Resume

Manager Medical

Location:

Sherman, TX, 75090

Posted:

April 13, 2021

Contact this candidate

Resume:

Terri Case

Sherman, Texas ***** adln3b@r.postjobfree.com 671-***-****

https://results.talentbankonline.com/rm/p/card?o=8b0QMzJuIpg=MjA0MDQzMzc=&c=7301&p=74 3

Work Experience:

Guam Radiology Consultants

Revenue Cycle Director

4/2016 to 3/2020

Tamuning, Guam 671-***-****

• Managed all billing staff, offshore and onsite in Guam, 40 staff, three direct reports

• Assessed current revenue cycle processes and implemented improvements from pre-registration to claim resolution

• Increased electronic claim submissions through Trizetto from 49% in 2016 to 89% in 2018

• Increased Trizetto EFT/ERA participation by 40%

• Increased ‘first-pass’ clean-claim submission by 20% in 2016

• Designed and implemented denials management platform/s for US Mainland, federal and commercial, local payers and Guam Medicaid.

• Implementation of centralized authorization department (CAD) reducing prior-authorization denials 50%

• Decreased denials by 30% in first year by overhauling the pre-registration processes

• Monitored and managed offshore revenue cycle operations, Hyderabad and Noida, Delhi, NCR. Two teams, each with 30-40 staff.

• Increased total revenue by 4 million dollars in 12 months, from 2016 to 2017

• AR Aging – Reduced over 120 days A/R to 12%, (12% is low for Guam providers)

• Successful in obtaining the Tricare OS HPSA Bonus by updating our Taxonomy codes with Payer.

• Successful with local payers, Staywell, Calvos, and Netcare, in adopting US standards for DX FAMILY CODES to be changed without the need to amend the Prior Authorization

• Successfully renegotiated a direct contract with Aetna International. Worked directly with Jennifer Teti, Aetna Contract Negotiator for several months to come to a final agreement. Taking our 1.2m annual collections to a projected 4.5m

• Successfully implemented a new process for on-site patient access team can automatically calculate patient’s out of pocket prior to service • Successful in implementing a new process in company’s Radiology Information System to use custom fields showing insurance eligibility/verification and TOS payment in a modified dashboard view, making a significant impact to our TOS collections Touchstone Imaging

Director Patient Accounts

3/2015 to 1/2016

Denver, CO

877-***-**** (corporate office)

• Responsible for billing operations of 45 diagnostic imaging centers

• Managed over 40 FTEs with 5 direct reports and 35 indirect reports

• High-volume claim volume of 50K+ monthly

• Increased monthly collections from 11 million to 15.5 million in a period of six months

• Extensive assessment of revenue team and internal process workflow during first 2 months to form a plan of improvement

• Worked with corporate team to develop better integration of systems from center level to billing system to improve collections at center level and payer level

• Designed and implemented successful denials management platform

• Managed multiple teams, including Data Entry, A/R follow up, Patient Collections, Coding and Call Center Stride Community Health Center/FQHC

(formally-Metro Community Provider Network)

Revenue Cycle Director

11/2014 to 03/2015

Denver, CO

303-***-**** (corporate office)

• Billing and Revenue Cycle Manager for 23 FQH Centers

• 70% single payer system/Medicaid Colorado

• Developed and trained staff on business office metrics

• Improved processes of billing and submitting electronic claims Intercede Health (Hospitalist & Transitional Care) Revenue Cycle Manager

2/2014 to 7/2014

Houston, TX

832-***-**** (corporate office)

• Ensured that all billing and collection activities meet and adhere to Medicare, Medicaid and other insurance regulations, rules, and laws

• Worked with leadership in the planning, implementation and evaluation of modifications to existing operations, systems and procedures, especially those related to reimbursement maximization

• Monitored reimbursement and responded as needed to reimbursement issues

• Oversaw Intercede Health's client collection programs

• Handled management reporting for executive team, and work with analyst in developing month end reporting for clients Responsible for provider enrollment and credentialing for Texas and other markets Scott Medical/DME

Appeals Coordinator

6/2010 to 7/2013

Baytown, TX

832-***-**** (cell)

• Position responsible for working reconsiderations and redeterminations for Medicare patients.

• Position required a very deep knowledge of DME appeals process with Medicare

• Prepared and submitted complex appeals to Medicare for redetermination

• Understanding of Medicare LMRP, LCDS, and CMNs

• Appeals included hospital beds, oxygen, wheelchairs, and other durable equipment and supplies. Fairmont Diagnostic Center

Revenue Cycle Manager

3/2004 to 4/2010

Pasadena, TX

281-***-**** (sold/new owner)

• Assessed revenue cycle metrics and implemented improved processes from patient registration to claim resolution

• 25 direct reports encompassing 3 departments- front desk, scheduling, and billing

• Developed staff on appeals process with regard to third party payers, Medicare and Medicaid. Managed Prior Authorization, Pre-certification, and verification requirements

• Set-up of online access for verification, and prior authorization with insurance carriers, i.e., Availity, EMDEON, and carrier direct submission.

