Crystal Sullivan

Cell # 312-***-****

Email address: adcs6p@r.postjobfree.com

PROFESSIONAL SUMMARY:

My name is Crystal and I have over twelve years in the Healthcare Revenue Cycle filed. My expertise is, claims auditing, account receivables- accounts payable- electronic medical records (Cerner-PowerChart-Sorian-EDM- cash posting- patient billing -pro fee- insurance verification. -utilization review- appeals authorizations (Pre-Certification) and insurance verification, and health insurance collections and credential and medical billing. Coding (ICD9/10 in-patient and out-patient I have worked with all Manage Care insurance companies for several states. Medicare-Medicaid- UHC-Aenta- Humana-BCBS- Tricare- and so many more.

PROFESSIONAL EXPERIENCE

Banna Independent Transfer- Part- Time 11/2013- Present

Contact vendors to negotiate contracts for company

Post revenue to vendors accounts

Generate and Assure timely and accurate invoicing in Quick-Books

Contact vendors on past due accounts

Assure timely collection of monies due to company

Excellent Customer Service via phone or by email Zenith Health Solutions: Contracted 12/2019 – 3/2020 Biller

Maintained up-to-date billing system with Concur---and Sap and Quick-books

Generated and send out invoices to professional vendors

Followed up on, collect and allocate payments to labor union funds

Carried out billing, collection and reporting activities according to specific deadlines

Researched and resolve payment discrepancies and trouble shoot software when necessary

Investigated and resolve customer queries

Processed invoices on high profile clients

Provided supporting documentation for audits with accounting records

Maintained confidentiality with labor unions medical legal contracts

Posted payment in the amount of a quarter of one million in labor unions funds Ultimate Healthcare: Temporary Assignment 2/2019- Present Claims Auditor-

Healthcare FACETS (TriZetto Claims processing system)

• Conducted audits and reviews of claims. document the information in the patients file/ clinical information into the company data base on the findings and recommendations.

• Researched claims and providers contrcts for pricing and provivers configuration

• Worked collaboratively, diplomatically, maintain confidentiality, and with integrity in problem identification and problem- solving activities. Notified the providers of the incomplete medical documentation that was needed to support the icd-9/10 coding

• Audited fourteen hundred claims in two weeks, while teaching myself the companies claims processing software

• Investigated, evaluated and resolved claims through the normal claim handling process. Achieve optimal results through proper litigation and vendor management. Contacted manage care companies to resolved appeals for maximum reimbursement per provider/hospital contacted rate.

• Submitted audit results to Claims Manager based upon reading the patient’s medical records Frasier Healthcare Consulting- Remote 10/2018 – 12/2018 Claims Auditing/Coding/Accounts Receivables Hospital

• Demonstrated extensive knowledge and understanding of the proper accounting treatment for accounts

• • receivables. Supported Audited claims/Management And medical noted all by records manage distributing to care make timely and sure government ICD-and accurate 9/10 /accounts HCPS Accounts codes Receivable are accurate information for physician’s/ hospital billing purposes with Soarian Cerner EMR. on a daily basis, and noted what cpt or icd codes was paid based on providers contractual rate- agreement • • • Reviewed Contacted Verified patient insurance appropriate for Medicaid-eligibility claims payers Medicare through and for explanation additional (Part-several A&different payments B) of benefits/ -Manage web when RA’s care portals needed insurances. for possible on a daily under basis, payment and through on a daily Soarian basis -EDM system on a daily basis to read claims submissions that was not located on insurance web portals.

• Reviewed accounts with payment contacts for compliance or delinquency and applied payments on a daily basis, noted accounts through Soarian Cerner and on excel spreadsheet the root cause and claim status and, and patients receivable group numbers. Troubleshooted medical software when needed. Review ICD 9-10 codes on claims for multiple specialties such as

• ortho- Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable. Urgent Care Center West Chase FL 09/2016 –12/ 2017 Medical Referral Coordinator

Contacted patient on a daily basis and review patient medical records to determine specialty, and electronically emailed on a daily basis. Entered patients’ demographics on a daily basis

Ensured complete and accurate registration, including patient demographic and current insurance information, and called patient to inform about balance due on accounts, and facilitated requests for information from outside providers form multiple clinical specialties on a daily basis

Assembled information concerning patient's clinical background and referral needs. Obtained initial authorizations via insurance web portals or by contacting manage care companies by phone.

Per referral guidelines, provide appropriate clinical information to obtain authorizations -ICD 9-10codes and diagnosis codes for imaging appointments weekly. Such as

Contacted and review organizations and insurance company’s policy and procedures to ensure prior approval for authorizations and denials requirements were met.

