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Billing Epic

Location:
Louisville, KY
Posted:
May 11, 2020

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Resume:

Resume of Patrick Mono

SUMMARY

Epic professional bringing experience across Revenue Cycle, Clinical, and Reporting implementations to his work. He is certified in EpicCare Ambulatory, Resolute Hospital Billing (HB), HB Claims, Epic Remittance, and Benefits Engine. Well experienced in Tapestry, Reimbursement Contracts, Resolute Professional Billing (PB), PB Claims, Single Billing Office (SBO), Cadence/Prelude, Ambulatory, ClinDoc, Reporting with emphasis and experience in all Revenue Cycle applications, Charge Router, SER, Connect, and integration with Inpatient and EpicCare.

CERTIFICATIONS

Epic Resolute Hospital Billing

Epic Resolute Hospital Billing Claims

Epic Hospital Billing Remittance

Epic Benefits Engine

EpicCare Ambulatory

Tapestry Pending – Certification in May

Resolute Professional Billing – Certification in July

Reimbursement Contracts – Certification in July

EXPERIENCE

11/19 – 04/20 Sr. Billing/Claims/EpicCare Ambulatory Analyst

Infirmary Healthcare IT – Mobile, AL

Worked on navigator build and Configuration

Configured and built preference lists

Worked on building WorkFlow Engine (WE) Rules to re-design Navigators

Built and modified various EpicCare CER rules and Express Lane

Configured different Therapy Plans to suit clinicians needs e.g. display protocols of certain type, assign default orders, & assign Calendar views

340B – Configured the charge router to ensure charges price correctly

Revenue Guardian – revamped the Revenue Guardian to look for ECG/EKG Orders

Built and troubleshoot – Charge Router and System Action Queues

Optimized different Workqueue Types by updating existing rules

PCL strings for Claims – Work on adjusting paper claim forms to print correctly

Charge Champion Dashboard – Configured and added different components into the Dashboard

Built new DNBs and Account Activities to suit different Account Workflows

Maintained CDM built – Updated Fee Schedules, Procedures, Preference Lists, Cost Center assignment tables, category lists etc.

Work with external vendors and direct payers to perform routine build testing and troubleshoots e.g. clearinghouse 276/277 files, credit card rejections etc.

Cash Management – Set-up and maintain Payer ID mapping, set-up flexible cash loader etc.

Reimbursement Contracts – Configured and optimized the system to correctly perform reimbursement contracts based on updated payer requirements

Built new Consecutive Account triggers based on updated requirements

HB Statements – Updated SmartLinks within statement forms

CDF – Updated the CDFs with overrides such as addresses, occurrence codes, value codes etc.

UB/CMS Claim Forms – Built and updated various overrides within the claim forms for NPI, Tax IDs etc.

06/19 – 11/19 Sr. Billing/Claims Analyst & EpicCare Ambulatory

Montefiore Health IT – Yonkers, NY

Rotated within the revenue cycle to Help the EpicCare Ambulatory team with various optimization tickets

Worked on revamping Synopsis so clinicians can compare various patient data based on medications, vitals, procedures etc.

Built and modified various Flowsheets, Dynamic documentations, procedures etc.

Configured various SmartSets to improve on documentations making easier for clinicians workflows

Built and optimized the Revenue Guardian

Built and troubleshoot – Charge Router and System Action Queues

Revamped different Workqueue Types

Built several Claims overrides both at the Claims and CDF level

Maintained fee Schedules, Procedure and Payer-Plans

Built and optimized account activities and DNBs

Maintained and optimized unique Dashboards & Reports to users satisfaction

Coordinated troubleshoots for Direct Payer and ClearingHouse

Worked on reimbursement contracts with emphasis to build new contracts based on payer requests

Coordinated the transitioning of system from Legacy into Epic

Refined Discovery Session Questionnaires

Worked on WFWT – WorkFlow WalkThrough

Conducted Site Visits and gathered enough build information

Work on the build of SPARCS

Worked with EDI team to classify direct connects and Clearinghouse set-ups

Worked on ABF/FDF claim forms

Manage all the Remit Codes action set-up for various payors

Compare Payer-Payor Extracts in Legacy System and in EPIC

Configured the CDF to trigger various custom edits

Built System Definitions, Department Settings, EB Profiles, Account, various WQs, rules, and claim edits, as well as and a vast majority of essential Hospital and Professional Billing configurations.

Configured electronic and paper claim segments and CDF rules and overrides.

Configured Charge Router for PBB

CDM – Assists in data analysis between legacy and Epic. Prepared an export of all procedures from the legacy system into epic. Make use of the Charge Matrix to capture, review, & reconcile the legacy system into Epic system.

2/15 – 06/19 Sr. Billing/Claims/CDM Analyst

Hackensack Meridian Health – Hackensack, NJ

Go-Live support for EpicCare Ambulatory – Take calls pertaining to clinician workflow issues

Performed troubleshoots for Navigator build

Optimized different CER rules and Express Lane

Modified different SmartSets to better benefit clinicians workflows

Worked on building Dynamic Documentation set-ups and setting up WE rules to display specific navigators.

