CNJ

Christine Natalie Joan

**** * **** ****** **** 6712

Richmond, VA 23219

adxw1h@r.postjobfree.com

804-***-****

Medical Healthcare Specialist

An open-minded individual with a flexible approach to work, which enables accommodation of change.

Able to work well with a group or on own initiative. Willing to take any responsibilities and assignments, regardless of the challenge. A self-reliant individual with the ability to pick up new ideas and concepts quickly.

Enjoys learning new skills and methods of working. Takes pride in producing excellent work and can accept constructive criticism. Organized and can work under pressure in a busy environment.

Specialties

● Used Strong knowledge of Medicare billing regulations, general coding guidelines and company Compliance Policy.

● Provided Knowledge of anatomy, physiology, pharmacology or medical terminology

● Skilled negotiating Patient relations--professional/courteous

● Researched management and supervision Powerful writing skills

● Trained and developed employees.

● Detailed oriented Integrity; maintained high ethical standards.

● Significantly reduced outstanding accounts receivable over 90 days by 77 wrote off. the balance

● Reduced returned claims from Medicare/Medicaid by nearly 95%

● Collected $49,000 of monies scheduled to be written off.

● Maintained an above-average billing ratio of 73/77

. Medical Coding Certification

. Medical Billing Certification

Authorized to work in the US for any employer.

RCA LABORATORIES DBA GENETWORX

4101 Cox Road

Glen Allen VA, 23060

July 2022 to Present

Senior Accounts Receivable Specialist

The Senior Accounts Receivable Specialist is responsible for the extensive reviewing of explanations of benefits, denials, and open accounts receivable as well as a comprehensive analysis and resolution of all accounts receivable balances. Under minimal supervision and according to established procedures, policies, and detailed instructions, drive resolution and promote peak performance while delivering world class revenue cycle outcomes. This individual will serve as a solution seeker responsible for engaging staff and implementing best practice workflows. This position interacts daily with team members and other departments to quickly resolve outstanding account balances while enhancing the patient experience and promoting corporate integrity and compliance. Prioritizes daily work and accesses volumes to adjust workload and areas of focus as needed.

• Documents all responses and actions taken to reach claim or account resolution in the billing revenue cycle management system.

• • Exhibits strong communication skills and positive attitude with internal (team members, other departments, and leadership) and external customers (patients, clients, insurance companies, vendors, and employers). Defuses volatile situations in a calm, objective, and tactful manner. Directs customer complaints to management for immediate response if unable to resolve.

• • Maintains thorough knowledge of third-party eligibility and claim inquiry tools and applications, requirements, and regulatory guidelines.

• • Audits all inquiries to confirm appropriateness of patient responsibility to ensure correct registration, coding, payment/adjustment posting, and insurance processing of claims.

• • Meets all daily, monthly, and year end closing deadlines as they relate to the accounts receivable process.

• • Meets or exceeds departmental productivity standards on a consistent basis.

• • Conducts verbal and written inquiries to determine the reasons for unpaid/denied claims to reach resolution.

• Provides management, guidance, and training to staff in account research and resolution.

• • Alerts the Billing Supervisor of Lab Revenue Cycle regarding any anomalies with the integrity of accounts receivable.

• • Reviews and resolves claim issues in assigned error processing and denial queues in billing accounts receivable management system.

• • Verifies and processes assigned worklists according to established procedures.

• • Prepares billing, as required, including registration of patient demographic information, verification of insurance eligibility, review of charges, performs functions to validate accuracy, enters charges into the accounts receivable management system, and assembles supporting documentation as needed.

• • Ensures claims are submitted to the appropriate responsible party within designated filing limit guidelines.

• • Recognizes and researches problematic trends regarding non-payment to implement preventive measures to increase velocity of cash collections.

• • Processes remittance, payment, and other documentation including scanning and submission of information according to Genetworx policy and procedure.

• • Documents results to management team routinely and monitors improvement of identified issues.

• • Assists management in the development and implementation of new policies and procedures.

• • Assists with maintaining net receivables based upon contractual requirements.

• • Selects priorities and organizes work and time to meet them in order of importance.

• • Performs office related support tasks, clerical duties and/or general office duties which may include creating reports, typing, filing, faxing, answering telephones, taking messages, and making copies.

• • Participates as a team member by performing additional assignments not directly related to the job description when workload requires and as directed by management.

• • Projects/Maintains a positive attitude and conducts his/herself in a manner conducive to improving the working environment and morale and supporting leadership initiatives.

• • Maintains strictest confidentiality; adheres to all HIPAA guidelines and regulations.

• • Demonstrates attention to detail, initiative, and judgment.

• • Exhibits poise, tact, and compassion dealing with patients and clients.

• • Performs other duties and special projects as assigned. Sunrise Senior Living

Chesterfield VA 23235

October 2019 to April 2023

A Lead Care Manager acts as the supervisor in a Care Facility. They are responsible for dealing with and assisting individuals who need special treatment. They provide services based on the diagnosis of the health professional and ensure that every program under their division is compliant with the guidelines. They also give necessary care for individuals who are having difficulties and provides efficient customer service by updating social media platforms and local businesses.

Manage marketing programs for online and direct mail, including virtual tours, Facebook, Craigslist and managing realtor website.

Manage listings, websites and MLS data.

Manage a staff of 27.2 FTE, which include professional and non-professional employees. Utilize Salesforce (CRM) to manage/maintain client accounts. Perform on-call nursing assistance and cross-training as needed with caregivers. Review OSHA regulations and company policies, and pinpointed/minimize potential risks for residents and employees.

