Data Entry Customer Service

Brian A. Case

**** * ******** ***** ******, MI **187

248-***-**** *******@*******.***

REVENUE CYCLE MANAGEMENT

Experienced healthcare leader with revenue cycle management skills proven to drive result in turning around operational challenges, decreasing investments in accounts receivable and improving cash flow in profit and non-profit entities.

Exceptional project management skills that include process analysis, identification of critical issues, business planning, systems support, and customer satisfaction. presenter, negotiator, and communicator able to forge solid collaborative relationships and build consensus across multiple organizational levels.

Billing & Collection

Vendor Management

Disputed Claims Management

Feedback to departments

Training & Education on best practice

Process Redesign & change Management

Patient Registration Improvement

Customer Service Standards

Contract Management

Worked with the multi prison system in Boston, MA and was successful in leading a team to payment adjudication on claims that were as old as four to five years from the date of service. Net receivables exceeded $750,000.

Worked with problem payers on special projects which created additional reimbursement. These claims were six months to a year old and at the completion of the project the payer was now paying 85% of all claims within 30 days and brought in an additional $500,000.

In GA identified that babies were not being placed on the mothers Medicaid policy. This brought to the attention of the state of Georgia that there were 16,000 babies under the wrong Medicaid Plan. Set up monthly meetings with the provider representatives from all the Medicaid HMO’s and in a few accounts alone received $400,000 in reimbursement.

In NJ reduced the unbilled amount in the pre-billing register from $20,000,000 to under $1,000,000 within a ten-month time period. Conducted weekly meetings with department directors identified billing issues and implemented procedures for compliant billing.

Identified for a Cancer Center that chemo drugs were not being reimbursed. Implemented an authorization process that was retroactive six months which brought in over $200,000.

In over ten months, was successful in being able to bring in over $30,000,000 additional reimbursement from the business office redesign and improved denials management strategies.

PROFESSIONAL EXPERIENCE

CASE CONSULTING, Detroit, MI

National revenue management & consulting firm to hospitals. Re-designed and re-engineered Business Office functions within Patient Financial Services identifying trends to overcome denials and maximize reimbursement.

Financial & Revenue Cycle Consultant,. 2020-Present

Implemented systems to assist compliant bills so they reach providers in a timelier manner.

Worked with Coordination of Benefits identifying who the primary insurance payer is, when Medicare and ESRD are involved figuring out the timeframe that the large group health plan was primary and when Medicare became the primary insurance. Performed three-way phone calls with patients and third party payers to straighten out COB eligibility.

Worked with problem payers in identifying claims being held up that needed to be escalated for payment processing.

Trained all employees within patient financial services with the best practice policies

to insure that accounts were worked properly while measuring their productivity.

Provided leadership with disputed claims reporting and identified reasons for denials and root cause analysis and the areas needing improvement

Geisinger Regional Health System, Danville, PA

Worked with the 10 hospitals across the Geisinger system which is a provider to central, south-

eastern and northeastern PA including two research centers, a college of medicine, a 550,000-

member health plan serving more than three million residents and 55,000 employees.

Analyzed 51 Million in auto liability claims using provider portals, telephone contact and the health system’s imaging system.

Analyzed and completed all claims over $5,000 to assist with the system conversion to EPIC. Increased cash flow and decreased accounts receivable.

Worked with problem payers in identifying claims being held up that needed to be escalated for payment processing.

Performed analytical assessments on all claims identifying what was keeping the claims from being reimbursed and took next steps for payment or denial.

Identified reasons for denials and root cause analysis and the areas needing improvement.

WESTERKAMP GROUP LLC, Chicago, IL

Consulting firm with complete business outsourcing which provides overall strategic vision, direction, and reporting and staffs post-registration revenue cycle and management personnel.

Senior Analyst, 08/2014-05/2019

Hospital Business Office Analyst identifying financial opportunities with Medicare, Medicare Replacement Plans (Part C), Medicaid, Medicaid Managed Care, Commercial Payers and Self-pay. Identified denials preventing the hospital from being reimbursed for services rendered.

Wrote appeal and grievance letters identifying if there are payer specific forms needing to be filled out, submitted any supporting documentation to assist the insurance companies with claim payment

Trained registration staff within the hospital on registering patients correctly to avoid denials for no authorization and timely filing

Worked closely with the utilization management department with medical necessity denials and assisting with working with insurance companies to approve inpatient stays and outpatient procedures for medical necessity

TRINITY HEALTH, Farmington Hills, MI

One of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states

Payment Resolution Specialist- Denials 06/2019-06/2020

Analyst working with Medicare and Medicare Advantage plans specifically with lack of authorization denials and medical necessity issues.

Utilized the telephone, 3-way phone calls to have authorizations updated and claims reprocessed when utilization reviews are not uploading or updating authorizations to medical plans.

Rebilled of medical claims once approved thru an appeal or Diagnosis Codes that have been updated utilizing insurance company websites and the Chartmaxx imaging system

Appealed underpaid claims with contract issues or penalties taken that may not be appropriate

Worked with departments thru e-mail and the Trac and RWS system to identify the claim denial issues and to move the claims along to payment completion

UNIVERSITY OF MICHIGAN HEALTH SYSTEMS, ANN ARBOR, MI

Academic Hospital facility that provides clinical education and training to future and current doctors, nurses and other health professionals, in addition to delivering medical care to patients.

