Denise Marie Caffo

Boynton Beach, Florida *****

561-***-****

adv1bv@r.postjobfree.com

OBJECTIVE:

To become an integral part of a medical practice, office, or organization, where I can utilize my experience & cutting-edge knowledge of Revenue Cycle Management Processes, Medicare Compliance, Insurance Guidelines, AR, AP processes and the Implementation of policies & procedures that create a more financially prosperous business with great compassion & excellent customer service.

EXPERIENCE:

Ruth & Norman Rales Jewish Family Services 501©3 02/20-current

Revenue Cycle & Credentialing Manager/Software Super User

Boca Raton, Florida 33424

In charge of all Revenue Cycle Management & Credentialing Processes for the Behavioral Health segment of JFS. Upgraded software system to the latest version enhancement & optimum capabilities regarding billing & collection module. Designated as HIPAA Onboarding Compliance Officer. Execute the scrubbing, prebilling & preparation of electronic & paper claims & submissions. Work all rejections, denials & appeals. Post all client & insurance payments. Run statements & handle all collection processes. Negotiate & set up payment plans, run & manage client stored credit cards for copays & co-insurances. Set up all client insurance accounts, explain insurance benefits & answer all billing questions. Am the point person for provider diagnosis & CPT coding questions. Continuously update software data bases as needed. Just built the data base for new Children’s Specialty Clinic recently opened at JFS. Close the daily business for the entity of JFS & run monthly close reports & spread sheets. Assist in annual audits of the Financial Department. Implemented the Escribe program in software system. Liaison between software customer support & JFS for the business segment. Work closely with IT department regarding employee security level in software system for the business segment of mental health division. Handle onboarding & discharging of all clinical providers in Practice Management portion of system. In charge of setting up EDI access for providers & all credentialling & contracting for Behavioral Health department for Medicare, Aetna & Cigna Insurance Contracts. Maintain all providers CAQH accounts, assist in acquiring NPI #s and keep up to date liability insurance & licensures. Handle the account set up, maintenance & annual dues for 7 supplemental community service programs provided by JFS. Excel Spreadsheets & Accounting responsibilities.

Dr. Bruce J. Holtzman DPM, PC 01/2015-02/2020

Practice Administrator & RCM

Delray Beach, Florida 33848

In charge of running all aspects of the medical practice. Implemented office policies and procedures. Updated HIPAA manual and Employee Handbook. Handled all AR & AP responsibilities. Managed Quick Books program. In charge of hiring, firing, training of staff & getting all applicable certifications required. Managed the OSHA, HIPAA, & CLIA compliance. Spear headed all Marketing & Advertising, designed & created marketing materials. Executed all Government revalidations including DMERC and lab certifications & licensures. Set up collection module in computer system, negotiated old insurance contracts & gained participation in new ones. Managed every aspect of RCM Process. Managed Senior Physician’s practice & personal affairs, nursing home schedules & scheduling of all travel. Focused on polishing Customer service & relations skills, patient care & resolution of issues. Responsible for computer integration to cloud base & upgraded all office & computer/phone equipment. In charge of purchasing & maintenance of all clinical equipment. Monitored all supply inventory & ordering/purchase approval. In charge of a complete practice remodel thru to completion. Liaison for nursing home accounts, customer & vendor relations & networking. Marketing & Solicitation of new nursing home accounts. In charge of maintaining continued education for physicians & staff. Performed annual, quarterly staff training & meetings as well as annual productivity evaluations, salary & raises.

Glaucoma Specialists of South Florida, P.A. 01/2011 – 04/2013

Practice Administrator

Boca Raton, Florida 33434

Hired by consultant to start & build a solo practice for a Glaucoma Specialist who had only practiced in a multi physician environment. Managed all staff at the facility: front desk, check in, check out, technicians & assistants. Made decisions regarding hiring, firing, payroll, salary adjustments, promotions, & discipline. Conducted quarterly & annual performance evaluations, managed coverage concerns & all related human resource activity, including payroll entry and approval. Ensured the staff provided exceptional customer service to patients, visitors, vendors, and all referring physicians. Implemented front end procedures to maximize the revenue cycle and improve efficiency of overall total collections. Chose new software system & implemented EHR. Executed all insurance contracts under her new EIN number. Designed marketing material and guided physician with advertising decisions. Brought in retail products for patient benefits, revenue, and strong patient following. Dispensed all pharmaceutical products and pertinent paperwork according to state requirements & guidelines. Created policies & procedures. Created an employee manual. Worked side by side with staff in clinic, working up patients & scribing to keep physician on time. Had excellent relations with patients & employees. Had many compliments from long standing patients that I had positively enhanced the practice environment and created a warm, compassionate, and caring office for them to come and seek their medical treatment at. When I started, physician was seeing an average of 12 to 15 patients per day and that grew to running an average of 26 - 30 per day which caused us to look for larger office space to move into. Doubled, almost tripled the total collections in the first year than any previous year she was at that location as part of the group practice. Earned quarterly collection & product commission bonuses. Additional responsibilities included managing all AP-Netsuite, AR, and all external vendor management: the selecting of external vendors to provide necessary services, overseeing facility and equipment issues; including repair, renovation, fire and safety maintenance, security and housekeeping.

