Patient Account Representative
Resume:
Peggy Daniel
Hampton,GA *****
Experience:
Conifer Healthcare Systems
● Reviewed and appealed denied and underpaid claims for the following payers: California Medicaid (Medi Cal)
Managed Care plans, Medicare Advantage Plans.
Created appeal letters with documentation listing
why should the claim should be paid.
Documentation included Managed contract
agreement, payer specific guidelines also
payer authorization approvals.
Requested, reviewed and submitted medical
records to validate reason(s) for appeal .
RSource (Contract through Prestige Staffing) 2019 - 2020
● Reviewed denied claims for the following payers for appeal purposes.
● Managed Care - Traditional Medicare - Medicare Advantage Plans and Medicaid.
● Created appeal letters, reviewed medical records to validate appeal. Submitted appeal with medical records via fax and mail. Contacted patient when necessary to obtain required information to pursue appeal process. Called payers for status of appeal.
● Documented findings in patient accounting system accordingly. Closed accounts that were denied. Emory Healthcare 2017 - 2019
Billing, Collections & Denials (Georgia Medicaid & Medicaid CMO’s)
● Analyzed denial reasons utilizing
● Explanations of Benefits & or remittance advices
● Contacted payer online or by phone to submit missing, incorrect information or invalid info (date of birth-incorrect ID number- span dates of service- authorization numbers)
● Submitted refill request if applicable.
● Submitted appeals for claims utilizing payer’s appeal form. Uploaded appeals via payers web portal if available. Also created appeal letters if applicable.
● Submitted for adjustments when applying & submitted proof for timelines when appropriate. Contract Consultant 2015 - 2017
Billing, Collections & Denials - Remote and Onsite Projects Managed Care - Medicaid -Medicare- Medicare Advantage
● Analyze assigned receivables to determine root causes for denials, underpaid & zero paid claims
● Perform as a biller & collector for Washington State and North Carolina Medicaid & Medicare receivables Obtain pre-authorizations by contacting physician offices when applicable.
● Analyze Traditional Medicare & Medicare Advantage denials, appealing denials where appropriate
● Contact carrier for status of claims
Piedmont Healthcare Corporation 2013 - 2015
Manager,3rd Party Accounts Receivables
● Maximize revenue through strong payor contracts, complete and accurate coding, and strong collection processes Oversee Contract Compliance, Medicare and Medicaid Compliance
● Maximize and monitor cash flow
● Complete revenue cycle analyses to ensure claims are submitted and paid in a timely manner.
● Implementation, and manage process improvements to improve revenue cycle performance.
● Coordinate resolution of issues and concerns regarding claims processing and billing issues across the revenue cycle.
● Monitor key metrics and leading indicators to identify and ensure successful coding, claim submission and reconciliation and collections.
● Implement actions plans as appropriate.
● Cultivate and manage strong relationships with internal and external partners and vendors.
● Establish and communicate team goals; build and enact plans to achieve success.
● Perform all talent management activities such as hiring, promoting, job performance evaluations, and disciplinary actions with appropriate approvals as required. PiedmontHealthcare Corporation – Henry Medical Center 2012- 2013 ER Registration
● Responsible for managing the coordination of front-end patient access services. Including, the collection and distribution of demographic and financial patient data collection and verification, point of service collections, customer service and other activities related to the patient access services intake process.
● Manage and report on the performance standards of the front-end patient access process. Including, but not limited to, collections, productivity related to registration.
● Responsible for communicating all goals and objectives of the department.
● Use computer systems and analytical skills to understand how a computer system fits into the workflow of the Admission Department.
● Provide technical support and consulting for PC based applications and the ability to integrate their use in the continued improvement of the Admission Department. Piedmont Healthcare Corporation – Henry Medical Center 2009 - 2012 Manager, Billing and Collections
● Direct patient accounting and reimbursement services for Commercial &Government Payors.
