SIHAM A. ANDRAOS

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

Gaithersburg, Maryland 20882

301-***-**** Email: adbptc@r.postjobfree.com

PROFILE

Reimbursement Director with extensive experience in mentoring, leading, knowledge and interest of Hospice care, Medicare hospice benefit, industry experience, strong research and analytical skills, assisting staff with the accomplishment and timely reimbursements of accounts receivables, patient accounts, cash receipts, cost report preparation, and escrow deposits. Responsibilities include supporting budget process for revenue, disbursement, and financial reporting compliance, maximizing revenue by teaming with the contracts department in the renewal of contracts, preparing surveys, revenue analysis, and developing and maintaining polices and guidelines. Oversight responsibilities include ensuring all Medicaid applications are filed and approved, analyzing impacts of any proposed reimbursement change and presenting the results to all levels of management, maintaining the accuracy of billing software and validating any data entry, developing training tools for staff, reviewing monthly financial statements, credentialing, and insurance verification functions for a mid-size healthcare organization. Other similar experience in Insurance, Medicare, Medicaid, Managed Care and other medical industry setting reporting.

Experience with CMS 1500, UB04, electronic billing, and multiple health care systems.

PROFESSIONAL EXPERIENCE

THE WASHINGTON HOME & COMMUNITY HOSPICES July 2004 – PRESENT

Reimbursement Director

Provide management and oversight of all functions pertaining to billing and collections, patient banking, insurance verification, financial case management, cash posting, budgeting, cost reports, surveys, contracts and audits for long term, rehabilitation/skilled nursing and hospice operations. Direct the activities of the claims by reviewing and analyzing medical claims inventories, timelines, accuracy, productivity, cost, appeals, and complaint reports. Served as the organization’s subject matter expert regarding documentation, coding, credentialing, billing, reimbursement, compliance management, including Staying up-to-date with all industry updates and regulation changes. Supervised a team of 12 analysts and processors.

PRIMARY RESPONSIBILITIES:

Developing new methods of reducing cost and increasing revenue.

Manage the development of policy alerts.

Provide analysis and review monthly financial statements and reports.

Coordinating and preparing monthly accounts receivable and cash reports.

Preparing, filing and monitoring cost reports and other regulatory reports.

Evaluate the age of receivables and allocate appropriate staff to reducing outstanding accounts receivables.

Develop tools, including policies and procedures, for staff to ensure accurate and streamlined reimbursement processes and filing.

Maintain bad debt write–off at 2% or lower of net patient revenue for the fiscal year.

Coordinate and assist with the annual audits and Surveys.

Review and negotiate all contracts, including insurance companies, at the renewal time to maximize revenue.

Credentialing, pre-certification, and pre-authorization functions.

Strong research and analytical skills with attention to detail and familiarity with health care publications and data source.

Approving and implementing operational strategies, plans and objectives, monitoring and ensuring the efficiency and effectiveness of the operation.

ACCOMPLISHMENTS:

Reduced Accounts Receivables over 180 days from $5,000,000 to $70,000

Reduced Accounts Receivables days from 149 to 44

Reduced “Bad Debt” from $2,000,000 to $50,0000

Selected and implemented company-wide electronic billing for Medicare, Medicaid and all commercial payors resulting in faster collections.

Created and trained all reimbursements team members for execution of new departmental and interdepartmental policies and procedures ensuring compliance with Medicare and Medicaid regulators.

THE HOSPICES OF THE NATIONAL CAPITAL REGION (NOW KNOWN AS CAPITAL CARING) November 1997 – November 2003

Patient Accounts Director

Reported to the CFO resulting from the merger of three hospices (Suburban Maryland, Northern Virginia and District of Columbia). Managed and oversaw operations for insurance verification and reimbursement, patient accounts, cash receipts and accounting system data entry. Supervised and mentored 14 finance department team members. Routinely interfaced with Medicare intermediaries, state Medicaid, and private insurance representatives.

ACCOMPLISHMENTS:

Created a dedicated Patient Accounts Department, Utilization Department, and Insurance Verification Department resulting in ensuring appropriate authorizations and regulations were met.

Reduced Accounts Receivables over 120 days from $5,000,000 to $30,000

Reduced Accounts Receivables days from 140 to 32

Reduced “Bad Debt” from $900,000 to $80,000

Created and implemented all electronic billing for all commercial payors resulting in faster collections of money to 7-14 days from 2-3 months.

Created departmental and interdepartmental policies and procedures ensuring compliance with Medicare and Medicaid regulators

Reconciled Accounts Receivables as a part of the “Due Diligence” process in acquisitions of Maryland and DC Hospices

Ensured all Medicaid applications are filed and approved in a timely manner and reduced the outstanding reimbursement from $1,000,000 to $240,000.

Set up billing and credentialing of employed and contracted physicians for the company’s Palliative Care Program, including creating the provider ID number and IRS tax ID number. Also vetted and selected the billing vendor for cost effectiveness.

CORAM HEALTHCARE August 1997 – November 1997

Reimbursement Manager

Managed 3 offices in the DC metropolitan area and Norfolk, VA. Supervised activities and special projects for Admission and Reimbursement Departments including billing, collections, and accounts receivables as well as preparation of end of month reports and spread sheets. Liaised with pharmacy, sales and insurance carriers handling both clients and negotiating settlements. Oversaw electronic and HMO billing. Supervised 14 team members.

VISITING NURSE ASSOCIATION OF NORTHERN VIRGINIA INC.

September 1993 – August 1997

Patient Accounting Manager

Directed Patient Accounting Department. Ensured timely collection and application of patient receivables. Directed preparation and submission of claims to payment sources and collection efforts related to claims. Maintained agency accounts receivable records and cash receipt ledgers including private pay collections and third party. Coordinated insurance settlements. Communicated with Management Information personnel to ensure accurate information and timely updates to accounts receivable system. Established Department goals and monitored staff in meeting goals. Supervised 6 staff members.

PROTOCOL, BLUE CROSS BLUE SHIELD OF THE NATIONAL CAPITAL AREA May 1990 – September 1993

Billing and Collection Team Leader

Oversaw billing and collection of premiums in the international and Special Risk Insurance Section. Processed $1.5 million in premium payments per month from international accounts located in Washington. D.C. Apprised management of status of policies, funds and collections. Traveled to meet with clients and reconcile accounts. Oversees the enrollment process for new or existing member/group. Supervised 4 staff members

EDUCATION

BS, Accounting, University of Maryland

Completed courses toward a Master of Business Administration degree

FOREIGN LANGUAGES

Arabic (Fluent Verbal and Written Communications)

COMPUTER SKILLS

Suncoast Solution, answers on Demand, Optimus, Access, Excel, Word

STATE/FEDERAL LAWS

Medicare, Medicaid for DC, MD, And VA

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