Customer Service Team Members
Resume:
Amy Chapman
LaGrange, Ga *****
********@*****.***
WORK EXPERIENCE
Revenue Integrity Analyst
Ensemble Health Partners – December 2020- Present
Responsibilities
Daily review of charge items in work queues to ensure they are resolved accurately and in a timely manner to meet the deadlines.
Analyze billed charges, medical records and related medical documentation to look for missing, incorrect or late charges.
Evaluate charge capture practices for their assigned facilities to ensure accuracy & completeness of charge capture and compliance with government and non-government payers’ rules and regulations.
Follow up as appropriate when unusual items are noted and ensure problems are resolved and prevented in the future.
Maintain working knowledge of CPT and HCPCs coding as well all billing, CCI, MUEs, and other relevant coding/ billing guidelines.
Provide recommendation based on finding to improve charge capture workflows and to standardize charge capture practices.
Reports on trends, findings, and opportunities for improvement to managements detailing findings and high-risk items that leaders should be monitoring, including missing, incorrect, and late charges.
. Work closely with individual facilities representatives/clinical staff to establish and maintain positive relations to ensure revenue integrity goals are achieved.
Participate in meetings and interact on regular basis with site-based department leaders regarding changes in charge capture practice.
Performs database editing/auditing functions to maintain and/or improve data quality.
Other job duties as assigned.
Revenue Integrity Analyst II
Conifer Health Solutions - July 2019 – July 2020
Responsibilities
Coordinate, approve, and edit all changes made to the charge item master for Lab for multiple facilities
As facility liaison for 2 Chicago facilities - coordinate, approve, and edit all changes made to the charge item master and provided training for departments on Vital Ware
Analyze pricing and coding discrepancies in the CDM to promote appropriate and consistent billing and coding practices
Cross-train as needed with team members to serve as a back-up
Assisted in special projects - OPPS changes and price increase project for multiple facilities
Perform requests in Vital Ware for facilities
Extensive experience with Charge Description Master Development and management. Ensure accuracy of coding and billing, with full compliance to all current state, federal and industry regulations and guidelines. All CDM maintenance - Adding, deleting, changing codes in charge master. Develop appropriate charges for new services. Educates departments on charge capture processes
Ability to utilize and research various published resources, appropriate reference materials, Internet resources, seminars, and other associated information sources to continually stay abreast of changes in regulatory information.
Facility Liaison for two hospitals in Chicago. Responsible for maintaining the Chargemasters accuracy and compliance.
Trained facility staff on VitalWare processes including but not limited to submitting appropriate requests through the electronic workflow tool. Exporting CDM reports. Looking up coding and pricing information in the VitalKnowledge tool.
Part of project team that implements quarterly and annual OPPS updates. Participant in annual unutilized and rate adjustments projects.
Cross-trained on several different Patient Accounting systems to serve as support/backup for other team members. Systems include PBAR, Invision and Med Series 4 (MS4).
