Medical Billing Manager

DAVID NEWMILLER, COC

** ******** *****, **********, ** 19468 267-***-****

EXPERIENCE:

**/**** - ******* **** ******** Health System, Philadelphia, PA Manager, Revenue Integrity and CDM

Responsible for the development and maintenance of the Charge Description Master (CDM); ensuring data integrity and compliance between the CDM and all hospital department clinical systems; researching coding and revenue reporting requirements; development of policies, procedures and educational materials for CDM maintenance and usage. Also responsible for establishing pricing for all facility services performed at Holy Redeemer Hospital and meeting the strategic pricing goals for reimbursement. Manages the Revenue Integrity staff and monitors the daily workflow, quality and productivity of staff's assigned duties. Additional responsibilities include maximization of billed revenue through the accurate and complete capture of all charges as well as the implementation and maintenance of charge capture processes which may include creating and disseminating educational materials and training. Works closely with the billing office and all revenue generating clinical departments to enhance charge capture and help identify and trend root causes of billing edits/denials and assist with corrective action. Oversees charge capture,revenue integrity, comprehensive CDM, compliance, and pricing audits to ensure the accuracy of patient charges and NCCI billing and 3rd party payer edits.

7/2019 – 05/2020 Nazareth Hospital, Philadelphia, PA Director of Hospital Finance

Responsible for providing strategic and operational leadership and direction in the development and implementation of financial management, budgeting, accounting, supply chain and revenue cycle operations, serving as a member of the Hospital's Management Team and leading the annual budget process for the hospital, ensuring development of operational budgets that support the organization's strategic objectives. Ensures the establishment and maintenance of sound financial information and functions as a liaison between the Financial Reporting Team and Operations. In addition, plays a key role on operational committees by conducting research, making recommendations for process improvements and efficiencies.

5/2017 – 7/2019 Universal Health Services, Inc., King of Prussia, PA Compliance Auditor

Sole Compliance Auditor for Revenue Cycle team supporting 27 acute care hospitals nationwide. Responsible for review of work plans for the OIG, RAC and other government organizations responsible for auditing the Healthcare Industry and reporting to Revenue Integrity Manager on potential risks and areas of concern. Conducts audits of claims and hospital records related to the aforementioned risks and areas of concern as directed by the Revenue Integrity Manager. Assists regional CBO staff with the resolution of claims denials and rejections as requested. Monitors the Patient Financial System ensuring that recirculating errors are resolved in a timely manner. Assists Chargemaster Specialists with charge compliance research and questions. Provides education to hospital nurse auditors, regional CBO staff and corporate PFS staff of compliant coding and charging practices as needed. 2/2012 – 5/2017 Mercy Health Systems, Conshohocken, PA CDM Supervisor

Assumed responsibilities of the outgoing CDM Director. Responsible for supervision of a multi-hospital Chargemaster Compliance Department supporting as many as five facilities. Managerial duties included but were not limited to developing the departmental budget, payroll, oversight of the day-to-day team operations, providing guidance on proper resolution of claim edits and denials. Participated as a member of individual facility Change Control Committees. Participated as a member of the Corporate Cancer P & T Committee. Participated as a member of Revenue Cycle teams at supported hospitals. Worked closely with Hospital Finance Departments to develop pricing strategies. Participated in annual strategic pricing reviews required by Trinity Health's Corporate Revenue Excellence Team. 12/2007 – 02/2012 Mercy Health Systems Conshohocken, PA Senior CDM Compliance Analyst

Team Lead for a five-person team supporting three hospitals. Responsible for analysis related to the processing of CDM change requests, oversight of CDM and charge capture reviews and CDM updates related to yearly coding changes. Responsible for oversight of CDM related issues for three hospitals during conversion to standardized CDM. Responsible for oversight of CDM related issues for three hospitals during conversion from Siemens Invision to Meditech Client Server. Assisted in the education of charging staff in use of new and existing CDM items as required. 7/2006 – 12/2007 Mercy Health Systems, Conshohocken, PA CDM Compliance Analyst

Responsible for analysis related to the processing of CDM change requests, oversight of CDM and charge capture reviews and CDM updates related to yearly coding changes. Assisted in the education of charging staff in use of new and existing CDM items as required.

3/2005 – 7/2006 Mercy Health Systems, Conshohocken, PA CDM Billing Analyst

Responsible for the processing and tracking of all CCI edits, processing of problem sheets related to CDM set up issues, oversight of commercial chart audits and coding of pharmacy items. Additionally responsible for reviewing medical records in conjunction with the Medicare ADR and CERT processes and appeals filings. Assisted in the education of charging staff as required.

9/2003 – 3/2005 Mercy Health Systems, Conshohocken, PA Level III Biller

Responsible for all aspects of Medicare facility billing for selected outpatient accounts at Mercy Fitzgerald Hospital. 1/2000 - 9/2003 MiddleStates Medical Management, Horsham, PA Billing Coordinator

Sole billing coordinator in a small medical billing/medical management company. Also responsible for individual workstation and LAN maintenance. 11/1998 - 12/1999 Spectrum AQE, Blue Bell, PA

Billing Coordinator

Responsible for data entry for all aspects of inpatient billing for provider services in a midsize psychiatric practice. Also responsible for submission of all claims to insurance carriers (both electronic and manual, both inpatient and outpatient), generating patient statements, responding to patient inquiries, posting Medicare payments, responding to Medicare denials and software maintenance. Also, solely responsible for the training of new billing department employees. EDUCATION:

5/1994 Evangel University Springfield, MO

Bachelors of Science in Biology with a Minor in Chemistry CERTIFICATIONS:

Certified Outpatient Coder (formerly CPC-H)

AAPC

ICD-10 Certified

AAPC

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