Billing Coordinator Office Manager
Resume:
Marie E. Lara,CMPM
*************@*****.***
Professional Summary:
I am a dependable, hardworking, and assertive career individual. I am currently the Practice Administrator at Arthritis Center of Orlando. I share my caring, positive attitude and strong work ethics with the physicians, staff, and patients I serve. I have over 30 years of working in a medical business office environment. I pride myself on having vast experience in people management, office management, and all phases of running an office administratively as well. I am self-motivated and work independently; I can also work very well with others. I feel through my professional experience I am qualified to be a part of your team and assist to exceed your goals. Areas of Expertise:
Credentialing* Office Management Medical /Business Infusion policies and Procedures Accounting/Billing/Accounts Payable RCM Payroll Administration
Office Management Medical /Business Inventory Management Human Resource Management Vendor Relationships
Recruitment full cycle Market Access
Financial Budgets, Financial Reporting and Projections EXPERIENCE:
Arthritis Center of Orlando, Practice Administrator 06/2015 – Present
Job Responsibilities
Responsible for oversight of the revenue cycle process for physician billing.
• Meets internal standards for accuracy & timeliness in charge documentation preparation and submission.
• Market Access: Expert getting the right treatment to the right patient at the right time, and possibly even at the right price.
• Problem solver, Recognizes routine problems and recommends suggestions, ideas, and solutions.
• Attends off-site meetings and participates on committees as requested.
• Participates in ongoing training/development/monitoring of staff by the office.
• Assists in training front/back-office personnel for front-desk, reception, and billing activities.
• Organizes, prioritizes, and expedites own workflow and uses independent judgment.
• Compiles daily statistical data as requested and reports data weekly, monthly, quarterly.
• Maintains accurate, well-organized, up to date files for retrieval of needed documentation.
• Receives, compiles, classifies, reconciles, and consolidates data from varied sources.
• Determines and establishes the explanation to complex calls, issues and questions not covered by specific instructions.
• Performs other general administrative duties as needed to support practice operations.
• Resolves all complaints and problems using independent judgment and decision-making skills, to ensure patient satisfaction and adherence to faculty practice standards.
• Plans, coordinates, and schedules the interrelated activities of the practice office.
• Ensures appropriate cross-training and cross-coverage for all practice administrative activities.
• Trains staff according to specific job responsibilities and expectations.
• Establishes office procedures and communicates responsibilities and expected performance to staff.
• Authorizes attendance, schedules, and sick time changes.
• Resolve employee issues and addresses procedure and performance related issues.
• Evaluate employee performance.
• Meets routinely with billing coordinator to review current tasks and assignments. Assists in establishing priorities, and allocating resources as needed to support operations.
• Responsible for the daily management and operations of the ACO staff. Directly supervises ALL ACO employees
• Help to identify and quantify operational deficiencies that may be adversely impacting physician billing, IT systems issues, process issues
(registration, clinical/operational staff on the floor), insurance payments etc. Assist in finding solutions to these issues.
• Assist in the implementation of new charge capture technology to the practice. Work with appropriate people to address physician concerns, operational and IT issues.
• Conduct and lead physician billing meetings. Coordinates meeting preparation including review of billing reports and presentation.
• Develop dashboard to track these indicators and conduct routine meetings with the staff to discuss the results of these indicators and redirect staff efforts as needed.
• Monitor weekly charge submission volume, weekly charges posted, daily cash, incomplete charges, denials, collection reports, refunds, etc.
• Direct the review and documentation of the charge submission process, determine best processes, and implement uniformly. Develop training manual to document the process.
