Customer Service Associate
Resume:
VIRGINIA MCCABE
**** ** *** **, *****, FL *****
*************@***.***
OVERVIEW
A highly motivated professional with experience in Human Resources, Medical Sales, Operations and Administration of Medical office, Customer Service and Billing (Medicare-Focused). Highly creative, recognized as a results-oriented and solution-focused individual. Areas of strength include:
Professional Management
Problem Collections
Organizational Skills
Computer Literacy
Work as Team Player
Networking
Strong Leadership Skills
Staff Recruitment and retention
Communication Skills
Time Management Skills
Research Abilities
Medicare Billing
Oversee Operations
Bilingual (Spanish/English)
EDUCATION
Nova Southeastern University
2000
Fort Lauderdale, FL
Bachelor of Arts in Professional Management
GPA: 3.75
COMPUTER SKILLS
Microsoft Window Products- Outlook, Word, Powerpoint, Excel, Access database
PROFESSIONAL EXPERIENCE
09/2020- present
Encompass Health
Ocala, FL, 34474
Audit and QI– Supervisor (formerly Regional Billing Supervisor)
Manage the daily branch billing operations. Responsible for end of episode/ period billing and reimbursement functions and all billing education. I work closely with the home office and local leadership to ensure billing submissions are completed timely and accurately in order to keep the unbilled percentage below 10% of total revenue. Supervise the daily operation of my team. Perform all counseling, evaluation and supervisor related functions. Organize and lead team meetings effectively and timely.
07/2019- 09/2020
Encompass Health
Ocala, FL, 34474
Regional Billing Specialist – Team Lead
Oversee the team and assist in the daily billing operations. Mentor new RBS to the team during the onboarding process. Complete all RBS Supervisor reviews and follow up with RBS on items that need improvement. This process could take up to 6 weeks or more. Work closely with the team supervisor on a daily basis to ensure billing submissions are timely and accurate. Work with various branches to help with education or issues in reducing their over 90 day claims. Work closely with team members and participate in their training and growth. Knowledgeable in the FEA/RCD process. Conduct monthly team meetings to discuss issues or help educate on any process needed. Contribute to make this a better team.
07/2015- 07/2019
Encompass Health
Ocala, FL, 34474
Regional Billing Specialist
(ORS Acquisition)
Process Medicare audits for final claims for regional offices. Facilitate billing meetings to clear up claims held timely. Work closely with the Branch Directors, Sales Managers, and other back office agency staff in developing a plan to eliminate claims being held and ensure more timely billing in order to keep the unbilled percentage below 15% of total revenue. Timely review of validation reports and HHA rosters. Assist with RBS Supervisor reviews and fill in as RBS supervisor when needed. Any other duties as directed by RBS supervisor.
8/2011 – 07/2015
ORS HomeCare
Ocala, FL 34474
Billing Coordinator/HR Coordinator
Ensure that all new hires are entered into the HR system. Recruit candidates for open positions. Facilitate new hire process by ensuring that all paperwork is completed. Level 2 background checks are completed; reference checks are done and facilitate orientation of all new employees. Assist in any disciplinary actions which may include terminations. Provide basic training on computer software. Update policies and procedures and ensure that all employee files are up to date. Act as backup to the office manager, duties which include processing all new referrals, insurance verifications and assign cases to clinicians, weekly schedules, input intake information, treatment plans into the system in order to generate plan of care. Prepare RAPS for billing, generate 485’s. Process charts for final billing, send orders to Physicians for approval, run DDE checks. Responsible for billing to Medicare, Department of VA and other third party billing. Review reports to ensure that RAPS, finals and non-episodic billing is completed timely and accurately. Review of AR on a monthly basis. Process payments when received.
8/2009 -8/2011
Meridian Behavioral Healthcare
Gainesville, FL 32608
HR Executive Assistant
High profile position reporting to the Director and Senior Vice President of Human Resources. Ensure accuracy of data in the HRIS system as it relates to salary changes and performance issues. Ensure that all new hires are entered into the HR system. Ensure that Position and Vacancy Report is maintained as required and ensure accuracy. Ensure credentialing information is entered accurately and kept up–to-date on Profiler system. Assist with the credentialing process for physicians and therapists. Required to monitor and maintain spreadsheet which includes Centerwide budgets. Mailing out forms for verification, review of forms and follow up by phone to ensure completeness of information. Handle all incoming and outgoing calls. Maintain an effective and efficient filing system. Act as backup for the recruitment process and verify new hire process. Facilitate all monthly and quarterly audits for compliance. Complete reports and projects in a timely manner.