Implement corporate CRM software plan consisting of ongoing training, strategy development, and staff evaluation.

Assist residents with daily livings including those with dementia and Alzheimer s. supervise and train employees on resident care.

Develop and implements systems for sellers, buyers, lead generation, contact database management and back-office support.

Input listing information into MLS and other websites, maintain showing booklets and keep files and social media update and

Private Home Care Specialist

Home Instead

Richmond VA 23228

February 2015 to April 2021

Provider Contract Negotiator

Aetna - Richmond, VA

August 2017 to December 2017

• Developed, contracted, maintained and enhanced relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members; fostered growth of managed care products; and enhanced profitability of Aetna.

• Recruited and negotiated physician and/or provider contracts in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goal. Direct Supervisor Jannette Anderson Aetna

804-***-****

Medical/Healthcare Consultant

Robert Half and Associates, Caliper - Richmond, VA June 1999 to 2017

Assignment through Commonwealth of VA (City Of Richmond) Position Workforce Senior Customer Care Specialist (Supervisor) Supervisor of Patient Billing and Physicians Billing overseeing all functions of the Business Office and Liaison between the outside billing company. Complete release of information for requesters of protected health information. Responsible for processing information for billing. Complete medical claim forms in a timely manner to assist patients and providers. Act as interface between patients, health care providers and third-party payers/insurance companies regarding claim form processing.

● Acted as liaison between the Director of Health Information Management, the Health Information Management Staff, and support staff in the Department.

● Assisted in assuring the medical record meets all requirements to effectively and efficiently promote customer satisfaction and assures continuity of patient care.

● Managed the day-to-day functions of the departmental billing to ensure compliance and billing standards are met.

● Specialties Entered department level charges for inpatient, outpatient, clinic and other sites in a timely manner. Ensure accuracy and appropriateness of charge data entered.

● Administrative Analyst

● Call Center Supervision Customer Service

● Processed all applications for physician enrollment with insurance carriers, including Medicare, Medicaid, commercial insurances and managed care contracts.

● HIPPA and PHI guidelines

Health Outreach Specialist Well

Point - Richmond, VA June

2007 to 2012

23219

Enrolled and Engaged Members in Healthcare Wellness Programs including in insurance policies in call center environment. Supervised, motivated, and monitored team members performance. Maintained detailed documentation of the company's policies and procedures.

● Lead team of 20

● Evaluated and selected report tracking template.

● Written weekly reports for management staff.

● Developed Training manual for employees and nurse project.

● Oversaw project for tracking system errors for telephony team and IT department ● Team Lead on Project with Manager on Special Project for back log on nurse call list reduction.

● Received bonuses for work on special projects.

● Top 20 Quality Performer

● Received numerous recognitions from management and directors and employees for my contribution for team support ● HIPPA and PHI guidelines. Medicare and Medicaid Insurance Analyst

Robert Half and Associates, Caliper - Richmond, VA January 2003 to 2008

Conducted research on Medicare Part D data, Medicare rules and regulations and other sources of information as well as utilized a variety of statistical tools to detect situations of potential compliance violations as well as support ongoing compliance investigations and audits.

● Utilized experience of data analysis to detect and prevent compliance violation required ● Worked with Medicare, Medicaid and Medicare Advantage rules and regulations analysis.

● Analyzed data to identify and compare norms, trends and patterns.

● Presented issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.

● Communicated effectively, internally and externally.

● Reported work activity on a timely basis.

● Handled confidential material.

● Conducted self-directed research to uncover problems in compliance to Medicare regulations.

● Organized a case file, research violations and accurately and thoroughly document all steps taken in project development.

● Worked independently and as a member of a team to deliver high quality work.

● HIPPA and PHI guidelines

Team Leader

Robert Half and Associates, Caliper - Richmond, VA February 2001 to 2002

Responsible for assisting the manager of the unit with PCS work files and automatic transfers and write-offs on collection agency accounts, analyzing individual action code used by the team, reviewing account adjustment batch proofs, and aiding collection analysts with difficult accounts and correspondences. Assists in the distribution of daily workflow within the unit. Serves as an assistant to the manager and provides feedback for improved efficiency in departmental processes.

● Acted as liaison between the Director of Health Information Management, the Health Information Management Staff, and support staff in the Department.

● Coordinated and documents referral and service authorization functions for managed care patients. Completes, coordinates and monitors necessary paperwork for in-network and out- of-network referrals.

● Audited current methods of billing and develops revisions of policies and procedures ● Assisted with billing questions and problems. Interfaces with patients and third-party carriers to expedite account resolution.

● Researched existing charges for each account updated and re-bills appropriate claims with corrected insurance information.

Education

Associate degree

Skills

. Billing (10+ years)

. CMS (7 years)

. contracts (10+ years)

. managed care (10+ years)

• Medicare (10+ years)

• Physiology knowledge

• Telephony

• EDI

• Anatomy knowledge

• ICD-10

• Over 20 years of experience reviewing and negotiating contracts for providers, with an additional 5 years of experience within a managed care setting.

• Experienced conducting provider contract negotiating and performing nationwide contract reviews for doctors, providers, and managed care organizations.

• Skilled with Microsoft Office Suite, Internet Navigation, and the following computer programs: Medic, Medisoft, PeopleSoft, Araya, EDI, Point of Care, SharePoint

• Well-versed in CMS guidelines with over 5 years of experience conducting research on Medicare Part D data and Medicare rules and regulations.

. Medical Billing

. Medical Coding

. Medication Aide

Contact this candidate