Medical Billing, Revenue Cycle, Patient Access
Resume:
Denielle Palmer
P.O. Box ***
South Montrose, PA 18843
848-***-**** *************@*****.***
OBJECTIVE
To assist a team that will allow me the opportunity to share and utilize my in depth knowledge and training in EHR implementation in conjunction with my experience in the healthcare including revenue cycle, patient access, information systems, software testing, process improvement, both manual and technical, electronic billing and payment posting and regulatory guidelines as well as offer opportunities for personal challenge, balance, and professional growth in a remote work setting.
EDUCATION
Master of Science in Computer Information Systems Management, University of Phoenix, San Diego, CA; 2003
Bachelors of Science in Business Management, University of Phoenix, San Diego, CA;2000
EMPLOYMENT HISTORY
MSGII
Atlanta, Georgia
Allscripts EHR Implementation Consultant, Revenue Cycle, Mercy Hospital, Iowa City, IA
01/2022-05/29/2022
Conducted revenue cycle testing for Allscripts Sunrise EHR implementation. Performed parallel revenue cycle testing with the legacy system, McKesson STAR, with detailed claim audits as well as integrated testing between Revenue Cycle and clinical departments, medical records and other interfaced departments such as laboratory and pharmacy. Worked closely with medical records and the Allscripts team, as well as experienced Allscripts contracted consultants, updating and re-testing issues on shared issue tracking Excel document for the VP of Revenue Cycle to keep project on track and insure claim integrity upon go live and verifying data on test claims prior to implementation. Conducted training sessions for scheduling, billing and access teams as well as training for scheduling in clinics. After go-live, reviewed claims for edits, worked with manual billing process to make necessary changes in information flow and performed corrections on claims with edits and dropped claims for final billing. Worked closely with Coding Department on abstracting and interface integrity.
Completed web based training through the Allscripts learning portal earning certificates in Registration, Revenue Cycle, Reporting, Claim edits, Work Queue Assignments and Productivity Reporting and Management, Managing Work Queues, Visit Creation and Maintenance, Denial Management, Payment and Batch Posting, Managing Transactions, Managing Appointments, Making Budgets.
Ascension Healthcare
Our Lady of Lourdes Hospital
05/11/2020-02/08/2021
05/03/2021-07/07/2021
Patient Access Representative
Performed registration by phone for scheduled procedures as well as lab work. Collect and verify patient demographics and verify insurance eligibility, and authorization for services. Assign correct insurance plans to patient account to assure correct billing. Communicate with doctor’s offices regarding patient orders. Working knowledge of AS400 and Cerner. Problem solving and policy and procedure knowledge.
Affinity Treatment Center
Vista, CA 1/2019-11/2019
Medical Biller/Admin Assistant
Acted as the first point of contact for private psychiatric residential treatment center and did all financial intake for facility and billing. Responsible for care reviews with insurance companies for authorization of admissions. Interacted daily with clients, therapists, staff M.D. and other staff. Responsible for setting up patient accounts and doing all insurance billing online. Also was the personal assistant to the administrator.
McGregor and Associates/CA Schools VEBA
Lead Member Advocate/Case Management
10/2013-01/2015
Reported to the Quality Assurance Director. Took incoming calls from insured members regarding care issues, authorization of services, prescription benefits and continuation of care during plan changes. Reported from Sales Force. Worked in and authorized prescription requiring prior authorization. Worked closely with our contract managers from Blue Cross and Kaiser Permanente.
Manager, Patient Access Services (PAS)
Sharp Healthcare, Chula Vista Hospital
Chula Vista, CA 8/2006-5/2010
Reported to the Vice President of Patient Financial Services of the Institutional Care Division of Sharp Healthcare as well as CFO of Chula Vista Hospital.
●Operational plan development for Access Department of 340 bed acute care hospital
●Manged the Revenue Cycle from admit to final payment
●Implementation of new software to go completely paperless
●Data collection, analysis and report compilation on collections, productivity
●Compliance to commercial, Medicare and Medi-Cal billing regulations
●Maximized reimbursement and patient collections
●Responsible for management and daily operations of patient admissions, eligibility, and billing processes for the Sharp Chula Vista Admitting, E/R, and Outpatient Surgery center
●45 direct reports
●Managed the scheduling and pre-authorizaiton staff for outpatient surgery
●Monitored employee productivity through data collection and analysis
●Review and approve time cards
●Worked in conjunction with Utilization Management and Medical Records
●Strengthened communications interdepartmental
●Reduced DNFB
●Reduction of A/R by 15 days within first 6 month period
●Standardization of policies and procedures
●Increased “clean claim” drops
●Determined patient cash payments and payment plans
●Prepared budgets for PAS
●Front Office Scanning Solution implementation and staff training
●Integral to upgrades to GE/IDX and user training.
●Determined staffing ratios and scheduling
●Completed performance evaluations
●Created and implemented self-pay bundled fee packages
●Ensured excellent service to physicians and patients by staff
Projects with Sharp
●PAS Career Ladder
●PAS Pre Hire Assessment
●ED Triage Improvement Six Sigma
●Cerner Training and Implementation
●Training and implementation of “Virtual” or “Transitional” ER beds
●Admitting, authorization and pre-billing policy and procedure development
●Team building, employee appreciation and incentive programs
●Member of Six Sigma projects for palm scan patient ID tools
●MedeConnect electronic insurance, “real-time” verification design and implementation
●Committee member for Sharp Awards for Employee Recognition
●Automatic QA process design and development
●MPV Automated Eligibility Implementation
●Health Academy for Comm. Service and Ed.of Healthcare Opportunities
Honors:
●SHARP CORE Award Accounts Receivable Improvement Team
●SHARP CORE Award MS-DRG Team
●SHARP CORE Award DNFB Reduction Team
●Community Services Pillar Award for Health Academy – CV Medical Center
OTHER QUALIFICATIONS
●HFMA Certified PAS representative
●Experienced in al areas of Revenue Cycle from pre admit to billing follow up, insurance guidelines, fee schedules, authorizations, reimbursement
●Data analysis through a variety of reporting tools
●Troubleshoot procedural roadblocks, both technical and manual
●Strong analytical skills
●Able to work well independently
●Detail oriented
●Strong process improvement skills
●Excellent customer service and problem solving skills
●Team management
●Crisis management
●Public speaking and presentations
●Self-educator
OTHER EXPERIENCE
Medical billing from admit to d/c in various areas such as hospitals, psychiatric/psychological, partial hospitals, ENT, Ortho, Ophthalmology/Optomoetry. Software implementations, both complete system replacements and upgrades. Knowledge of ICD-10, CPTs, DRGs. Beta product testing, automated and manual payment posting, 10-Key by touch. medical terminology, patient responsibility determination and regulations, Windows/Office applications – user and trainer, including but not limited to Excel, Power Point, Outlook and Word, Allscripts, Meditech, GE Flowcast (IDX), OnBase hand scanning, Carecast, Sales Force, EMSTAT, EPIC, Electronic Billing, Cerner, McKesson-STAR
EMPLOYMENT AND PERSONAL REFERENCES AVAILABLE UPON REQUEST
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