Serves as dedicated resource and final approver for the Lab service line requests
Assists clients hands-on when needed with any questions or support needed
Charge Master Analyst
St. Francis Hospital - June 2016 to July 2019
Responsibilities
Key contributor in the Implementation of the STAR patient accounting system (PAS) to CERNER PAS conversion
Duties consisted of: Mapping the hospitals current chargemaster (CDM) to a standardized CDM
Extensive experience in the Cerner Pricing tool to create a new charge codes or to edit an existing charge code
Responsible for verifying orders within CERNER are mapped to the appropriate charge code
Experience with Charge Inquiry in CERNER to identify that posted charges reconcile with the orders they are mapped to post GO-LIVE
Created reports in the CERNER reporting system to identify charging errors
oMissing charges
oIncorrect charges
oduplicate charges
Hands on experience with FIRST NET (CERNER –Emergency Department system)
oReviewed patients orders for verifying Observation charges
oHelped ED employees navigate in FIRST NET
Worked in MedHost for the ER to run reports and verify orders matched charges
Coordinate, approve, and edit all changes made to the charge description master
Coordinates with revenue departments in reviewing and maintaining that respective portion of the charge master
Evaluate and assist in the analysis of charge processes to ensure compliance
Assist departments with new services or procedures to ensure appropriate charge line items are developed and are in accordance with billing compliance regulations
Provide training and education to clinical revenue departments
Responsible for performing charge audits for missing or incorrect entries with information provided by Opera and using that information to coordinate with the correct department and ensure charges are corrected
Reviews charge error reports generated from the SMART procurement system to identify and assist departments with charge errors
Scheduling patients
Verifying insurance for patients and billed/re-billed as needed
Worked in billing department reviewing overpayments/underpayments and resolving
Worked with denials to get claims paid
Resolves billing issues with the assistance of the Patient Business Office
Monitor compliance issues such as departments charging for services not rendered, bundling and unbundling of charges, and appropriate units of service
Maintain information needs to complete SOX Control 2293 which describes how to remain compliant with the addition of new items to the Item master
Assist in the proper charge process for observation patients
Follow up with departments on missing charges that have not been addressed or resolved in a timely manner
Complete monthly 10 account random sample of inpatient and outpatient accounts to provide all documentation, records, UB, Itemized bills, and send to Adreima/NThrive for audit
Receive, research, and disseminate all bulletins, program memorandums, and transmittals from the Centers for Medicare Service as well as other payers to recommend and document required changes
Interact with all revenue departments, coding staff, patient accounts, and Information Services to ensure the interface is accurate for the charge capture process, CDM items, and UB output
Perform quarterly SOX Audits on 3 departments to ensure they remain in compliance with all applicable SOX requirements
Perform the Surgical Implant audit for Blue Cross/Blue Shield patients by pulling operative reports, implant logs, the UB, as well as all relevant invoices.
Attend all meetings/calls as requested regarding reimbursement, billing, or operational workflow.
Assists Senior Administration Director of Finance as needed with retrieving reporting data
Cross-train as needed with team members to serve as a back-up
Additional experience gained processing refunds to insurance companies and patients, billing health insurance companies, and sending adjusted bills out when needed
Review accounts for correct posting of payment and adjustments
Worked with Supply Chain for accurate pricing in our Resource Catalog
Team Leader
Aspirion Health Resources - Columbus, GA - April 2014 to June 2016
Responsibilities
Call customers to locate Insurance information
Responsible for all communication with 9 hospitals for Aspirion
Ensure employees are following guidelines and procedures properly
Preform audits on a weekly basis
Assist with invoicing customers
Post payments to accounts
Run daily reports
Skills Used
Customer service
Basic Accounting
Personnel Management
Branch Manager
Alabama Title Loans - Phenix City, AL - November 2013 to April 2014
Responsibilities
Overall store management
Processed title and pay day loans
Made collection calls
Reviewed the profits and losses for the branch
Ensured supplies were stocked appropriately
Made banks runs and nightly deposits
Ensured store employees followed guidelines and met expectations
Preformed audits
Skills Used
Personnel Management
Customer service
Collections Accounting
Concession Stand Manager
Smiths Station Softball League - August 2011 to May 2013
Responsibilities
Create and maintain team work schedules
Maintain financial records
Manage Inventory
Coordinate fundraising projects
Accounting Specialist II
Aflac - September 2006 to August 2010
Responsibilities
Processed changes to policies upon the request of the customer
Resolved complex/time sensitive customer complaints received by the call center
Assured information on policies was correctly entered
Assisted management on special projects to improve company procedures/processes
In Store Coordinator
Winn Dixie - October 2000 to September 2006
Responsibilities
Created work schedules for cashiers, baggers, and office associates
Managed money in the safe and made daily bank deposits
Processed new hire paperwork
Supervised front-end employees
EDUCATION
Columbus Technical College
Associate of Accounting
August 2014 to Present
SKILLS
Epic
McKesson STAR
Medhost
Horizon Patient Folder
Citrix
MS4
PBAR
Invision
VitalWare
Craneware
NThrive
REFERENCES
Available on Request
Contact this candidate