Presented necessary medical documentation from patient medical records such as history, diagnosis and prognosis from HCFA 1500 on daily basis with Eclinicals Works

Provided specific medical information to financial services to maximize reimbursement for collection purposes

Established and maintain relationships with identified service providers

Released medical records upon Attorney’s request that provided a subpoenaed for the patients that received medical attention from the Dr’s at Fast Track Urgent Care Center on a weekly basis (ROI daily to over 17 medical specialties and Workers Comp and Auto accidents patients

Ensure that referrals (Stat-Urgent) and authorizations were obtained within a few hours with progress notes and medical codes were accurate for medical necessity that was provided and signed off by clinical staff. Identify and utilize cultural and community resources.

Assisted in credentialing Medical Doctors, ARNP(s) and PA ‘s on a monthly basis Pediatrix Medical Group /St. Joseph Women’s Hospital. Tampa, FL 02/2015- 8/2015 Hospital Medical Biller/Auditor

Gathered and verifying current demographic information from speaking with parents or hospital to register babies on a daily basis. Verified on a daily basis reviewing patient’s information with the hospital EHR system

Obtained correct insurance information from mothers to assist in filing for Medicaid for their new born. (short form applications)

Supplied authorization numbers as requested by the insurance companies for claims to be paid accurately. Reviewed medical census by providers to obtain through hospital EMR (PowerChart-Cerner) for correct ICD 9-10 Diagnosis codes for correct physician’s billable amount to be paid per contractual rate

Utilized the correct verification forms for requesting insurance and referring physician codes after reviewing the claims on a daily basis. Follow up on appeal process.

Provided credentialing assistance to non-par providers to participating providers. Communicated with providers and RN’s to obtain medical records through the hospital EMRs systems on a daily basis electronically

Managed request for information from outside providers on a daily basis to troubleshoot medical software.

Registered One thousand and one hundred and ninety-three new born babies in Dr. Connect (EMR) in one month

Reinstall and Uninstall Software.

Generated medical reports for providers on weekly basis. Reviewed patients’ information through hospital EMR/Power Chart to make sure the MD’s used the correct code

Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable. Moffitt Cancer Center Tampa, FL 01/2014- 12/ 2014 Financial Clearance Specialist III

Assisted RN’s with coding high profile chemo therapy drugs/ patients in obtaining authorizations. Referrals- ICD 9-10 Coding, and insurance verification process. Notated patient’s files in EMR and updated patient’s demographics and reviewed HFCA 1500 for the claims to be paid accurately. Released medical records via email/fax to several (17) medical clinics upon Dr” s request for patients scheduled for multiple clinics.

Ensured delivery of exceptional customer service to patients, families and all internal clinical staff.

Reviewed patient’s EMR. (Sorian) records/ clinical notes on a daily basis to determine the medical procedures and diagnosis of the patient was accurate for the RN’s and Physicians on a daily basis. (HEDIS)

Processed medical orders for seventeen clinics. GI, HEM, OB-GYN.ect. Completed the appeals process for RN’s on the high chemo therapy patients on a daily basis

Coded for seventeen medical specialties / clinics on a daily basis with Moffitt EMR. (Cerner) system for out/patients on a daily basis with

Pyramid Healthcare Solutions Clear water, FL 6/ 2011 – 9/2011 Insurance Verification/Accounts Receivable - Consultant

Contacted insurance companies to verify client’s eligibility for Medicaid and Medicare and commercial insurance through there medical web portals (Medicaid- Aetna- United Healthcare- Humana)

Processed payments from insurance companies and prepares a daily deposit when requested.

Performed various pre-collection actions including contacting patients and insurance companies by phone, correcting and resubmitting claims to third party payers.

Initiated follow-ups and reports status of delinquent accounts from third party insurance carriers.

Ability to interpret EOBs (explanation of benefits), perform actions based on EOB and process responses from insurance companies after reading the medical records for accuracy purposes for coding Lamperts Home Therapy Largo, FL 11/ 2009 – 12/2010 Patients Accounts/Medical Billing -Consultant

Answered questions from patients, clinical staff and insurance companies

Processed responses to patients, payers, physicians and other providers of services as identified by the client

Collected and processed payments from patients, payers and other providers of services as identified by clients

Obtained and provided medical records EMR when requested by payers for medical denials purpose and updated patient demographic information accurately. Prepared and mailed invoices to patients.

