Verification Specialist Billing
Resume:
EDYNE THOMAS
Tomball, TX *****
***********@*****.***
SUMMARY OF QUALIFICATIONS
Health Care Administrator with an MBA, BBA and 18+ years of experience in health care administration, clinical support and management operations
Outstanding track record of achievements in financial management and quality patient care
Effective communicator with physicians, management, administrators, insurance companies and patients
Hands-on Manager with a proven ability to build and lead productive teams
Knowledge of strategies for project management and risk assessment
Leadership ability to develop operational policies and procedures
Experience in JCAHO, UCA, CLIA & HIPPA regulatory compliance matters PROFESSIONAL EXPERIENCE
2019-PRESENT
PRACTICE MANAGER, EVERGREEN SPINE AND NUEROSURGEY CENTER
• Manage the daily operations including staff scheduling, cash reconciliation, charge entry and operational checks and balances.
• Responsible for interviewing, hiring, orienting, provider on boarding, completing performance evaluations and disciplinary actions.
• Ensure the practice complies with industry standards including pay for performance incentive and merit incentive payment system.
• Maintain, track and update all credentialing documents.
• Prepare, recommend and set clinic budget and goals to ensure the practice stays within the budget parameters.
• Develop and implement policies and procedures necessary to improve office flow and overall operations.
• Oversee the billing department and ensure billing and follow-up is completed timely. 2016-2019
CLINIC OPERATIONS ADMINISTRATOR, LITTLE SPURS PEDIATRIC URGENT CARE
• Responsible for the daily operations of two urgent care facilities.
• Worked closely with administration to ensure all facets of the clinic are effectively addressed and resolved.
• Collaborate with physicians and advance practice providers to develop and implement common priorities and goals.
• Assisted with troubleshooting reimbursements and claim issues including missing charges, insurance verifications and benefits issues.
• Responsible for processing payroll, hiring, training, conducting performance evaluations, disciplinary actions for clinical and non-clinical staff. PROFESSIONAL EXPERIENCE CONTINUED
2014-2016
BILLING AND COLLECTIONS SUPERVISOR, MEDICAL PRACTICE SOLUTIONS
• Responsible for A/R for out of network physicians and facilities totaling over 25MM in charges each month including: billing, collections, credentialing and negotiating third party denials.
• Hired, Trained and led a team of Patient Account Reps, Billing Specialist and Insurance Verification Specialist.
• Conducted audits to monitor productivity, quality assurance and enforced appeal protocols.
• Identified the cause of claims processing failures, underpayments, and payment delays and implemented procedures to correct the issues.
2008-2014
PATIENT ACCOUNT REPRESENTATIVE, TEXAS CHILDRENS HOSPITAL
• Perform billing and collections on pediatric ophthalmology, congenital heart, general surgery, orthopedic, plastic surgery, dermatology, neurosurgery and physical medicine and rehabilitation patient accounts
• Knowledge of government, managed care, commercial, international, and self-pay reimbursement processes
• Review denial reports, identify trends and initiate corrective methods as needed
• Provide recommendations and follow up actions to operational inefficiencies
• Contribute to team goal of over $11 MM in collections every month
• Consistently meet or exceed individual and departmental quota and quality standards 2003-2006
PATIENT ACCOUNT SUPERVISOR, NSUH-LIJ HEALTH SYSTEM
• Maintained and updated database of $3 MM in monthly payment denials
• Prepared reports on A/R, denial trends and appeal status to monitor accounts
• Developed and maintained relationships with payer provider relation representatives
• Supervised and trained support staff to ensure effective operation and maintain financial targets
SOFTWARE PROFICIENCIES
MS Office Suite, SMS Q-care, Intergy, WebMD, Claim Tracker, IDX, PWL, Logician, EPIC, eMD, Nextgen, STAT, Claim Tracker, Scantrax, Omni Pro, Med Assets EDUCATION
MBA, BUSINESS ADMINISTRATION, TEXAS WOMAN’S UNIVERSITY BBA, BUSINESS ADMINISTRATION, BRIARCLIFFE COLLEGE
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