Reimbursement Specialist Safety Officer
Resume:
JoElle K. Vicknair
Harahan, LA *****
**************@*****.***
EDUCATION Our Lady of Holy Cross College, New Orleans, LA Major: Behavioral Studies (1996-1999)
EMPLOYMENT
**/****-***sent Owner/CEO/Consultant, HALO Revenue Solutions, LLC With over 16 years in Home Infusion Revenue Cycle expertise, I assist Specialty Pharmacies by reviewing current A/R and aged A/R. My clients are small business accounts with revolving revenue averaging around $450K-$850K monthly. An analysis of each clients services is accessed at the time new clients are onboarded; BI reporting is populated, then an assessment is determined as to what drugs/services were provided within the last calendar year. Once the data* has been compiled ( *what is reimbursable and billable) each account is mapped out and accessed for any erroneous billing that is holding up revenue or any missed charges. If necessary an Action Plan is created for the Client’s Revenue Cycle Team. All clients receive reporting that shows where their front line is lacking and an Intake process is written customized to strengthen the front line, so any ongoing issues are resolved and moving forward all components that are payable are added to MD orders for benefit verification and authorization; this ensures clean claims are created and revenue is captured and DSOs improve. I work closely with the Executive Teams of clients and provide forecast revenue for the months following. Clean claims result in expedited receivables. I am responsible for problem solving for Providers, and managing a Team of highly skilled Billers and Collectors. 11/2019-9/2020 Manager of Revenue Cycle Management, Infusion Plus, LLC. As the Departmental Manager, I was responsible for the Authorization/Benefits/Reimbursement Team in Louisiana and Mississippi. When I started in November 2019 the Louisiana site was accruing between $17-18K of revenue monthly. By September 2020, monthly receivables averaged $350-$385K for Louisiana. I was responsible for month-end reporting; weekly Management calls to report progress and projections. I was a working Manager. I was the only Reimbursement employee in Louisiana; by September 2020, the Louisiana Team evolved into Team of 5. The software used was CareTend [Line-item-Financial based system]. I worked with Management (GMs, Pharmacy Managers, Director of Nursing) and reported to Managing Partners. Note all responsibilities noted below for other Home Infusion positions were an ongoing part of my day-to-day workload.
11/2012- 11/2019 Reimbursement Supervisor, CarePoint Partners/Bioscrip As a working Supervisor, I work along-side up to 20 Reimbursement Specialists, responsibilities include but are not limited to assisting with billing claims to all Payor types and Therapy types [Medicare Part B for Payment and Denial, Part C (Advantage), Part D], Commercial, Workers Comp, Early Release (Hospital to Home), Provider to Provider (Contracts—Cost-share), Louisiana Medicaid (including Bayou Plans-Healthy Blue, LA Healthcare Connections, UHC, Aetna Better), Private Pay, Other Government Payors (TriWest, VA, Tricare), Adjudicated payors like Part D coverage through Medicare for non-covered drugs or cases where Part B coverage is not met, and secondary Payors as listed above in addition with Financial assistance programs CarePath Janssen, Medmonk, Touch, Igsource, etc.) for therapies IVIG, TIMS, ABX, Misc. other infusions, Misc. injectables, Enteral/TPN, and Nursing. Mini-closes are performed on a weekly basis, and confirmed deliveries(based on proof of delivery) are billed promptly— The payor setup on client accounts are closely monitored and issues are expedited to the Intake/CVA, so proper insurance can be added and authorization of service obtained. HI—is a multi-dimensional industry from a reimbursement perspective; this results in multiple Payors needing to be billed so all components are submitted for processing-- (drug, supplies, line care, pumps, nursing, etc.). When working A/R, billing and collection processes must adhere to federal, state, and payor guideline requirements. Daily activities include working to ensure that present claims are submitted, aging A/R, denials, and secondary’s, and electronic rejections are resolved promptly; Approving adjustment requests (per Company policy), working with GMs to resolve profit issues, coordinating with the Inventory Department to have an inventory items updated
(pricing, coding, etc.); Notifying the Contracting Team of any payor issues and communicating any reimbursement issues with General Managers at the Branch level and any Regional Managers (AVP, Reimbursement Director, Intake/Onboarding Management). Lines of communication are always open between Reimbursement Management and the Intake/Ops Team—many times during onboarding of a new referral, bounce off between teams is required to properly and profitably accept the referral this open line of communication ensures Team building/strengthening Ongoing responsibilities included training new employees, cross-training employees assigned new responsibilities. I was responsible for evaluating reimbursement staff including interviewing, hiring and training new hires—planning and assigning workloads to staff and appraising performance and rewarding/disciplining employees, addressing complaints, and maintaining a positive work environment. 2/2012- 11/2012 Reimbursement Specialist III, CarePoint Partners As the Team Lead, I worked closely with 8 Reimbursement staff members to manage A/R (Revenue Cycle) Management. Home Infusion is a specialty provider that allows patients to live outside of a medical facility setting and receive IV medication. Most cases consist of chronically ill patients—one important virtue ingrained within the Team was not only knowledge of our industry and how to maximize profitability from a provider perspective, but locating funds through Assistance Programs (whether through Drug Manufacturers or Foundations) to alleviate out-of-pocket paid by our patients to reduce burden for our patients. Understanding the means to maximize reimbursement for Home Infusion includes understanding Medicare coverage (through Part B, Part C, Part D), Medicaid (Traditional and Bayou Plans), Third Party Administrators, PBMs (drug adjudication), Cost share, 340B identification. 1/2011- 1/2012 Reimbursement Specialist II, CarePoint Partner Responsibilities included billing and collecting for 3 pharmacy branches (including remote Ambulatory Infusion Suites) in Louisiana with over 1000 patients for two Infusion Centers. Monthly goals were set between $1.4M-$1.7M. Goals were achieved with a success rate of 98%-115% of the monthly goal. Aging A/R over 90 days was maintained at below 23% of total A/R (A/R over 90 days was required by Corporate to be maintained below 32%). I collaborated with provider representatives at insurance companies; these established relationships which allowed prompt resolution of contract/claim issues. In order to manage accounts, the following tasks were performed (in addition to routine billing/collecting procedures): submitting Adjustment requests, working daily account follow-ups, submitting financial hardship requests, managing the daily deposits—which included assisting the Cash Posting Department with any Unapplied Cash issues, working with Copay Assistance Programs—these are programs offered by Drug Companies to aid patients during hard times, working with and backing up the Intake Department (Intake was responsible for verifying insurance benefits and obtaining authorizations), and I trained new/existing employees/pharmacy students.
