Customer Service Health Care

BABITA SHIVNAUTH

***-** ***** ******, ******** Hill, NY 11419 • 718-***-**** • **********@*****.***

SUMMARY

I am a seasoned and Certified Manager, Medical Account Receivable, Billing and Coding Specialist with 20 years plus of experience working in the medical industry with Hospitals and Physician Revenue Cycle Departments. I specialized in Medical Insurance Billing, Claims Investigator, Contract Negotiator, Complex Problem Solving and Process Improvement to ensure the highest level of customer satisfaction. Offering excellent Asset Management, Project coordination and customer service skills, a "can do" approach to all tasks with a consistent level of high productivity

Team lead, managing multiples projects at one time, approving work orders and time sheets

Excellent management, leadership, organizational, Billing, HIPPAA, and communication skills

Strong Critical Thinking and analytical skills, Team lead, Managing multiples projects

Motivated self-starter with advanced computer, data mining, and analysis skills

Knowledge of patient accounting from hospital/physician Billing, claims processing and investigations of healthcare, Strong knowledge of Managed Care, Medicaid, and Medicare billing including guidelines

Strong knowledge of Revenue Cycle Management including Medical Terminology

Hospital and Physician RCM. Specialized in Government, WC/NF billing, cash posting/investigate

Strong knowledge of Revenue Cycle Management, Account Receivable Specialist

Medical Insurance Billing, Health Care plans, HMO/PPO, Managed Long-Term Care (MLTC)

Manage and complete various projects, Enrollment and Verification project as assigned

Medical Coding, CPT-4, ICD-9-CM, ICD-10-CM and HCPCS coding. CM1500 forms and UB04 forms

PROFESSIONAL EXPERIENCE

Northwell Health - North Shore -Long Island Jewish Health System New Hyde Park, NY (2010 – Present)

Healthcare Analyst -Accounts Receivables

Specialties: Patient Financial Services -Accounts Receivable

•Provide support and communicate directly with patients, physicians, outside providers, vendors, and payers’ in-person, telephonically, and via e-mail, with strong focus on maintaining customer confidence.

•Develop and implement process and procedures for established internal and third-party payer requirements to ensure appropriate billing and payment cycles are accurate and met within billing period. Claims Investigator, Contract Negotiator. Identify and resolve issues to ensure priority patient satisfaction.

•Establish record in writing and implement appropriate billing policy procedures, as well as procedures for all billing activities including follow-up on third-party approvals and collection of overdue patient accounts.

•Gather, analyze, and evaluate statistical reports with Information Technology team

•Create reports for total practice, A/R aging, monthly closing, credit balance, trial balance and census.

•Gather, analyze, and evaluate analytical reports to determine the best approach for action within the customer service organization. Generate a collection of analysis reports including productivity analysis, payer analysis, CPT analysis and provider analysis.

•Working knowledge of CPT-4, ICD-9-CM, ICD-10-CM and HCPCS coding. Work EOB’s and insurance correspondence to adjudicate claims quickly and provide feedback to Claims Management Unit for billing corrections.

•Manage and lead staffing levels and work distribution to ensure efficiency in workflow for various areas within the department.

•Communicate processing changes that may impact revenue from insurance carriers with my team.

•Coordinate, perform and training coding, support for budget and billing to my team

•Provide support and resolution to patient issues to maintain the highest level of customer satisfaction.

•Participate in the hiring and onboarding process of new employees.

•Knowledge of insurance industry reimbursement, and the organization department function and operations including EM experiences. Proficient in Claim Administration, All Health Care Plan, HMO/PPO Insurances W/C, N/F & Coding, Medicare, Medicaid, and Group Waiver Plans.

•Develop process and procedures for department including all Health Care plans, HMO/PPO, W/C, N/F, Medicare, Medicaid, and Group Waiver Plans to promote higher performing team

•Create instructions for my team to transfer all patient accounts into the corrected status.

•Review carrier’s reimbursement to ensure compliance of contract is met.

•Assess denial data with strong emphasis on Medicare, Medicaid reimbursement guidelines.

•Monitor workers compensation and no-fault carriers for process improvement.

St Vincent’s Catholic Medical Center, New York, NY (2001 – 2010)

Healthcare Revenue Cycle Business Analyst Manager

Specialties: Inspired academic excellence to my employees by engaging in training as well as knowledge sharing sessions including, EOB, enter payments into medical database, reimbursement, and negotiation strategies of payment.

•Directed and managed account receivable team to ensure accounts are collected accurately from Commercial, Medicare, Medicaid, Managed Care, and patients.

•Provided process and procedures to ensure compliance with all Federal, State and City Laws, regulations, and Hospital policies.

•Conducted review and audit to ensure process and procedures of compliance met Quality Assurance Plan.

•Identified and resolved variances from contracted insurance carriers of impacted revenue.

•Generated credit balance reports. Managed and assigned team assignments.

•Verified rates were loaded accurately in the contract management system.

•Reviewed multiple hospitals department to determine trends and process improvement.

•Motivated and coached my team to promote her performing team and quality work.