Lafayette Chiropractic Clinic 06/2005 – 02/2010

Practice Administrator & Billing Specialists

Tallahassee, Florida 33208

Evaluated practice procedures, financial figures, software program & all staffing issues. Implemented, installed, & programmed new software version to reflect accurate figures both financially & statistically. Researched demographic fee schedules & formulated a new super bill. Developed new patient paperwork, financial responsibility, Medicare, treatment, liability risk & insurance verification forms. Executed new office policies, procedures, employee agreements and non-compete contracts. Improved the implementation of HIPAA rules & regulations & was designated HIPAA Compliance Officer. Determined OSHA requirements within the clinic & implemented them. Replaced former staff members with new employees to better reflect the clinic’s vision of health, well-being & positive attitude which resolved the negative energy & poor moral in the clinic among the patients & employees. Completely resolved all account balances in the old system within a six- month period. Negotiated all legal cases with attorneys that were years old with perseverance that had previously been left unresolved. In charge of all scheduling, coding, posting & check out. Was responsible for all insurance verification and eligibility for private insurance, workers compensation and PIP & Liability claims. Handled all insurance & patient billing, posting of payments & all insurance appeals. Managed hiring, firing, training & motivation of all staff & staff coverage. Was responsible for end of day balancing, end of month reports, continued education of current billing & insurance guidelines, collection legalities, documentation requirements, medical ethics, & medical records. Negotiated all insurance contracts & handled physician credentialing & licensing.

Delray Eye Associates 01/1996 – 10/2004

Billing, Insurance & Collection Specialists

Delray Beach, Florida 33498

Was personally responsible for AR, charge & payment posting of all Medicare, Secondary, Tertiary, & Private pay. Authorizations of all workers compensation, Trauma & ER services & collections. Extensive knowledge of -ICD9/CPT coding and insurance filing guidelines. Quick and accurate payment posting ability and understanding of EOB’s. Executed all written insurance appeals and worked closely with the State Insurance Commission Board regarding insurance legalities. Successfully brought lawsuits against patients & insurance carriers resulting in payment for medical services rendered. Handled all end of day balancing & preparation of bank deposits for medical practice & in-house optical shop. Responsible for all end of month reporting, quarterly stats, quotas, & working of all AR. Able to schedule multi-testing & surgical appointments with multi-physician schedules. Able to triage emergency calls & appointments. Assigned all physician ER and practice on call scheduling.

11/1993- 12/1996

Stay at Home MOM

QUALIFICATIONS:

Many years of strong Revenue Cycle Management & Administration experience. Specializing in trouble shooting & problem solving with medical collections, insurance appeals, software applications, policies & procedures. Have drastically reduced AR in many positions, including resolution of dormant account balances that went previously uncollected. Have strong written & verbal communication skills & can communicate effectively with physicians, patients & staff members. Am extremely detail-oriented & multi-tasking and work well with heavy workloads & under pressure. I can work both independently & as a team player, am able to function & make decisions independently in the absence of direct supervision. I have strong organizational, time management & interpersonal skills. I demonstrate effective management & excellent customer service. I am described as a people person. I have a strong old-school work ethic, have impeccable follow up skills & am a very dependable & loyal individual. I have implemented EMR systems, collection modules, computer conversions & software application enhancements. I have had my own RCM Consulting business in addition to a full- time career where I consult on receivables, claim & billing issues, front end & business office procedures, and the implementation of policies & procedures to create resolutions to resolve issues. I have assumed personal assistant role to many physicians to manage their professional schedules & financial needs as well as their personal schedules & financial responsibilities. Have established goals, objectives, policies, procedures, & protocols for the administrative areas of many practices. Have overseen & managed recruiting, interviewing, hiring, & training of employees. Performed coding, charge entry & capture processes to assure that billing is accurate, billable & payable. Managed fee schedules & fee adjustments. Developed strong working relations with referring physicians & have skilled networking & marketing skills in the community. Conducted performance evaluations & recommend merit increases, promotions, & disciplinary actions. Ensure timely completion of payroll & HR functions. Managed all AP & daily tasks of all departments at any given time. Ability to prioritize projects to meet deadlines. Have handled HIPPA, OSHA & CLIA compliance, Behavior Health credentialing & contracting, marketing, advertising & designed marketing products.

EDUCATION:

Art & Business Institute of Ft. Lauderdale

AA Degree in Business Management & Administration

06/1984 – 09/1987

American Heritage Private Preparatory School

College Prep High School Diploma

08/1980 – 06/1984

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