● Perform Supervisory and administrative work related to managing the insurance and other reimbursement functions of the Billing department.
● Monitor financial objectives and evaluate operating metrics to identify corrective actions to improve efficiencies throughout patient financial services and the revenue cycle.
● Develop corrective action plans based on findings to increase efficiencies and optimize revenue.
● Identify process improvements to increase cash flow, accelerate reimbursement and reduce denials.
● Monitors progress and resolution plans.
● Oversee the Denial Management Team focusing on root cause analysis, denial reduction planning, and denial reporting.
● Utilizes findings to modify revenue cycle policy, procedures, and processes.
● Develop, test and update changes to work queues to ensure equal changes that expedite receivables and enhance workflow and timely resolution of accounts.
● Implement standardization of revenue cycle processes and documentation of process mapping.
● Ensures standard operating processes are current and maintained on the shared folder.
● Provide oversight and direction to effectively manage the open accounts receivable volume to assure Denial Analysts have a portfolio of accounts within benchmark standards.
● Makes staffing recommendations to Director and prepares staffing analysis as requested.
● Develop and execute productivity and quality metrics across Denial department.
● Ensures Supervisor trends outcomes weekly, monthly, and annually for each denial analyst’s productivity and quality across the department.
● Perform annual performance reviews for direct reports.
● Regularly mentors and develops staff to ensure continued professional development.
● Performs weekly to bi-weekly 1:1 meetings with direct reports.
● Identify payor contract compliance discrepancies related to Commercial, Managed Care and Affordable Care Act (ACA) insurance plans.
● Conduct payor compliance trend analyses from system reports, identifies gaps, and develops program components to mitigate identified gaps.
● Conduct appeal and denial reviews and trend analysis from various sources.
● Utilizes audit reports and other appeal and denial data to revise the appeal and denial processes to ensure optimum patient outcomes with appropriate utilization of services.
● Provide ongoing evaluation and assessment of facility practices and industry changes to ensure the organization remains current in processes related to appeals and denials.
● Partner with Division Provider Relations and Clinical Appeals Unit to engage with various payers to provide feedback regarding trends and issues related to denials and underpayments.
● Assures compliance of payers to regulatory guidelines. Morgan Memorial Medical Hospital 2008 - 2009
PFS Director of Registration and Business Office
● Establish controls and review mechanisms for policies and procedures related to Patient Access, Billing and Collections
● Oversee facility operations of Patient Access, Billing & Collecting functions (e.g. pre-registration, benefit verification, preauthorization, admission/registration, service pre-payment, billing, denials management, collecting, payment posting, etc.) to ensure daily operations are maintained according to standard
● Manage the daily development and implementation of appropriate Revenue Cycle Management policy procedures, and procedures for all billing activities including follow-up on third-party approvals and collection of overdue patient accounts and Letter of Agreements (LOA).
● Supervise actions relating to delinquent accounts, collection agencies, special adjustments, and/or write-offs. Manage the development and implementation of mechanisms and controls to ensure appropriate, accurate and timely billing and payment cycles, in accordance with established internal and third party payor requirements. Monitor charge posting, billing, and/or collection operations for compliance with established policies, regulations, procedures and standards.
● Works to decrease A/R days to industry standards.
● Identify root causes of payor trends and determine appropriate resolutions.
● Effectively manage competing priorities and delegates as needed to ensure work is completed in a timely manner. Maintain up-to-date expertise and knowledge of coding (CPT and ICD-9/ ICD-10), healthcare billing laws, rules, regulations.
● Implement and monitor audit processes for a variety of disciplines.
● Maintain and promote good customer relations with facility management, physicians and physician office staff. Review Patient Access performance to ensure timeliness, accuracy, compliance and standards fulfillment.
● Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff
● education.
● Inform staff of relevant changes and developments in payer requirements.
● Ensure quality review measurements are in place.
● Oversee management of Patient Access personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action where appropriate.