• Prepared month-end reports for CEO with regard to charges, collections, and physician percentages for payment

• Prepared and presented spreadsheets and reports related to revenue cycle management to physicians.

• Worked with referring physicians, office managers, administrators, and office staff to assure proper delivery of care to their patients.

Brazos Valley Open MRI

Billing Manager

6/2001-12/2003

College Station, TX

979-***-**** (sold/new owner)

• Set-up entire billing department

• Implemented policies and procedures for entire office in relation to billing and reimbursement.

• ICD9, CPT coding for all procedures.

• Electronic Billing

• Payment Posting, EOB review and analysis

• Network Contracting

Burzynski Research Institute

Patient Intake Coordinator

11/1999-3/2001

Houston, TX

713-***-**** (corporate office)

• Performed intake of prospective patients for FDA approved clinical trials using Antineoplastin Therapy for the treatment of Cancer.

• Utilized medical acceptance criteria to screen and schedule appointments for new patients in a way to ensure optimal efficiency in clinic operations.

• Provided financial counseling options to patients including cost estimates, payment plans.

• Collected and completed accurate financial data during intake process to ensure appropriate financial screening of new patients and verified data during new patient registration to ensure compliance with required forms and consents.

• Used technical expertise to obtain insurance information for billing department.

• Coordinated travel arrangements for patients and family as needed.

• Used cross-functional knowledge to understand inter-departmental connections.

• Demonstrated commitment to collaborative professional relationships with physicians and all members of the health care team.

USAF Veteran

Medical Service Specialist-Tech School/OJT surgical post-op & Internal Medicine Clinic Lee College (non-degreed)

RHIT/Nursing Studies

Medical Terminology

Pathophysiology

A&P I & II

Legal Aspects of Medical Records

Pharmacology

AAPC

CPC Certification

AAHAM

Currently working toward CRCE-I & CRCE-P

Skill Set Summary

• RC Project Management

• Revenue cycle process assessment, solutions and implementation

• Pre-Reg- Eligibility & Benefits, Prior Authorization, Pre-Certification

• Billing Environments-Medicare, Medicaid, Commercial, Work-Comp, Personal Injury

• Billing guidelines & regulations- CCI/NCCI/LCD/NCD/MEUs

• HCFA 1500, 837P, datasets format

• CPT/HCPCS-Drug/Supply Coding

• Revenue Coding-NUBC, working knowledge

• EOB/CARC/RARC- Strategic Denial Management

• UB04 837I, CMS 1450, datasets format, working knowledge

• IP & OP Hospital DRG/APC, working knowledge

• Coding Compliance/CPC AAPC

• Pre-Claim review optimization / first pass clean

• HIPAA 5010-Standard Transactions Codes &

• Loop Segments

• Optum Encoder Pro

• Data Analytics/Dashboards, Monthly KPIs,

• Oracle Business Intelligence- Ad-Hoc Reporting

• RIS HL7 Migration

• MS 365 for Teams/MS Office/Excel Pivot Tables

• Lucid Charts/Adobe DC Pro

• Clearinghouses, Cognizant, Emdeon, Availity.

Billing Software:

Medisoft, Meds-America, Sage-Medical Manager, Mestamed, MSI, Intergy, Logos, Mercury Medical, RISlogic, Ramsoft, Merge Elligence, Sequelmed, EDI Live, Alteer, various EHRs, Optum CareTrac Contracting Skills:

• Contract Negotiation

• RBRVS Value Scale Components/FFS

• Practice Conversion Factor R&D

• Fee Schedule R&D

Offshore BPO/KPO Management/Set-Up & Onboarding:

• India/Offshore BPO Teams

• Hyderabad / Delhi - Onsite & Offsite

• International Offshore Liaison

• Comfortable and experienced with multicultural teams

• Specialized Billing Markets Expert

Soft Skills:

• Strong Interpersonal Skills

• Proven Revenue Cycle Leadership

• Team Building & Mentoring to meet RC objectives

• Problem-Solving

Clinical Environment Experience:

Radiology, IR Surgical, Anesthesiology, Primary Care, Cardiology, Pediatrics, DME/HME, HH Skilled Nursing, Hospitalists, Transitional Care, Orthopedics, Physical Therapy, Chiropractic, Allergy & Asthma, Hematology/Oncology, Psychotherapy, ENT, Internal Medicine, Pulmonary.

Professional References:

Melkon Yezdoghlyan

Global Trading Partners

Boston, MA

617-***-**** (cell)

adln3b@r.postjobfree.com

Arun Palakala

Akurate Management Solutions

Hyderabad, India

India Cell Phone: +91-994**-***** USA

Phone: 302-***-****

adln3b@r.postjobfree.com