Coordinated the transitioning of system into Shared Payor-Plan

Built NON-PAR claims form records for unique providers

Assisted with the build of PINs for Professional Billing providers

Build Excel Macros for various internal use such as SharePoint Dashboards, Automation etc.

Manage all the Remit Codes action set-up for various payors

Configured the CDF to trigger various custom edits

Built System Definitions, Department Settings, EB Profiles, Account, various WQs, rules, and claim edits, as well as and a vast majority of essential Hospital and Professional Billing configurations.

Configured electronic and paper claim segments and CDF rules and overrides.

Configured Charge Router build to automate BB modifier addition if Certain codes are linked to Medication records

Resolve ICN errors triggered from ClearingHouse

Go-Live command center and elbow support for 50+ clinic and department rollouts.

4/13 – 2/15 Sr. HB Application Coordinator

New York University Medical Center - NY, NY

•Developed an enterprise-wide utility tool that automated the process of importing provider eligibility records including network, credentialing restrictions, par/non-par status, claims reconciliation, etc.

•Built System Definitions, Department Settings, EB Profiles, Account, various WQs, rules, and claim edits, as well as and a vast majority of essential Hospital and Professional Billing configurations.

•Released accumulated AR

•Reduced “60 days+”AR aging to less than 3%

•Built and modified Fee Schedules, Fee Schedule Groups, RVUs in Fee Schedules, Alternate Revenue Codes into EAPs, Alternate CPT Codes into EAPs, Associated Cost Centers into EAPs, Modifiers into EAPs

•Configured electronic and paper claim segments and CDF rules and overrides.

•Built Claim Edit and Charge Review rules and workqueues in support of numerous clinics and hospital departments.

•Set up SPLIT Error type Claim Edit Checks for various conditions e.g. Worker’s Comp 9700 Attachments errors, Taxonomy Codes, NPI/UPINS, SER restrictions, etc.

•Configured various batch jobs for numerous departments with creative mnemonics and properties in order to release the desired outputs.

•Developed new screens, scripts, programs, queries, reports, and/or other technical components according to specifications either developed through interaction with the customer or provided by project manager or team lead.

•Monitored and evaluated business needs and service requirements related to the charge description master (CDM)

•Assisted with system analysis related to charge master and charge capture functions, including the reconciliation of charges from all sources

•Go-Live command center and elbow support for 100+ clinic and department rollouts.

9/10 – 4/12 Sr. HB Analyst

Rochester General Hospital, Rochester, NY

•Managed functionality within both Resolute Professional Billing and Resolute Hospital Billing Applications

•Managed charge handling enhancements within the charge router including charge capture, and Dx/Px CPT handling

•Managed ticket resolution and change control within Remedy

•Validated various billing and security workflows and configurations

•Researched, organized, analyzed and synthesized data to support effective decision making while working within tight deadlines

•Configured MyChart access and training for billing office and patient access

•Maintained data quality

•Wrote reports for various departments in Crystal Report, and SYBASE SQL.

•Worked with Central Billing Office to acquire data requirements for reporting needs and following through with development and validation data.

•Coordinated billing activities with HIM, clinical integrity members and built third–party reimbursement contracts and reports.

•Supported internal and external reviews, assisted in business development, reimbursement, and charge capture processes

•Analyzed and developed technical guidance on healthcare finance issues and provided education to service areas as needed for accurate charge capture, billing and coding

•Provided analysis and review of charge capture processes and the charge description master (CDM)

•Researched and analyzed charges held up in Epic Charge Review, Charge Router, Account Workqueues and Error Pool edits

•Assisted in deployment to new practices including build, testing, training & support

08/06 – 5/08 Resolute PB/HB Analyst

Sisters of St. Francis

•Provided functional expertise to implement resolution processes and to optimized edits that defined the workqueues to drive accountability to the appropriate areas.

•Assisted in formulating and defining system scope and objectives for new departments and service areas.

•Analyzed and tested billing, as well as clinical workflows based on business operations

•Designed, configured, coded and tested security settings in ADT/Prelude, Cadence, Ambulatory, and Hospital and Professional Billing.

•Developed system security specifications and decision flows based on requirements.

•Worked closely with the Install team to modify Epic model content.

•Developed and documented internal procedures.

•Recommended new reports/existing report improvements that ensured leading practice revenue cycle performance monitoring

•Provide feedback to applicable Clinics and Departments regarding issues identified and facilitated discussions to further identify root cause(s) and potential resolution(s).

CREDENTIALS

B.S. University of Louisville, Louisville, KY

Engineering

M.S. University of Louisville, Louisville, KY

Engineering

RHIA

Professional Billing, Professional Billing Claims, Hospital Billing, CDM (Charge Description Master), Hospital Billing Claims, Single Billing Office, Tapestry, Reporting Workbench, Charge Router, Electronic Remittance, Ambulatory, Connect trained and experienced, SQL Server, Chronicles, Cadence/Prelude, Security, Epic implementation methodology, Clarity Reporting: ADT/Prelude/ASAP/HB/PB/ Radiant/Willow/Amb/Inp, Go-live planning/execution, Software testing, Multiple go-lives/Implementation Cycles, Mentoring of staff/consultants, Staff/end-user training, Management and movement of data, Issues, communication, and risk management, Interfaces/FTP/Servers and Hardware, Printing and Faxing



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