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Reimbursement Manager Medical Billing

Middletown, NY
April 13, 2022

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*** ******* ******

Middletown, NY 10940



** */* ***** ********** in Hematology/Oncology Billing and coding- CPT-ICD-9 and ICD-10 HCPCS coding in Hospital & private practice. Knowledge of third party payers (Medicaid, Medicare and Commercial). Patient Advocacy, Pre-Auth., referrals, appeals, and Follow Up experience. Familiarity with HIPPAA in accordance with regulatory compliance. Strong communication skills and interpersonal skills, ability to multi-task, work independently and as a team player. Customer Support to providers, payers and patients.


-ECW billing program for Middletown Medical remote Billing & Coding.

-Epic billing program for Garnet Health Medical Billing & Coding for the Cancer Center.

-ARIA software for Radiation Oncology Coverage while Biller is away.

-Bilingual (Fluent in Spanish and English)

-Knowledge of healthcare reimbursement from patient and provider perspective (Miscellaneous J codes, billing coding, appeals process)

-Knowledge of private payer, Medicare (CMS-LCD, NDC) and Medicaid structure systems and reimbursement process.

-Ability to interpret and analyze regulation and legislation

-Specific knowledge of specialty pharmacy (Oncology drugs and regimens)

-Patient and Family advocacy assistance-Knowledge with pharmaceutical Patient Reimbursement Assistance Programs-(i.e. Genentech-Access Solutions, Lilly Patient one, Janssen Biotech-Remi-Start, Amgen Assist and other Pharmaceutical assistance programs available.

-ICD-10 Preparedness- (hosted by Genentech- Field Reimbursement Manager and Lilly –Patient Reimbursement Manager.

WORK HISTORY: 2018 to Present. Remote/Part time Oncology coding and billing –Middletown Medical – Responsible for the review of Medical records for Oncology claims to apply correct ICD-10 codes and CPT administration codes.

2006 to Present –Garnet Health Medical Center-Middletown, Catskill and Calicoon Sites (Formerly Known AS Orange Regional Medical/Catskill Regional Medical Centers.

-Lead coder for each Oncology Unit, Observation and Hemo-Dialysis (Effectively manage charge capture, coding, and data flow processes daily. Manage the processing of the Financial, Clinical, and Demographic data generated from each department. Ensure complete and appropriate receipt of reimbursements from all insurance carriers.

-Offer assistance to patients with the process of filling out Financial Assistance Applications offered by Garnet Health Medical Centers- Financial assistance Program, as well as Pharmaceutical Financial Reimbursement Assistance Programs (i.e.: REMI-START, TYSABRI-TOUCH, AMGEN ASSIST, LILLY PATIENT ONE, etc.)

-Offer assistance to patients with denial claims and appeals by following up with insurance carriers, resolving and resubmitting corrected claims for proper reimbursement.

-Mentor and trainer for new hires and existing employees as a lead/expert in my field.

-Frequent communication and personal interface with Pharmaceutical Sales Representatives, Education and Patient Access Specialist, obtaining updated drug information for the scheduling of Oncology Educational Luncheons and Dinner In-Services offered by the top Pharmaceutical Companies (i.e.: Lilly, Amgen, Bristol Myers-Squibb, Seattle Genetics, Eisai, Genentech, Octapharma, Janssen and more.)

1996 to 2006/Patient Financial Service Representative, Orange Regional Medical Center:-Responsible for the daily transmission of electronic claims, and follow -up of rejected claims; including correction of ICD-9 HCPCS, MODIFIERS, or other claim rejected issues (i.e.: Prior Authorizations); resolved errors by resubmitting corrected or unacknowledged claims, medical records, appeals, and other documentation for timely payments.

1990 to 1996/Owner & Director of Rainbow World Learning Center-Owned and operated pre-school, day care and after school program for children ranging in ages from 3 months to 6 years. Duties included operations, fiscal management and development/facilitation of curriculum for enrollees.

EDUCATION: - Associate in Applied Sciences, 1989-Bergen Community College- Paramus NJ.

-Continuing Field Reimbursement Education with GHMC Affiliates: (CMS/MED LEARN/NTRIEVE PORTAL/AMGEN ASSIST /Genentech-Webinars, Workshops)


--Course Webinars:-Billing for Hospital Supplies: Minimizing Compliance Risk and Revenue Loss.

-Clearing the confusion with injections and Infusions.

-Reimbursement tools and resources for all Amgen medications.

-Coding Essentials for Hospital Infusion Services.

-Transition to ICD-10 and HIPPA Version 5010 (Hosted by Genentech)

-ICD-10-CM Coding Workshop Analysis: Crosswalks, preparation and practice (Sponsored by AAPC)

-ICD-10 Preparedness- (Hosted by Genentech/Lilly)

-COC- Certification class (90 classroom hours attended- Completed August 27, 2016)

-CHONC- Certification class completed November 2017.


-Within less than a year as an Oncology Coder/Billing Compliance Specialist at ORMC Oncology Department, I successfully reduced aging accounts significantly.

-Received Employee Appreciation Award in 1999, during my position as a Patient Financial Service Specialist and in 2008 received Shining Star Award while holding my present position.

-In all cases worked with the assistance of Financial Reimbursement applications for Oncology Patients, -I was successful in obtaining 100% courtesy discounts from the ORMC patient Assistance Program for those patients that applied.

-Assisted patient’s obtaining Car Services to Oncology Treatment appointments and Doctor Appointments through charitable organizations.


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