Medical Billing

Christine Holmes

601-***-**** ************@*****.*** Coldwater, MS 38618

PROFESSIONAL SUMMARY

Organized, focused and versatile Healthcare Administrator with 10+ years of proven expertise in healthcare operations, patient administration, medical logistics, and medical readiness for over 20 personnel. Skilled in medical billing and records, HIPAA, medical facilities, and medical contracting. Collaborative communicator; focused on fostering positive relationships and building consensus. Adept at empowering teams to achieve highest quality outcomes through process improvement and continuous education. Devoted to collaboration, coaching, compliance, and program success. Demonstrate ability to supervise, train and motivate employees, as well as a professional attitude in relating to executive management, professionals and third-party insurance carriers

CORE COMPENTENCIES

Patient Care & Safety Employee Training & Development Personnel Management Cost Reduction

Inventory Management Process Improvement HIPAA Compliance Strategic Leadership Medical Terminology

Budget Adherence Problem Resolution Electronic Healthcare Recordkeeping Health Information Technology

EDUCATION

Master of Arts in Healthcare Administration Ashford University Graduated: 2013

Certifications: CPCS HIPPA

PROFESSIONAL EXPERIENCE

SENIOR CREDENTIALING SPECIALIST 03/2018 – Present

Baptist Medical Group Memphis, TN

Leads, coordinates, and monitors the review and analysis of practitioner/physician applications and accompanying documents, ensuring applicant eligibility.

Assist in preparing and coordinating provider information to / from managed care quality committees and other internal departments and / or external entities.

Identifies issues that require additional investigation, validates discrepancies, and ensures appropriate follow up.

Prepare and monitor credentials file for completion and presentation to the Medical Staff Committee ensuring file competition within time period specified and conducts audits for delegated entities.

Perform primary and secondary source verifications of credentials according to departmental policy.

Assist in continuous re-evaluation and verification of workflow to ensure processes are efficient.

Working knowledge of Medicare/Medicaid Revalidation, CAQH, AMA, NPDB, CACTUS, PECOS, NPI, PQRS, MIPS, and PDSV.

Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies.

PAYER ENROLLMENT/RELATIONS SPECIALIST

Responsible for the development and implementation of payer strategies and patient appeals to ensure optimized coverage and reimbursement for company products.

Complete understanding of the billing/collection process to resolve complex, outstanding claims.

Ensure accounts are billed accurately and timely by providing proactive oversight and direction for billing and collections.

Provide operational oversight for the Billing Supervisor, mentoring them in their responsibilities.

Maintain current knowledge of hospital billing systems and government payer systems, including applicable federal/state laws and regulations, as well as all aspects of third-party reimbursement policies and practices.

Monitor approval and claim history to help identify contract opportunities; Perform all job duties while maintaining compliance with all appropriate regulatory requirements including HIPPA.

Organized and lead efforts for maximum operational efficiency and optimize reimbursement.

Continuous monitoring of payer contracts through the load date confirming fully executed contract and fee schedules are in secured.

ADJUNCT INSTRUCTOR - HEALTHCARE ADMINISTRATION 06/2017 - 02/2020

William Carey College Remote

Created and implemented course agendas, lesson plans and activities to successfully meet course objectives.

Developed and implemented lesson plans that resulted in high level of student success and course completion.

Recognized as top 10% of instructors; oversaw training, mentoring and guidance for 6,000 students; providing over 3,000 hours of instruction with an impressive 85% average.

Distributed course syllabus and responded to student questions and concerns regarding standards, material, grading and progression.

Provided a more hands-on approach to education incorporating and exceeding the course requirements.

Sought solutions for better instruction and encouraged feedback between instructors in order to improve the quality of instruction from the entire team.

OFFICE MANAGER 01/2016 – 02/2018

Northwest Mississippi Otolaryngology & Desoto Thyroid & Endocrinology Southaven, MS

Supervised the family medicine clinic, managed schedules for 6 physicians/residents.

Incorporated the clinic's new training program, ensuring HIPAA, BLS, and the other medical training was kept up to date for 20+ staff members.

Provided direct supervision to six employees and oversight of patient care for over 5000 patients.

Directly responsible for health and welfare, training, professional development of six employees.

build and manage provider schedules and booking; ensures staff complies with HIPAA regulations and mandated training and are proficient with various health information systems.

Knowledge of contract language and financial impact.

Addressing patient concerns, issues, grievances, and questions including the review of patient satisfaction surveys.

Developing and communicating efficient and timely patient schedules to ensure maximization of facility efficiency.

Managing the facility compliance with federal, state laws and all state agency regulations (CMS, AHCA, JCAHO, and OSHA).

Assisting as needed with patient workflow, monitoring pre, intra, and post, procedures as appropriate.

Successful in optimizing delivery of care by electronic charting systems and continuously measuring performance metrics.

ACCOUNT SPECIALIST 01/2011 - 01/2016

Health Revenue Group Remote

Worked outstanding aged account reports.

Review claim denials and submit corrected claims and/or follow up appeals.

Verification of insurance eligibility and member benefits.

Research and review denied CPT codes.

Identified and correct billing errors and convey these issues with leadership to prevent incorrect posting information.

Initiated precertification approvals prior to surgical procedures or office visits.

Reviewed outstanding AR accounts and identified collection attempts.

Ensure all consent forms and documentation meet required accuracy and time sensitive deadlines.

Maintained current knowledge of hospital billing systems and government payer systems, including applicable federal/state laws and regulations, as well as all aspects of third-party reimbursement policies and practices.

Initiate and follow up on claim appeals after efforts for payment have been exhausted.

Communicate with management to assure communication of information necessary to maintain HIPAA compliant and implemented and understood in accordance with policies and procedures.

Data entry of financial and insurance information into an Electronic Health Record.

TECHNOLOGY PROFILE

Software: Microsoft Power Point, Microsoft Word, Microsoft Share Point, Microsoft Excel, Microsoft One Note, Microsoft Outlook, and Adobe.

Operating Systems: Blackboard, Canvas, Mac, Microsoft, and Office 365.

Holmes Page 2

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