•Ensured tools and resources were made available to team while staying within department budget and manage and complete various projects.

•Reviewed and analyzed error reports to increase clean claim submission rate.

•Developed and presented customized educational, action plans and reports including payment review underpayment and overpayment auditing for leaders.

•Developed and maintained policies and procedures for department unit.

•Acquired and maintained relationships from our clients (insurances carriers) and serves as the primary point of contact for overall day-to-day service delivery inquiries.

•Coordinated with other functions team to implement carrier systems, complete projects, and address ongoing service needs. Provided status reports to upper management on carrier and areas of escalation.

•Reviewed and analyzed carriers to determine retention risk and issues.

•Informed and advised contract management and various Hospital departments to comply with DOH, CMS and OMH regulations.

•Created payment schedules for all behavioral health claims, conducted in house carrier meetings and internal unit team meetings, as needed, and continually learning the latest information on products and services.

•Work all billed receivables to maximize cash collection such as processing and reconciling insurance claim forms/payments. Also, Follow-up on all Third-Party claims to ensure correct reimbursement.

•Verify patients’ insurance information, work all Medicaid audits and issuing patients’ refunds. Processing credit balance reports, preparing pre-collection notices and other correspondences.

•Work all end of the month Financial Reports such as Month-end trial balance reports, Ad hoc reports, analyze data and report findings.

•Performs administrative duties for executive management. Responsibilities may include screening calls, making meeting arrangements, preparing reports and financial data, and customer relations

•Develop office policies, procedures, and comprehensive practice reports and data analysis to monitor productivity. Correct all billing Errors, also transferring third party accounts to self-pay status.

•Work EOB’s and insurance correspondence to adjudicate claims quickly and provide feedback to Claims Management Unit for billing corrections.

Dr. Muntaz Majeed, Dr. Baldeo Philip & Dr. McKesson Corporation, NY Multi-Specialty Physician Practice

Healthcare Manger- Claims Investigator, Contract Negotiator

Specialties: Medical billing, Coding, Medicare, Medicaid, Commercial Insurance Billing, CPT-4, ICD-9-CM, ICD-10-CM and HCPCS coding, All Health Care Plan, HMO/PPO Insurances W/C, N/F & Coding, Medicare, Medicaid, and Group Waiver Plans

•Assessed patient’s functional abilities, and limitation.

•Provided educational health information to youth and adults in community.

•Engaged in coordinating of groups for individual nutrition health education.

•Developed and implemented strategies to improve the health of individuals and communities’ patients.

•Provided support to clients and their families informing them about their treatment including direction of use, preparation to store and side effects.

•Discussed health concerns with members to improve health outcomes and reduce healthcare costs by informing them about healthy habits and behaviors, and utilization of available healthcare services.

•Generated credit balance reports. Managed and completed various projects.

•Identified and resolved variances from contracted insurance carriers of impacted revenue.

•Monitored patient activities to ensure they received the best recommendation for their health

•Provided information about resource availability for diabetes wellness and support groups events.

•Educated patients with health information risks and directions to perform blood glucose monitoring.

•Provided information for organizations research, wellness, stress management, weight management, diabetes management, sexual health, yoga, and counseling in groups and Maintained coverage in all division with healthcare members.

•Manage staffing levels, work distribution for effective and efficient workflow in all areas of the department. Assists patient with concern and complaints and promotes good customer service with patient and staff. Recruit and hire support staff

EDUCATION

TOURO UNIVERSITY, New York, NY

Master of Science in Health Science and Minor in Health Education, November 2016

UNIVERSITY OF PHOENIX, Phoenix, AZ

Bachelor Business Administration, Minor in Management, January 2011

UNIVERSITY OF PHOENIX, Phoenix, AZ

Associate of Science in Business Administration, January 2008

CERTIFICATIONS

Diploma Medical Insurance Billing & Coding, Caliber Training Institute

Certificate in Teaching Medical Billing & Coding, Coalition of New York State Career School

Certified Registered Medical Coder (RMC) National Certification, Medical Management Institute

Certified Billing & Coding Specialist (CBCS), National Certification (NHA) Lic#1255-3834

Diabetes Educator requirement of diabetes completed 2000 hours & DSME completed1000 hours

Certified Nursing Assistant (CNA) - Access Institute

Certified Health Educator Specialist (CHES) Exam (In progress)

Association, CCS (In progress)

Certification Diabetes Educator CDE Exam (In progress)

Diabetes Educator (CEUs) 40 Hours, Northwell Health

TECHNICAL EXPERIENCE

Medical software knowledge: Soarian Financial, GECB- GE Centricity business; BAR, TES and ETM, Medi Soft, IDX Group System, BAR, PCS and J.P. Morgan Lock Box System. Medical Manager System, and Working knowledge with Misy’s Homecare for LTHHCP/CHHA, eMed EPaces, Document Imaging, NEIC Invision systems, Seimens, Invision SMS, Eagle…

Windows Operating System, MAC OS, Microsoft office including Word, Excel, Access, PowerPoint, and Outlook.

REFRENCES FURNISHED UPON REQUEST

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