11/2008-7/2009
Comprehensive Homecare
Ocala, FL 34471
Community Liaison
Market and develop referral sources in the So. Marion/Lake/Sumter County areas.
10/2005-10/2008
NurseCore of Ocala
Ocala, FL 34471
Branch Director
Oversee the operations of the office, which includes field and office payroll, billing and collections, budgets, staffing coordinators and clinical compliance. Market and develop referral sources in the Marion/Lake/Citrus/Sumter/Hernando county areas. Focus primarily on staffing contracts in area facilities: nursing homes, hospitals, Drs offices, and Medicare agencies. Secondary focus on homecare, which includes skilled services, personal care, private duty and companionship services. Review reports to ensure compliance of current policies and procedures. Responsible for recruitment of prospective candidates and training. Experience in admissions process for homecare clients and generating Care Plans.
8/2002-10/2005
Optioncare
Ocala, FL 34474
Location Manager
Oversee the operations of the office, which includes all clinical, marketing, aging reports and technical staff. Responsible for payroll, interviewing prospective candidates and training. Conducting audits on patients’ charts. Facilitating the disbursement and retrieval of all paperwork necessary for billing purposes. Review reports to ensure compliance of current policies and procedures. Maintain key referral sources.
Marketing Representative, Patient Services
Market and develop referral sources in the Marion/Lake County areas. Attend bi-weekly sales meeting and training sessions. Provide community education sessions which includes physicians’ offices, rehabilitation facilities and home health agencies. Facilitate and promote a high quality of patient care and customer service to patients referred to us. Responsibilities include distribution of paperwork to be completed to ensure billing of equipment provided. Weekly review of referral sources and ensures that all referrals are logged and completed in a timely manner.
7/2001-8/2002
Outreach Programs, Inc.
Ft. Lauderdale, FL 33309
Area Operations Manager
Oversee the operations in Marion and Lake County areas. Assist in the marketing and developing of referral sources in the area. Recruitment of therapists (physical, occupational and speech) which included processing all paperwork, discussion of compensation and benefits package. Orient and train new employees. Facilitate a high quality of patient care and customer service to patients referred to the program. Responsibilities includes case management (inspecting tracking logs to assure goals are met); Oversee Territory Service Coordinator (train and inspect accuracy of all logs, charts, etc.); Weekly review of therapist status. Educate therapists to ensure an understanding of the company philosophy and compliance of policies and procedures as established by the company and regulatory companies (Medicare).
4/1996-7/2001
AvMed Health Plan
Gainesville, FL 32602
Physician Services Representative
Responsible to carry out all field operations within my assigned geographic region. Educate physicians and their staff to ensure an understanding of and compliance of AvMed policies and procedures and other standards as established by regulatory and accreditation agencies. Field investigation of customer service problems. Field visits for the purpose of enhancing the relationship of participating physicians and their staff with AvMed. Participate in various task force and committee projects as requested. Facilitate Office Manager Leadership Council meetings and Office Staff Educational Programs.
Administrative Assistant- Pre-Authorization Department
Responsible for all administrative support for the Director, Manager and others as directed. Handle all incoming and outgoing mail functions, which include logging, distribution and filing of confidential records and files. Maintain an effective and efficient filing system. Coordination of monthly staff meetings. Complete reports and projects in an accurate and timely manner, as directed. Arrange travel accommodations as needed. Prepare payroll reports. Assist in other Medical Departments and for Company Receptionist, when necessary. Backup for PALS Tech/Pharmacy Tech/Clerk, when necessary. Superuser and trainer for Amisys, Macess and PALS software. Assist in the management of the clerical and technical staff. Perform any special functions, as directed.
Member Relations Secretary
Responsible for all administrative support to the Member Relations Specialists. Handles all incoming and outgoing mail functions, which includes logging, distribution and filing of confidential records and files. Maintains an effective and efficient filing system as well as follow-up system to ensure completion of tasks. Coordination of monthly PREMAC (Pre Member Appeal Committee) and MAC (Member Appeal Committee) meetings. Responsible for completion and distribution of PREMAC and MAC packets to appropriate Committee Member in a timely manner. Assist Member Relations Specialists (HMO and Medicare) in the appeals process. Perform any special functions as directed by the Director.
ACCOMPLISHMENTS
Reduced A/R aging for ORS from an average of 120 days to 90 days in less than 4 months
Collection of VA payments which were over two years old (ORS)
High volume auditor for electronic claims
REFERENCES
Upon request.
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