Behavioral Health Financial Services
Resume:
Denita R. Kaherl
**** **** ****** ** • Franklin, OH 45005 • Phone: 207-***-**** • *******@*****.*** Profile
Having over 25 years’ experience providing patient financial services to organizations, I have extensive experience in medical records, medical & mental health billing, and other medical office responsibilities. I am a self-motivated, hard-working individual with strong interpersonal skills and unsurpassed work ethic. Combining patience, determination, and persistence to troubleshoot client/patient issues I have been commended for my reliability and trustworthiness.
With the ability to grasp new ideas and integrate them into desired results I have been responsible for leading others in high-demand situations and I work efficiently under pressure.
I also have the ability to prioritize and operate proactively and enjoy working as a team member as well as independently
Experience
July 2023-Current
Billing Manager, Northeast Cincinnati Pediatrics
Oversee 4 billing staff, review patient accounts, run end of months reports. Daily closing, ensuring charges and payments balance, daily bank deposits, review all patient refunds along with all collection accounts and payment plans. Oversee credentialing for the providers and keeping them up to date. July 2023-Dec 2023 (per diem)
Kennebec Behavioral Health
Working special projects and assisting in training the new Director. Oct 2005 - July 2023
Patient Financial Services Director, Kennebec Behavioral Health Direct oversight of 6 staff members, which include Credentialing, Managed Care and 4 medical billers.
● Work directly with all program directors, as well as other department managers, to solve issues and make modifications procedures as necessary. ● Ensure all grants are set up properly.
● Work directly with the DHHS (Dept of Health & Human Services) office to assure we receive payment for services. I review all new contracts with insurance carriers and review the new reimbursement rates and provide input to the CFO whether the agency should proceed or not.
● Oversight of all training for the staff in my department.
● Approve and finalize all payments entered into our system. s.
●. I set up and manage all the Grants for the agency. I work directly with our IT dept to update/improve and make changes in our billing system.
● Review all financial applications that come into the department and work with the program directors to determine the best decision for each member.
● Oversee the entire department to assure billing goes out the door in a timely manner.
● I work with all programs across our agency to ensure we receive prior authorization
● I run weekly, monthly and end of year reports
Credentialing/Team Leader, Kennebec Behavioral Health
● Meet with new clinicians to set up NPI #’s
● Credential all licensed providers with proper carriers
● Provider Revalidation with insurance carriers
● Make sure all licenses and insurance are up to date
● Team Leader for all Medical Billers
● Problem solve any system issues prior to contacting the IT Department MaineCare (Medicaid) Billing Specialist/Team Leader, Kennebec Behavioral Health
● Answer multi-line telephone and transfer calls as appropriate.
● Approve all MaineCare (Maine Medicaid) bills. Batch, review, print, and send all MaineCare claims. Process approximately $250,000 - $450,000 per week in payments from the MaineCare remittance.
● Apply all miscellaneous patient payments.
● Assist in reviewing and sending out Medicare claims as well as entering the Medicare and commercial insurance payments.
● Review all outstanding accounts receivables. Re-bill all outstanding claims for MaineCare (Maine Medicaid).
● Review and send out monthly statements to clients or to our collection agency. Run weekly and monthly reports for the Chief Financial Officer.
● Responsible for sending out monthly Substance Abuse and Community Support Reports directly to the state for payment.
● Assist in processing of various grants available for our clients.
● Assist with obtaining prior authorizations required prior to providing services. I have decreased the outstanding MaineCare A/R from over 25 % down to 7
%. Work directly with Program Managers on coverage for services and verify all MaineCare (Medicaid) eligibility for our clients.
● Responsible for training all new staff for the Patient Financial Services Department. Assist staff with resolving issues regarding billing and IT/billing systems.
● In March 2007, developed and implemented a new billing software package, trained all management staff and employees. Worked directly with the IT Department to get the system up and running as well as troubleshooting and problem resolution.
2003 - 2005
Medical Receptionist/Medical Billing Clerk, Midnight Sun Family Medicine.
● Answers multi-line telephone and transfers calls as appropriate.
● Manages patient schedules for 1 Family Practice Physician and 1 Physician Assistant. Performs release of information duties.
● Accomplishes the End-of-Day report ensuring that all charges and receipts are balanced.
● Works with insurance companies (i.e. Medicare, Medicaid, BCBS, etc.) to get payments for clinic visits. Audits patient accounts for accuracy.
● Inputs checks/payments from patients and insurance companies into Medical Billing III.
● Sends out monthly bills/statements/collections to patients and insurance companies.
● Performed all front desk receptionist duties. Answers questions and checks patients in/out for appointments. Made any follow up appointments needed using exceptional customer service skills. Scanned in medical information for our electronic medical records and checked for accuracy. Maintained a high level of patient satisfaction. Decreased outstanding aging report balance by 50%.
1997 - 2003
Health Services Management Apprentice/Journeyman, 55th Medical Group, Offutt Air Force Base, NE, United States Air Force. Floor leader for one of the teams in Family Practice Clinic. Performed all tasks associated with primary care and a medical records office.
● Managed daily schedules for 25 Family Practice Physicians.
● Scheduled patient appointments, to include minor procedures.
● Provided direct oversight of the third-party billing/collections program.
● Performed release of information duties, preparing medical information for patients, attorneys, and insurance companies.
● Maintained medical records, including lab and radiology results, for providers and patients.
● Worked directly with the Legal Office to ensure the proper documentation was in order for billing insurance companies, employers, and self-pay patients. ● Performed admissions to and discharges from the hospital. Processed all paperwork for patients being transferred to another medical facility. ● Produced and reconciled the Worldwide Workload Report (WWR) monthly utilizing the Expense Assignment System III (EAS III).
● Paid travel expenses for all personnel assigned to a geographically separated unit attached to Offutt AFB.
● Worked in CHCS
Created tracking database for third party liability claims; increased money coming into Medical Group by 10-15%.
Computer Skills
MS Word, MS Excel, Medical Billing III, Healthpac Billing Software, Qualifacts Software, Neo (in-house clinical & billing software), Greenway (PrimeSuite), Phreesia
Education
1997
Health Services Management Apprentice Course 7 Weeks United States Air Force, Sheppard Air Force Base, TX. 1998
Health Services Management Journeyman Course 1 year United States Air Force, Offutt Air Force Base, NE. References
Kathy Reardon, JMG Teacher
********@***.***
Jody Bucknam,
Clinical Quality and Compliance
************@*****.***
Kennebec Behavioral Health, 207-***-****
Frith-Ann Mahar, Office Manager
Kennebec Behavioral Health, 207-***-**** cell
207-***-**** ext 1037
Josee Shelly, Chief Financial Officer
Kennebec Behavioral Health, 207-***-**** ext 1613 D.O. S. Gayle Carpenter
Family Practice Physician, Midnight Sun Family Medicine.
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