Health Care Process Improvement

CHERYL SYLVIA

Middleboro, Ma ***** 774-***-**** *********@*****.*** WWW: Bold Profile

A SME expert in the Revenue Cycle of Health Care. 28 Years of experience in a health care setting. My abilities are recognized as a results-oriented and solution-focused individual. Areas of strength include: Excellent Interpersonal Skills, A Team Player, Adhering to billing compliance and procedures. Contract analysis and interpretation. Interpreting and implementing payer policies and guidelines. Process improvement ideas that result in time saving workflows and increased revenue. Excellent time management. Identifying 837 claim and 835 remittances issues and implementing corrections. Epic

Soarian Financials

STM Billing

Change Health Care

Microsoft Office

NThrive

Medi-Tech

Experian

Hyland On-base Scanning

SSI/Billing Audit Management

Craneware

Waystar

01/2018 - Current

Payment Variance, Cape Cod Healthcare

Intricate part of the contract builds in Epic hospital launch resulting in 94% accuracy Identifying and recouping underpayments, reporting, and resolving overpayments Process improvement ideas involving, claims, credits, audits, and payment variances Daily intervention of proper observation billing per industry standards Weekly and monthly variance reporting

Supporting audit management program with monthly analysis of audits based upon payer guidelines Point person to guide the audit analysts on payer and hospital policies and procedures Providing patient estimates per CMS and hospital guidelines. Accounts Recovery Analyst, 01/2011 - 01/2018

Jordan Hospital/BID Plymouth

Developed and maintained a denials database for tracking and reporting on all hospital denials Responsible for underpayment Excel reports and appeals to third-party payers for corrected payment per PROFESSIONAL SUMMARY

SKILLS

WORK HISTORY

contract review

Management of weekly denial database for interdepartmental communication and follow-up on authorization, med necessity and level of care denials Identifying incorrect service reporting as well as billing errors Creating and maintaining issues grid for payer resolution Provide daily support for proper denial follow up, for all hospital staff Tracking and logging of all interdepartmental appeals Initiate and implement process improvement procedures to reduce denials Consumer pricing requests for services provided utilizing Nthrive. Patient Account Representative, 01/2002 - 01/2011

Jordan Hospital

Review and analysis of billing, follow-up, accounts receivable adjustments for third party and self-pay accounts

Ensured all billing time limit requirements are followed for necessary appeals process Batch and scan financial documents to optical imaging system Established monthly budget on self-pay accounts

Follow up on outstanding accounts through appeals and/or write –off requests for unattainable recoveries Professional follow-up with departments, patients, and insurance companies for account resolution. Prepared reports detailing billing actions, flags and other key information Patient Account Representative, 01/2000 - 01/2002

Brockton Hospital

Review and analysis of billing, follow-up, accounts receivable adjustments for third party and self-pay accounts

Ensures all billing time limit requirements are followed for necessary appeals process Batch and scan financial documents to optical imaging system Established monthly budget on self-pay accounts

Follow up on outstanding accounts through appeals and/or write –off requests for unattainable recoveries Professional follow-up with departments, patients, and insurance companies for account resolution. Patient Account Analyst, 01/1994 - 01/2000

Community Counseling of Bristol County

Registration, charge entry and claim submission of a multi service psychiatric facility Obtain authorization for all services

Provide coverage for all office support staff on daily tasks when needed Follow up on all outstanding claims, file appeals for any denials and report on the status of AR to upper management.

Certificate Billing Specialist, 06/2011

EDUCATION

Massasoit Community College

Certificate Billing Specialist, 06/1994

New Directions

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