Customer Service Accounts Receivable
Resume:
Cheryl G. Victor
Port St Lucie FL, 34983
Phone # 954-***-****
Email: ady2dv@r.postjobfree.com
Professional Summary
Main objective is to obtain a position in which I can utilize my skills to enhance the growth of an organization.
My professional background includes over 25 years of medical claims processing and auditing and over 14 years of leadership in healthcare. My focus is to specialize in management. I am familiar with all insurance claim submission, processing, vizio, audits, and contracts, customer service and collections. Currently have a Bachelor’s of Science degree in Healthcare Administration and Master’s degree in Business Administration
I am currently employed with the Veterans Administration at the Florida Caribbean Consolidated Patient Account Center (FCCPAC) in Orlando. Please feel free to contact my Manager Desiree M Brown at email ady2dv@r.postjobfree.com for work reference.
Cheryl Victor
Resume of Qualifications
Personal Strengths
Dependable, Committed to excellence, Flexible, Loyal, Adaptable to change and Serene.
Education
2010 –2012 University of Phoenix, Palm Beach Gardens, FL – MBA
2007 - 2010 University of Phoenix, Cypress Creek, FL – Healthcare Management/BS
1997 - 1998 Broward Community College, Coconut Creek, FL – Healthcare Management – 6 semester hours
1994 - 1995 Miami Dade Community College, Miami, FL – Physical Therapy Assistant – 42 semester hours
1982-1985 St Croix Central High School, Kingshill, St. Croix USVI – Highschool Diploma June 1985
Experience
10/2017 - Present
Veterans’ Health Administration (VHA) – Facility Reimbursement Technician (FRT) 40+ hours per week
OCC Series/Grade: GS-0303-07
Salary - $51,185.00/yr
Manager: Brown, Desiree M (ph.) 305-***-**** ext. 13436 (email) ady2dv@r.postjobfree.com. Contact - Yes
Location: Miami VA Healthcare System 1201 N.W. 16th Street Miami, FL 33125-1693
Duties:
Review cases for Third-Party Insurance, Specialty/Unique Billing (Tort Feasor, Worker's Compensation, Choice Billing, Ambulance Billing, Veteran First-Party Billing, Dialysis Billing, Non-Veteran Billing, Fee Basis or Non-VA Billing, Emergency Dental Billing, Prosthetic/Durable Medical Equipment Billing, Allied beneficiary, and Sharing Agreements. Review FBCS, FPPS, Tri-west PC3 Portal, CCPAT, ES, CPRS, CHOICE SharePoint, NPPES, CCRS and ICB software pertaining to revenue capture for non-VA care to fully analyze information that comes from the Non-VA/Fee Program through the FBCS software. Review Code of Federal Regulations, OCC, PMO, Medical Center, and Fiscal policies and procedures as well as Directives pertaining to Release of Medical Information, Revenue Program, Eligibility, and HIPAA regulations. Identifies gaps in billing and collection data. Sets regular deadlines, projects, and work to be done based on subject matter expertise of the revenue program. Providing administrative support such as drafting reports, sending office wide emails and tracking office workload. Gathering, researching and providing technical information in response to inquiries. Using computers and variety of software programs to carry out daily responsibilities.
Achievement:
Completed Lean Sigma Green Belt course; Selected to partake in the FRT SME group in the FCCPAC.
02/2016 – 10/2017
Veterans’ Health Administration (VHA) – Medical Reimbursement Technician (MRT-IV) 40+ hours per week
OCC Series/Grade – GS-0503-06
Salary - $37,832.00/yr
Supervisor: David Smith (email) ady2dv@r.postjobfree.com (ph.) 407-***-****
Location: Florida Caribbean Consolidated Patient Account Center (FCCPAC), P.O. Box 140793 Orlando FL
Duties:
Processing of Military Veterans insurance file by verifying eligibility status, obtaining updated insurance information, such as group number, identification number, and precertification information; Create new insurance files for new or existing Veterans; Respond to billing issues; Respond to issues generated by the Billing Department, Accounts Management Department, or Utilization Review Department.
Achievement:
Selected for special project to assist Central Plains Consolidated Patient Account Center (CPCPAC), to reduce backlog of accounts.
Selected to attend Lean Six Sigma Course (Yellow Belt).
Promotion to Facility Reimbursement Technician
09/2015 – 02/2016
New Frontier Ventures (NFV) – Patient Account Representative (contract-temp)
40+ hours per week
Manager: Gerhard Powell (ph) 954-***-****
Location: Bert Fish Medical Center, New Smyrna Beach FL
Duties:
Review and process Managed Care accounts prior to submitting claims to insurance companies for reimbursement. Reviewed denial claims received from insurance companies and resolved denial issues by contacting insurance denials department for a resolution or by resubmitting claims electronically or by paper. Coordinated medical records request received from insurance or other facilities to assist in reimbursement.
Achievement:
Exceeded expectations on resolving accounts and cash flow that resulted in contract extension.