(Marie E. Lara /resume
page 2 of 2)
Arthritis Associates
Winter Park, FL
Billing/Office Manager
09/2009 – 06/2015
Coordination of benefits: Collaborating with the patients, prescribing specialist, specialty pharmacies manufacturers and insurance companies. Run benefits through the hubs, processing information deciding if it is “buy and bill” or specialty pharmacy, scheduling infusion appointments, checking to see if patient has access to copayment card through their commercial plan or if PAP is a resource due to high deductibles, low income, insurance does not cover medication. Write appeal letters for denials. Inquiring if there is a “bridge program” available for the patient to still receive medication while the drug is in process of getting approved. Educating patients on what to expect and communicating the importance of being compliant regarding appointments and taking biological medication on time. Responsible for setting up copay assistance through credit card, ACH for commercial patients, collecting and posting to account. Responsible for quarterly pricing for infusion drugs adjusting fee schedules, calculating rebates-discounts on biologic medication. Working closely with the field reimbursement team. Responsible for ordering all infusion drugs and negotiate best prices. Billing: Responsible for collecting, posting, and managing account payments, and for submitting claims and following up with insurance companies. Prepare and submit clean claims to various insurance companies either electronically or by paper. Answer questions from patients and Insurance companies. Identify and resolve patient billing complaints. Prepare, review, and send patient statements. Evaluated patient’s financial status and established budget payment plans. Follow and report status of delinquent accounts. Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers. Process payments from insurance companies. Translate patient information into alphanumeric and numeric medical codes. Use several coding systems, including Level 1 HCPCS and Level 2 HCPCS. Investigate and corrected rejected and denied claims. Participate in educational activities. Maintained strict confidentiality and adhered to all HIPAA guidelines and regulations.
Legal: Comply with all local, state, and federal laws and guidelines. Update CAQH, Availity keeping them current in a timely manner. Make sure risk management policies are being followed. Make sure medical records are stored and released appropriately. Infusion Managerial Services
FL, NY & AZ
District Human Resources Manager
01/2004 – 08/2009
Human Resources: Monthly travel to offices, onboarding, new hire orientation, termination, counsel, discipline, evaluate, train, coach, mentor, and schedule staff. Develop and maintain personnel policies, wellness programs, pay scales, and job descriptions. Resolve conflicts. Document Worker’s Compensation injuries, FMLA paperwork. Address unemployment inquiries. Presented and created PowerPoint slides. Facilities: Shop for, negotiate, recommend, and expand-maintain buildings establish new suites. Obtain paperwork for permits for new business. Purchasing and Expense Management: Shop, negotiate and recommend suppliers for medical biologic medications. Education:
City College Business Management (54 credits) Currently preparing for CPC Certification- AAPC Certified Medical Practice Manager- Doctors Management HIPAA Certified -Society Human Resource Management CPR- Certified
Exponents/Arrive Cycle 89 New York, NY - Social Services & Human Resources, Phlebotomy/ X-Ray/First-Aid, OSHA Organizations:
National Organization Rheumatology Managers (NORM) Board of Directors Florida Society of Rheumatology (Office Manager Committee) Active Member – past chair Orange Technical College Medical Administrative Specialist- Advisory Board Boehringer Ingelheim - Advisory Board
Lilly Pharmaceuticals – Advisory Board and National Speaker Novartis Pharmaceuticals – Advisory Board and Speaker Specialty Networks/United Rheumatology – Active Member ARN – Active Member
The Society for Human Resource Management (SHRM)- Active Member Training:
HR & Office Management Government Training, Policies & Procedures (SHRM), Multiple certificates for continuing education (contact hours) from EndoNurse Institute. Continuing education “Critical Decisions- Long Term Effects” (contact hours) from Proassurance Indemnity, Acevedo Consulting, Doctors Management, Fred Pryor Seminars, and various other organizations. Knowledge of Electronic Medical Records for GE, Affinity, E-Clinical, IMS- Suite MED, H-DOX, knowledge of Athenanet, Cerner, Microsoft Office Suite - word, excel, power point and publisher. Certificates of Training in Mental Health Awareness in the workplace, Geriatric Communities, HIV-AIDS Confidentiality Law Addiction Training, Alcohol & Substance Abuse counseling, Relapse Counseling, MICA (Mental iIllness & Chemical Abuse Disorder) Counselor Training, Domestic Violence GLBT, Harm Reduction, Emergency and Disaster Management, Ethics in A1-SA counseling, and Human Sexuality. Bilingual - Spanish
Excellent References Furnished Upon Request
Contact this candidate