to suit authorizations with attorneys.
Solely in charge of finance programs for Dean Health System to include LASIK, Bariatric, Plastic and Dynamic Orthotic Cranioplasty.
Writing, proposing, and completing finance contracts.
Recruited from Administration to role of Physician Liaison because of my dynamic customer service level and understanding of patient satisfaction
I was the conduit between the Clinic Physicians and the Administration staƯ
Responsible for forming, growing and maintaining long-term partnerships with physicians, urgent care facilities, medical specialty groups and other clinical groups to increase referrals and gain market share.
Daily Physician meetings, weekly administrative reporting for comparative analysis in seeking new and eƯective strategies
Acoustical Consultant Project Estimator
Sullivan Brothers Inc June 1999- January 2002
Performed varying duties in sales and accounting to include accounts payable /receivable, collections, finance.
Collections Manager
Daily reconciliation of company accounts
Dailey collection calls, payment plans, payment posting, weekly reconciliation
Inside and outside sales, preparing picking tickets for supply pick-up.
Project estimator Sullivan Brothers Supply Inc.
Inventory control management.
Project estimating, providing and answering bids. Providing excellent customer service.
Human Resources assistant to the president & CFO for Sullivan Supply Store Manager
Musicland- On Cue Inc 1994-1999
Recruited, hired, retained eƯective associates
Coach and train team to achieve maximum results
Identified and focused on development for future growth
Created eƯective schedules and manage payroll daily
Supervised daily operations of the store
Conducted weekly-monthly employee meetings on new product: new artists, books, movies, instrument products
Completed ninety-day employee probation reviews
Conducted yearly reviews; ensure that all team members understood and accepted their roles and responsibilities
Ensured the store achieved all store sales goals and comp plans
Conducted sales pull-downs
Tracked and reported key project metrics to include daily productivity
Attended yearly Management Corporate training
Completed accounts payable-receivables, managed daily cash flow, bank deposits
Reviewed customer complaints, found immediate resolution
Trained and promoted staƯ to management positions throughout the company
Participated in new stores openings in the United States to enable turn-key customer service Computer Skills;
Microsoft Word
Microsoft Excel
Microsoft Power Point
Microsoft Works,
Microsoft Outlook
Lotus Notes
Health Industry Software
EPIC *Certified* Resolute Professional Billing & Self-Pay Follow-up. Version Spring 2008
Medtech, Bloodhound
TRACS
Craneware
Brightree
Education
2 years in Marketing / Economics
Nicolet College & Technical Institute - Rhinelander, WI August 1989 to June 1992
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