07/2014 – 07/2015
Conifer Health Solutions – Client Readiness Manager
40+ hours per week
Director: Lisa Hanson (ph.) 661-***-****
Location: Various (travel)/Telecommute
Duties:
Assigned to new Tenet Hospital facilities in Georgia, Nebraska, and Washington to assist in implementation of new software, EPIC. Conducted numerous visits to facilities to conduct dashboard meetings on Revenue Cycle areas of concerns in HIM, Registration, Billing, and UR after implementation of software and to optimize the process flow. Provides position management advice and recommendations to managers including providing advice on the distribution of workload among positions and organizations, and the skills mix, or categories of employees needed to do the work. Develops proposals to merge or establish new organizational units within an existing organization for the purpose of improving workforce distribution, position management structures, efficiency, or productivity. Performs organizational and/or manpower utilization studies on a limited scale to identify and develop improvement and efficiency of manpower and work methods. Plans, develops and conducts internal review studies. Analyzes management techniques, processes, and styles for improving organizational effectiveness. Uses basic analytical techniques not requiring advanced knowledge or training. Works with senior analysts and/or has work checked by senior analysts before presenting work to management. Maintains a Records Management Program for a stable, established records system. The program includes a centralized records function, standardized handling/retention, improved records, conversion from paper to film/electronic data, and document searches. Develops tools promoting effective coordination of a Records Management Program. Supported staff members at facilities with pending issues and provided ad hoc solutions. Created On-Boarding document for new hires to the department to ease transition into position. Determines the root cause of errors and anomalies, and taking appropriate action to ensure accuracy
09/2009 – 07/2014
Conifer Health Solutions – Government Audit Specialist
40+ hours per week
Manager: Yvette Lambert (ph.) 954-***-****
Location: Boca Raton FL/Telecommute
Duties:
Conducted process on Recovery Audit Contractor (RAC) and Medicaid Audit Contractor (MAC) claims involved in medical audits initiated by Medicare, Medicaid, and commercial insurances; Assisted in developing training documents and policies and procedures for the department; Created job aides with more detailed information for various scenarios that occurred; Assisted in creating workflows utilizing Vizio; Communicate with RAC vendors, Conifer governmental team, Tenet facility Stakeholders and Vendor on process of audits; Research on valid RAC audits approved by CMS to ensure audit review is approved; Process and follow-up on appeals for Tenet Core and Non-Core facilities (facilities no longer owned by Tenet); Train new employees on RAC and MAC process; First point of contact for Conifer Clinicians, Executive Health Resources (EHR), and RAC vendors.
Achievement:
Based on knowledge and success of the process with minimal error or recoupment of payment was selected to be the trainer and go to person for the outsource employees in India.
06/2008 - 09/2009
Tenet Healthcare/Conifer Health Solutions - Facility Liaison
40+ hours per week
Manager: Yvette Lambert (ph.) 954-***-****
Location: Boca Raton, FL/Telecommute
Duties:
First point of contact between Tenet facilities and Conifer Business Office (CBO) on Revenue Cycle issues that may arise or cause issues on claims and reimbursement; Collaborate with facility to assist in resolving hospital or region specific issues and trends; Provide updates on Medicare regulation to staff members and facilities on a quarterly basis; Serve as the primary contact with the Fiscal Intermediaries (FI) and Centers for Medicare and Medicaid Services (CMS) to obtain information on global issues or clarification of issues; Train facilities as needed to ensure issue at hand has been addressed and resolved; Oversee Denials management and the Appeals process for multiple Tenet facilities and coordinate with facility coding logs to ensure all changes of diagnosis and procedure codes recorded timely and accurately; Resource for Accounts Receivable Leadership team, trainers, and representatives; Represent the National Medicare Center on user group committee meetings on a monthly basis.
Achievement:
Selected as the designee for the newly implemented Recovery Audit Contractor (RAC). Had the privilege of being a SME in providing suggestions on a new addition to the accounting software to include a real-time tracking mechanism on the RAC accounts to eliminate reporting on an excel file.
07/2004-6/2008
Tenet Healthcare - Medicare/Medicaid Accounts Receivable Supervisor
40+ hours per week
Manager: Yvette Lambert (ph.) 954-***-****
Location: Boca Raton, FL
Duties:
Oversee daily functions of the Accounts Receivable (AR) team of 25 employees; Audit and monitor AR representative processes to ensure compliance with Medicare/Medicaid regulations and Tenet policies and procedures are being adhered to; Analyze and resolve problematic or high profile accounts; Collaborate with AR Manager to implement enhanced or new policies and/or procedure for the AR teams and create development plan for growth for each individual employee; Train and coordinate standard training with the AR Reps on internal processes and CMS regulations to ensure effective and compliant operations; Monitor Medicare/Medicaid suspense and rejection files for patterns requiring intervention and/or escalation; Forward billing editor edit requests to the National Medicare/Medicaid Center (NMC) edit analyst for an ad hoc solution to ensure submission of compliant claims. Performs administrative work, which includes, but is not limited to, the management of a functional Unit, identifying priority-based objectives and areas of improvement for system redesign purposes, and reviewing the Employee Compensation Unit's set of standard operating procedures (SOP's). Provides administrative and technical supervision necessary for accomplishing the work of ensuring that all Healthcare System Employees are fully and correctly compensated every pay period.
08/1998-07/2004
Alliance One - Healthcare Consultant /Nationwide (Contract)
40+ hours per week
Manager: Gerhard Powell (ph.) 954-***-****
Location: Various (Travel)
Duties:
Travel to various contracted facilities nationwide to provide revenue cycle support to decrease backlog of accounts from over 180 days to 30 days and increase cash flow to 14-21 days per claim; Train facility employees on proper billing, collection and registration procedures; Assist facility in collecting revenue on aged accounts over 180 days; Ensure facility complies with government and commercial insurance regulations; Coordinate and review government and commercial insurance additional documentation request letters for medical records in a timely manner and comply to the designated timeframe for submission; Communicate with government and commercial insurance customer service department to obtain additional information on reasons for claim denial, rejection or suspense reasons and an estimation on reimbursement; Maintain contract employee hours worked for reporting purposes; Lead contact person on projects that involved two or more contracted personnel.
Achievement:
Had successful results on all contract positions that resulted in contract being extended from initial three months to four or more. Locations include, Naples FL, Saint Petersburgh FL, Tampa FL, Miami FL, Orlando FL, Boca Raton FL, Burlington VT, Evansville IN, Tucson AZ, Phoenix AZ, Charlotte NC, Winston Salem NC, and St Croix USVI
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