7/2005- 10/2010 Reimbursement Specialist, Infusion Partners/CHS/Bioscrip Responsibilities included billing and collecting for over 1000 patients for two Infusion Centers. Monthly goals were set between $1.4M-$1.7M. Goals were achieved with a success rate of 98%-115% of the monthly goal. Aging A/R over 90 days was maintained at below 23% of total A/R (A/R over 90 days was required by Corporate to be maintained below 32%). I collaborated with provider representatives at insurance companies; these established relationships which allowed prompt resolution of contract/claim issues. In order to manage accounts, the following tasks were performed (in addition to routine billing/collecting procedures): submitting Adjustment requests, working daily account follow-ups, submitting financial hardship requests, managing the daily deposits—which included assisting the Cash Posting Department with any Unapplied Cash issues, working with Copay Assistance Programs—these are programs offered by Drug Companies to aid patients during hard times, working with and backing up the Intake Department (Intake was responsible for verifying insurance benefits and obtaining authorizations), and I trained new/existing employees/pharmacy students. 6/2002 -5/2005 Billing Specialist, HealthCare Development Systems, LLC Responsibilities included billing for physicians, anesthesiologists, ambulatory surgery centers, and a 10-bed hospital (including diagnostics and interpretations). Billing required the knowledge of the following: Medicare Part A and Part B, Medicaid, Commercial Insurance, Workers Compensation, and Private Pay (Cash Pricing). I posted daily cash receipts—HCD accepted OON benefits for non-contracted Payors—the OOP on an account was determined by applying in-network benefits. One of my focal billing specialties was pain management billing. Some procedures that were billed frequently (for facilities and physicians) were pain pumps/drugs and refills and spinal cord stimulators. During my time at HDS, many database conversions occurred—I played an active role in the smooth transition of completing these projects. 9/2001- 6/2002 Industrial Hygiene Tech/ Safety Officer, P&W Safety Consultants, Inc. Responsibilities included monitoring environmental conditions at industrial sites to ensure healthy atmospheric quality. Collecting airsamples and analyzing them for content of hydrocarbons such as benzene, as well as other impurities. Performing various real-time analyses of hydrocarbons and other elements affecting general health at contract sites, and I audited contractors and their job sites to identify any safety breaches. I possess plant-turnaround experience, and I am proficient with the use of the following instruments: Photovac 20/20, Photo Snapshot, UltraRae, Scientific Industrial ATX 612, Spectrex Flow Meter, SKC Flow Meter, and ELF Flow Meter. I am also familiar with the various media employed by each instrument for its specialized analysis. Calibration and testing of all laboratory instrumentation are performed several times daily. Isupervised up to 30 technicians at turnarounds forsafety assignments. Additional responsibilities included employee scheduling, payroll, and hiring, and subcontract billing. 12/1999-9/2001 Assistant Chief Editor/Partner, Birch & Price Publishing, LLC 1/1999-1/2000 Student Chemist, CII Carbon, LLC
As a Student Chemist with an ISO 9002-certified company, I was responsible for performing the multiple analyses of Calcined Petroleum Coke. Daily Coke testing consisted of: CO2 Reactivity, Air Reactivity, Grain Stability, Apparent Density, Sodium concentration by Inductively Coupled Plasma, Multi-element Concentration (metals), and Vibrated Bulk Density. All tests were conducted in compliance with ASTM regulations, and all site conditions were strictly maintained in conformance with OSHA standards. Additionally, I conducted several routine environmental analyses and inspections of plant runoff water, including Oil and Grease levels, pH, Total Suspended Solids, Total Organic Carbon, and Chemical Oxygen Demand. The student chemist position is reserved exclusively for college students enrolled in science-related curricula.
2/1996-4/1999 Billing Specialist/Executive Assistant, Priority Mobile Health, Inc. My duties as assistant to the Chief Executive Officer included maintaining relationships with key personnel. I trained staff members ofselect departments and was a liaison between the CEO and other departments. I was responsible for billing and collecting for ambulance services provided to patients. I billed/collected for Medicare, Medicaid, Commercial Insurance, Workers Comp, Hospital/Agency Contracts and Private Pay. COMPUTER
EXPERIENCE MS-Office (Word, Excel, Outlook, PowerPoint) Adobe Reader, QuickBooks,
Internet Explorer, Chrome
Billing Databases: Calyx, Corridor, Fast Cash, Surgisource
+, POM, CPR+, MRO, CareTend Zirmed, Change Healthcare, Provider Payor Sites REFERENCES Available upon request
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