Reviewed medical claims and ICD 9 coding for billing purposes

Contacted insurance companies to obtain authorizations/referrals for scheduled appointments for multiple specialties US Oncology Central Billing Office Clearwater, FL 01/2008-12/2008 Patient Accounts Rep/Cash Application

Performed audits on patient account/claims to ensure accuracy and timely payment and resubmitted insurance claims

Followed up on 3rd party insurance billing to ensure timely receipt of payments

Reviewed EOBs to ensure proper reimbursement of claims

Demonstrated the ability to deal with patients and insurance companies in a professional manner

Verified insurance, the effective date and coverage, type of plan and payable benefits through multi insurance web portals

Checked to see if the patient has any pee-existing clauses to accounts,

Informed patients regarding drug replacement and assistance programs for prescription drugs through Medicaid and advised of supportive programs eligibility if necessary.

Maintained records for accounts receivable billing and participated in patient write off submissions

ROI on a daily basis for or appointments per request by clinicians. Coded for seventeen clinics- Cutaneous Clinic-Nuclear Medicine-CT Scan-Diagnostic (DX) Pet/CT- Ultrasound- BMT-GI- GU- GYN-Head & Neck -Sarcoma -Thoractic-Neuro – Senior Adult Clinic- Endo – Radiation and Interventional Pain- DRC – Hematology- MIP- also use Secondary DX codes Principle Counseling and Consulting Out Patient Mental Health Charlotte, NC 02/2005 – 12/2007 Assistant Finance Director

Billing of co-pays, deductibles, and third-party insurance companies.

Prepared patients account for outside collections, audit accounts for accuracy and troubleshoot as necessary

Responsible for monitoring patient accounts and account receivables, and coding claims for outpatient mental health services. troubleshooted soft when it was necessary

Initiated hard collection towards third party insurance carriers and processed claims and posted payments to patients’ accounts daily

Reviewed denied claims and ICD 9 and CPT codes for accuracy and resubmitted the claims on a timely basis, identifying deceased patients and estate to confirm dollars amounts for collection

Followed up with patients regarding delinquent accounts to make payment arrangements, determines financial clearance for each patient and refers patients for financial counseling as necessary

Credentialed LCSW non-par providers to participating providers and searched data base CAQH for provider’s information. Did follow-up through company data base to make sure providers state licenses was not expired. Reviewed medical records for clinical staff for correct ICD-9 and CPT diagnosis for billing purposes SUMMARY OF SKILLS:

Ten Key Calculator

SQL

QuickBooks

Concur Invoicing Software

Microsoft Office Suite

ICD-9 /10 -CPT Coding & CMS-1500/HCFA’S

Medical Terminology

Milliman & InterQual

Soarian Clinical Software EHR

AppsBar Clinical Medical Records Software

Med iSOFT Electronic Medical Billing Software

E-Clinical Works Electronic Billing

Medical Manager Electronic Medical Billing Software Tiger /Misy Company Billing Software

ZirMed Electronic Medical Billing Software

DME Medical Billing/EMC/HMO’S/HCPC Coding

Medicare Billing/NaviNet

CPR+Electronic Billing Data Base

Stratacare/Strataware & Claims Platform Software

Homecare Home Base Electronic Software -EHR

Excellent Interpersonal skills

Dr. Connect /Power Chart EHR Software

TheraManager Electronic Medical Billing/Records Software Web Xtender, FL Depart. Of Health/ NPI Website

Paymentech Credit Card Machine

Soarian -Cerner EHR - Software-People Soft

Medical EDM – Electronic Document Management

EDUCATION :

2020 – HIPPA Certified

2019 – Certificate Part-C- Organization determinations, Appeals & Grievance Medicaid and Medicare (CMS 2019 – Certificate Part-D Coverage Determinations, Appeals & Grievances Medicaid and Medicare (CMS) 2019 – Medicare Part -C & D General Compliance Training- Medicaid and Medicare (CMS) 2019 - Combating Medicare Part- C- and D Fraud, Waste, and Abuse Medicaid and Medicare (CMS 2009 - Option Care Billing Claim Preparation Pharmacy and Infusion Services - St Petersburg, FL 2009 - Certificate Medicaid Provider - Florida Medical - Largo, FL 2004 - Diploma C.N.A - Leary Technical Education Center - Tampa, FL 2002 – Medical Office/ Certificate ICD -9/10 & CPT Coder - DESI - Jacksonville, FL 2020 - CPR Certified - Temple Terrace Fire Department - Tampa, FL 2014 - Certified HHA - Tampa Bay CNA Institution - Tampa, FL 2014 - Certified Hospice Care – Tampa Bay CNA Institution - Tampa, FL 2014 – Certified Personal Healthcare Tech - Tampa Bay CNA Institution – Tampa, FL GED

Associates Degree - Paralegal- Florida Metropolitan University – Clearwater, FL Certified Business Software Applications- Pinellas Technical College- Clearwater, FL- 2020 – Certified Professional Coder/ AAPC

2020 – Member of Healthcare Financial Management Association (hmfa)

Contact this candidate