Independent financial revenue cycle analyst, 06/2013-08/2014

Led hospital in resolving underpayment variances within the revenue cycle billing department.

Documented processes and trained team members on appeals to third party payers that had underpaid hospital claims according to the contracts established.

Subject Matter Expert and implementation with the best practice in how to handle problem claims and the re-billing of problem accounts

ACCRETIVE HEALTH, Chicago, IL

Consulting Firm specializing in helping to strengthen the financial stability of healthcare providers through excellence, providing best people and leading technology, thereby increasing healthcare access .

Senior Managing Consultant/ Beaumont Hospital Team Consulting, 2012 – 2013

Consult with hospital and physician practices in revenue cycle process improvement. Document processes and develop procedures related to revenue cycle operations.

Advised clients on billing, reimbursement and compliance issues related to clinical and ancillary department operations.

Worked with management and patient financial services to implement best practice with denials management.

Worked with off-shore vendors and outsourced agencies to monitor their performance. Perform vendor audits.

CASE CONSULTING, Detroit, MI

Financial & Revenue Cycle Consultant, 2007 - 2012

Re-designed and re-engineered Business Office functions within Patient Financial Services, identified trends to overcome denials to maximize reimbursement, implemented systems to assist compliant bills so they reach providers in a timelier manner for hospital clients.

Worked with problem payers in identifying claims being held up that needed to be escalated for payment processing. Trained all employees within patient financial services with the best practice policies and procedures.

Performed analytical assessments on collector’s accounts as well as customer service representatives, to insure that accounts were worked properly while measuring their productivity.

Provided leadership with disputed claims reporting and identified reasons for denials and root cause analysis and the areas needing improvement

NAVIGANT CONSULTING

Senior Managing Consultant, 2004-2007

Consulted with Hospitals, Redesign of the Business Office, Writing and implementing of Policies and Procedures in the areas of Billing, Collections, Cash Posting, and Customer Service.

Implemented system conversions. Acted as an interim Business Office Director. Collector Observations to identify cash acceleration, trained on billing, customer service and collection staff.

Resolved issues in discharged not final billed (pre-billing edits) to assist with claims being billed with errors in the legacy system.

Managed collectors on cash acceleration projects and assisted with appeals for timeliness of claim submission, pre-existing conditions, coordination of benefits and lack of authorization denials.

Implemented procedures to decrease credit balances. Analyzed and completion of spreadsheets in areas of inappropriate contractual allowance discounts posted, missed cash opportunities and analyzed accounts unpaid with suggestions for resolution.

COAST TO COAST CONSULTING LLC ( FRASIER HEALTHCARE CONSULTING)

Revenue Cycle Management specializing in registration, scheduling, eligibility, billing, collection, cash application programs, business office improvements, denial contract, management service

Healthcare Revenue Consultant, 2000-2004

Consulted with Home Care Facilities, Hospice Billing Operations, Hospital Business office for I/P and O/P billing guidelines and revenue reimbursement.

Performed such duties as Billing, registration, admissions and Census balancing, resolution of accounts, reviewing EOB for correct payment and contractual posting, training of employees in every area of business office.

Assisted with billing on the SSI billing system, and the Medicare credit balance report.

Consulted and implemented process improvements at fifteen different hospitals within the USA.

MICHIGAN VISITING NURSES

Business Office Manager, 1997-2000

Supervised registration, data entry, benefit enrollment, billing, collections, cash posting, appeals, obtaining physician orders for Home Care billing. Supervised employees, employee reviews, daily cash reconciliation, interviewed potential employees.

Collections.

Assisted CFO with any financial spreadsheets needed.

Worked with CEO on all accounts over $5000, over 90 days, with resolutions and cash acceleration.

Served on quality assurance council for compliance issues, assisted with Joint Commission Tri-annual surveys, prepared for Blue Cross, Medicaid audits from outside intermediaries.

TRINITY CONTINUING SERVICES- PRIVATE PAY CLAIMS EXAMINER, MEDICARE

Reimbursement Coordinator, 1994-1997

Patient relations to perform such duties as direct phone contact to assist with billing problems and concerns, correspondence etc.

Billed and collected for several large Home Care agencies in Michigan & Iowa. Utilizing the Medicare, Blue Cross, HMO, and commercial payers.

Worked correspondence, denials, corrected patient eligibilities with Medicare.

ARBOR HOSPICE PERSONALIZED NURSING SERVICE

Reimbursement Specialist, 1991-1994

Performed registration, data entry, billing, collections, payment posting, Medicare credit balance reports, Nursing Home Hospice bed billing, collections and follow up.

COMPUTER SYSTEMS

HMO Amisys system, Medipac, Homepro, Medicare DDE, Medical software programs, HMS, HBOC, FSSO, AS400, HCIS systems, BC Hart system, HAMS, Word, Excel, Outlook, Eclipsys AM-PFM, IDX,SMS, Meditech, Epic,Mckesson, Champs Medicaid

EDUCATION AND CREDENTIALS

BA, 1990, Eastern Michigan University

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