Data Entry Reimbursement Specialist
Resume:
CAREY S. MILLER
Fishers, IN
adxrxc@r.postjobfree.com
ACCOUNTING/FINANCE/COMPLIANCE
SUMMARY OF QUALIFICATIONS
Strong knowledge of Financial Management and Accounting Theory and Practice including knowledge in Medicare and Medicaid reimbursement; with a thorough knowledge of applicable reimbursement and general corporate laws, guidelines and professional standards; a keen understanding of skilled nursing and other general health care operations; good computer understanding and skills; excellent communication skills; strong change management skills.
A high-level commitment, motivation and energy; team orientation; professionalism; trust; personal honesty and integrity, and a demonstration of placing others in a place of high value and treating them with dignity and respect.
Offer the potential employer substantial relevant academic preparation.
Computer proficiency in Lawson Accounting Systems, MS/Excel, MS/Word, PowerPoint and Lotus Notes/Outlook.
PROFESSIONAL HISTORY
Anthem BCBS, Indianapolis, IN 2/2018 – 5/2023
Staff Accountant
Compile and analyze financial information to prepare entries to general ledger accounts.
Analyze financial information detailing assets, liabilities, and capital.
Prepare balance sheet, profit and loss statement, and other reports to summarize current and projected company financial position.
Audit contracts, orders, and vouchers, and prepare reports to substantiate individual transactions prior to monthly close process.
Establish, modify, document, and coordinate the implementation of accounting and accounting control procedures.
Prepare, examine, or analyze accounting records, financial statements, or other financial reports to assess accuracy, completeness, and conformance to reporting and procedural standards.
Report to management regarding the finances of establishment.
Note: Life Care transferred this position to Tennessee. I elected to stay in Indianapolis because of my son’s May 2018 high school graduation date.
Life Care Centers of America, Inc., Fishers, IN 10/07 - 7/17
Reimbursement Director – NE Division
Prepared and reviewed Medicare and Medicaid cost reports for skilled nursing facilities.
Analyzed rates for accuracy and summarized for management.
Responded to audit requests & filed appeals as required.
Booked cost report settlement entries as needed.
Prepared salary surveys and special audit requests made by Medicare and various Medicaid agencies.
Oversaw staff accountants on annual cost reports.
Communicated with facility bookkeepers and regional staff related to cost report requirements and statistics.
Corresponded with federal and state agencies for transmittal of cost reports, desk review and field audit requests.
Worked with in-house programmers to plan and prepare mappings, reports and data downloads as necessary to complete cost reports.
Alegent Health, Omaha, NE 1/07 - 10/07
Reimbursement Specialist
Reviewed Medicare cost reports and tax returns prepared by Reimbursement Analysts for accuracy and enhancement.
Insured maximum 3rd party reimbursement through strategic financial planning; served as a department representative on committees for program planning, review and evaluation as requested.
Prepared the system’s annual contractual budget in concert with the System Finance division, which was prepared in a manner consistent with the system-wide strategies and operational planning activities.
Responsible for the maintenance of Medicare and Medicaid regulation library and the communication to all areas of Alegent impacted by changes in reimbursement law and regulation and the development of strategies to implement new requirements; Investigated, analyzed and reported on all changes in Federal and State reimbursement.
Provided the technical resource and coordination with all financial and operational aspects of the Protected Health Information (PHI) initiative; provides technical support to Managed Care.
Reviewed the monthly computation of deductions from revenue prepared by Reimbursement Analysts, including proper statement of balance sheet reserves. Provided a concise and simplified monthly analysis to the Operations Leader on variances in the financial statements as related to reimbursement.
Assisted the Operations Leader in coordinating a team of professionals developing a chart of accounts, including projections of the impact of such changes.
Coordinated third party audits, including Medicare, Medicaid and tax audits.
Prepared exceptions and appeals to Federal and State payors as required.
Provided the Operations Leader with projections and trend analysis and projected the reimbursement impact of the decisions.
Provided backup to the Reimbursement Analysts in the event of turnover, including cost report and tax return preparation.
Participated in all safety, security and infection control programs that are mandatory as well as those required and provided by the department.
Demonstrated work practices consistent with Alegent Health and department-specific safety, security and infection control policies.
Mutual of Omaha, Omaha, NE 5/02 - 1/07
Supervisor Systems and Provider Enrollment
Planned, staffed, directed and controlled unit activities, including personnel management decisions such as budgeting for and controlling expenses, interviewing and selecting personnel, appraising performance, administering salaries, resolving disciplinary problems, developing subordinates, long-term and short-term planning and assuring compliance with Corporate Affirmative Action guidelines
Performed secondary reviews of more complex (e.g. hospitals, multi-location, complicated ownership structures, multiple sub-units, etc.) provider applications for enrollment in Medicare Part A programs, ensuring compliance with Medicare regulations or policies relating to Provider Enrollment.
Supervised and coordinated the compilation and analysis of Provider Enrollment and/or System for Tracking Audit & Reimbursement (STAR) data for special projects and initiatives directed by the centers for Medicare and Medicaid Services (CMS), Department of Justice, General Accounting Office and Medicare division management.
Monitored and remained abreast of Medicare and STAR regulation changes and related interpretations, analyzing the effects of such changes on Provider Enrollment procedures, existing budgets, production and quality standards. Informed appropriate personnel of necessary changes and oversaw implementation.
Mutual of Omaha (Continued)
Supervised the timely completion of the Provider Enrollment forms, Provider Enrollment process to ensure compliance with CMS requirements and supervised the accuracy and timeliness of the data entry into the System for Tracking Audit and Reimbursement (STAR) system.
Supervised the accuracy and timeliness of the Contractor Report Operation and Workload Data (CROWD) report, the Contractor Audit and Statistical Report (CASR), the Interim Expenditure Report (IER), the Contractor Performance Evaluation (CPE), and related department reports.
Represented the Companies at National and Regional Intermediary conferences with CMS to set national Medicare policies regarding Provider Enrollment issues and STAR reporting requirements.
Maintained excellent working relationships with providers and their representatives to clarify information provided on applications, or to respond with information regarding regulations/legislation/policies pertaining to Provider Enrollments.
Created a culture within the unit which requires associates to live Mutual’s Values for Success in all activities and working relationships in order to contribute to the achievement of division objectives. Personally live the Values for Success.
EDUCATION
University of Nebraska at Omaha, Omaha, NE
Bachelor of Science in Business Administration
Majors: Business Finance, Banking & Financial Markets.
Major: Accounting
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