● Develop specific objectives, budgets, and performance standards for each area of responsibility Identify and implement process improvements to lower costs and improve services to facility customers.
● Perform staff reviews and prepare performance documents for direct reports.
● Recommend sufficient number of qualified/competent staff.
● Determine staff qualifications and competence.
● Develops and maintains accurate initial and annual competency checklists, and initiates completion of initial and annual competency attestation forms.
● Actively seeks ways to control costs without compromising patient safety, quality of care of the services delivered.
Emanuel Medical Center 2008 - 2008
PFS Director of Registration and Business Office
● Establish controls and review mechanisms for policies and procedures related to Patient Access, Billing and Collections
● Oversee facility operations of Patient Access, Billing & Collecting functions (e.g. pre-registration, benefit verification, preauthorization, admission/registration, service pre-payment, billing, denials management, collecting, payment posting, etc.) to ensure daily operations are maintained according to standard
● Manage the daily development and implementation of appropriate Revenue Cycle Management policy procedures, and procedures for all billing activities including follow-up on third-party approvals and collection of overdue patient accounts and Letter of Agreements (LOA).
● Supervise actions relating to delinquent accounts, collection agencies, special adjustments, and/or write-offs.
● Manage the development and implementation of mechanisms and controls to ensure appropriate, accurate and timely billing and payment cycles, in accordance with established internal and third party payor requirements.
● Monitor charge posting, billing, and/or collection operations for compliance with established policies, regulations, procedures and standards.
● Works to decrease A/R days to industry standards.
● Identifies root causes of payor trends and determine appropriate resolutions.
● Effectively manages competing priorities and delegates as needed to ensure work is completed in a timely manner. Maintains up-to-date expertise and knowledge of coding (CPT and ICD-9/ ICD-10), healthcare billing laws, rules, regulations.
● Implement and monitor audit processes for a variety of disciplines.
● Maintain and promote good customer relations with facility management, physicians and physician office staff. Review Patient Access performance to ensure timeliness, accuracy, compliance and standards fulfillment.
● Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education.
● Inform staff of relevant changes and developments in payer requirements.
● Ensure quality review measurements are in place.
● Oversee management of Patient Access personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action where appropriate.
● Develop specific objectives, budgets, and performance standards for each area of responsibility Identify and implement process improvements to lower costs and improve services to facility customers.
● Perform staff reviews and prepare performance documents for direct reports.
● Recommends sufficient number of qualified/competent staff.
● Determines staff qualifications and competence.
● Develops and maintains accurate initial and annual competency checklists, and initiates completion of initial and annual competency attestation forms.
● Actively seeks ways to control costs without compromising patient safety, quality of care of the services delivered.
Southern Regional Medical Center 1998 - 2008
Manager, Government Billing, Collections and Government Accounts Receivables, Customer Service
● Maximize revenue through strong payor contracts, complete and accurate coding, and strong collection processes Oversee Contract Compliance, Medicare and Medicaid Compliance
● Maximize and monitor cash flow Complete revenue cycle analyses to ensure claims are submitted and paid in a timely manner.
● Implementation, and manage process improvements to improve revenue cycle performance.
● Coordinate resolution of issues and concerns regarding claims processing and billing issues across the revenue cycle.
● Monitor key metrics and leading indicators to identify and ensure successful coding, claim submission and reconciliation and collections.
● Implement actions plans as appropriate.
● Cultivate and manage strong relationships with internal and external partners and vendors.
● Establish and communicate team goals; build and enact plans to achieve success.
● Perform all talent management activities such as hiring, promoting, job performance evaluations, and disciplinary actions with appropriate approvals as required. User Knowledge:
DDE, EPIC, EPREMIS, Meditech, SMS, PMMC, Box, FACS, Ring Central, McKesson, Siemens, Invision, Allscipt, Passport, Image Now, One Content, Excel, Word, Power Point
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