Customer Service Manager
Resume:
Rhonda Sustar
Professional Summary
A CERTIFIED - EPIC PB RESOLUTE APPLICATION COORDINATOR, who is knowledgeable and proficient in Epic Claims build, with over 15 years b experience in Revenue Cycle billing management, seeking a challenging position where I can build and expand my IT professional career.
Senior Application Analyst 8/2019 – Current
Nordic Consulting Services Madison, WI
Responsible for the end-user support and training of 2 multi facility clients through Service Now ticket system.
Research to develop, configure and modify moderate to high complexity "break fix" solutions in Epic.
Created and maintained PB and Claims functionality workflows such as CERs, Workqueues, LPPs, CDFs based on user-specific issue and/or request.
Created documentation and training manuals for new and existing build and workflow.
Preformed upgrade and counterpart build and workflow validation testing.
Provided phone and Webex training and support and training to users.
Participated in on-call monthly rotation.
Epic PB Resolute Application Coordinator 2016 – 7/2019
Community Connect - Piedmont Healthcare Atlanta, GA
Coordinate and support the full PB and Claims build for multiple Community Connect sites with the revenue cycle implementation and ongoing optimization and stabilization of the Epic Resolute Professional Billing. Served as the PB and Claims Project Lead.
Implement and custom build the Epic PB application to meet the needs of different client specialties by analyzing the client’s workflows, departmental policies and procedures, and Billing structure.
Maintenance of Facility Structure, department, location and place of service shell records for new clinic. Build and charge testing, designing charge triggers, bill areas and general ledger.
Review existing external claim/charge review edit and created CERs within Epic to identify these issues internally
Create and maintained Claim Definition Files, extensions claim edits value rules, billing indicators, claim overrides and updates to other related master files.
Build and customize Workqueues using CER’s: Charge Review, Charge Router, Follow-up, Claims, Remittance, Retro Review, KCQ.
Add and updated information within the payer/plan master files this includes creating alternate payers and Remittance build and workflow.
Build job, runs and batches for specialized workflows such as collection agency workflow, and custom billing extracts.
Create custom claim edits and CERS in the CDFs for clients, as well as any new edits for Charge Review, that may include VCT/VCS needed in the Charge Router.
Work with clients on any Ambulatory Surgical Centers, making sure the UB04 populates the correct claim information.
Create and customized each client's ETX for statements, and or letters.
Optimize LPPs for the remittance so the RMOS can generate the correct payor in the Remittance run.
Manage, build, test and implement various types of statements (P/F, research, client, corporate, payment plan, demand statements, fee schedules, SER build,) and statement import from third party vendors.
Analyze, troubleshoot, and solved claims and billing issues presented via Help Desk through HEAT ticketing system.
Customized and maintain electronic and paper claim forms.
Revenue Cycle Manager 07/2015 – 12/2016
National Pain Care (Company Closed) GA, TN, KY, OH
Coordinate, supervise, and maintain the overall revenue life cycle, including registration, accounts receivable, audit, and medical records management functions for the Central Business Office.
Provide direction, motivation and mentoring to staff; Responsible for training and development of staff to ensure consistency in practice in various patient accounting functions to include A/R, billing, data audit, registration, and accounting systems.
Performed monthly audits of staff production and reviewed findings with them.
Review daily, weekly, and monthly key metrics to identify and document trends or areas of focus in developing and implementing action plans, as appropriate.
Provide multi-level reports and communication to staff, practice managers, and physicians as needed or directed.
Revenue Cycle Supervisor 11/2003 – 7/2015
Piedmont HealthCare Atlanta, GA
Increased collections from 9M to 10M.
Reduced A/R from $23M to 16M.
Reduced Greater than 120 AR from 8M to 5M.
Reduced A/R from 39.6 days to 27.7 days.
Achieved departmental objective of reducing greater than 120 AR by focusing on high dollar cases and key adjustments needed.
Responsible for collection, aging, establishing write-off standards and claim denial management.
Performed monthly audits of staff production and reviewed findings with them.
Review daily, weekly, and monthly key metrics to identify and document trends or areas of focus in developing and implementing action plans, as appropriate.
Provide multi-level reports and communication to staff, practice managers, and physicians as needed or directed.
Monitor insurance collection practices to assure all levels of aging and accounts receivables were maintained per CBO guidelines.
Insurance and Self-payment posting, Insurance Follow up.
Conducted monthly and yearly performance evaluations as well as interviewed and hired staff.
Drafted and carried out corrective action plans including performance management and termination.
Developed efficient and enhanced work flow process improving and increasing Transplant practice revenue.
******.******@*****.***
208 Martin Circle
Royal Palm Beach, FL 33411
Current
Nordic Consulting Services:
07/2019- Current
Senior Application Analyst
Piedmont HealthCare Career Path
EPIC APPLICATION COORDINATOR
PB-RESOLUTE - COMMUNITY CONNECT 2016 - Present
Piedmont Healthcare Revenue Cycle CBO:
11/2003 – 7/15
02/13 – 7/15 (CBO)
Revenue Cycle Supervisor
04/08 – 02/13 (CBO)
Revenue Cycle Coordinator
01/07 - 08/08 (CBO)
Transplant Billing and Collections Coordinator
06/05 – 06/07 (CBO)
Insurance Follow-Up Team Lead
06/04 – 06/05 (CBO)
Insurance Follow-up Rep
11/03 - 06/04 (CBO
Customer Service Rep
Software:
Epic, NextGen, E-Clinical Works, Greenway, Teleresults, Navicure, Trizetto and Zirmed, Service Now and HEAT.
Specialty Experience:
Internal Medicine, Multi-Organ Abdominal Transplant, Orthopedics, OB/GYN, Endocrinology, Intensivist, Nephrology, Hepatology, Occupational Medicine, Rheumatology, Dermatology, Podiatry, Pediatrics, General Surgery, Oncology, Sports Medicine, Hospitalist, Workers Compensation, Urology, Neurosurgery, Sleep Study, Tele-Medicine, Cardiology, Vascular, Pulmonology and Pain Management, Orthopedics, Pain Management
Certifications:
Application Coordinator: Epic Resolute Physician Billing 2015
PB NVT 2019
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