Human Resources Behavioral Health
Resume:
John B. Loperena
Pleasant Valley, NY 12569
Phone: 914-***-****
E-mail: ************@***.***
Accomplished executive with a proven ability to start businesses and ability to run and improve established Procedures. Managed operations and customer inquiries and complaints. Resolved customers concerns.
Work Experience:
Respected leader, able to build highly motivated teams focused on achieving revenue goals. Keeps up to date with changes in the industry through continuing professional development. Serves as a mentor to the staff.
Medical Bill Reduction Advocates LLC, Pleasant Valley, NY 12569
Role: Founder
July 2014 to Present
Directed the daily activities of the reimbursement team of a Patient Advocacy Company.
Established procedures for billing therapeutic procedures for children on the Autism spectrum.
Maximized reimbursements for patients using out of network providers.
Appealed denied claims for Inpatient Addiction hospitalizations.
Triaged new cases on a weekly basis.
Ensured members are satisfied with our services.
Assisted in the development of new lines of business.
HudsonDoctors IPA and IPA of Nassau/Suffolk Counties, Hawthorne, NY 10532
Roles: Director of Credentialing, Credentials Committee Liaison/Coordinator
July 2018 to October 2021
Reviews provider files and approves or rejects them according to the NCQA standards.
Prepares provider files for the credentials committee.
Runs reports of approved files monthly and creates rosters for delegated insurance carriers.
Manages the credentialing staff.
Imports provider data from CAQH
Evaluations
Assigns provider files to the credentialing staff for completion.
Reviews provider files and approves or rejects them according to the NCQA standards.
Prepares provider files for the credentials committee.
Runs reports of approved files monthly and creates rosters for delegated insurance carriers.
Diagnostic and Medical Specialists of Greenwich, CT 06841
Roles: Director of Population Health and Revenue Cycle Management
January 2015 to October 2017
Bring the billing process in house.
Maximize utilization of the EMR (eClinicalworks)
Act as a liaison between the PC and the IPA.
Establish a Chronic Care Management (CCM) program.
Create a centralized call center for appointments
Establish a check in/ Check out area managing referrals and authorizations.
Launched the utilization of Patient Open Access App
Set up patient access to Tele visits.
Implementing Patient Centered Medical Home (PCMH)
Work with software vendor to monitor HEDIS measures.
Establish billing process for internal lab and ultrasound services.
Monitored and adjusted workflows to maximize staff efficiency.
Implemented kiosk check in, data capture and patient balance collection.
Manage the credentialing process.
Health Quest, LaGrange, NY12540 845-***-****
Role: Director of Professional Billing
July 2014 – September 2014
Select credentialing software for medical practice.
Migrate the manual credentialing process to the automated Intellicred and Intelliapp software.
Compile the raw data to merge into the Intellicred
Review screen design of the intellicred software to capture appropriate data.
Select applications to be mapped into the intellicred/intelliapp software Responsible for the daily operation of centralized physician billing operation with fifty satellite offices, two Urgent Care offices, and three affiliated Hospitals throughout Putnam, Dutchess, and Ulster Counties.
Establish billing procedures and policies for the group.
Fix problems with the current billing system
Prepare for delegated credentialing.
Act as a liaison between the PC and the Insurance Carriers.
Monitors and adjust workflows to maximize staff efficiency.
Advanced Billing Service, Inc and MediClaims Liaison, LLC, Hawthorne, NY 10532
Roles: Senior Project Manager, Director of Claims Analysis
May 2008 - July 2014
Assist our sister billing service (Advanced Billing Service) with the Intellicred/Intelliapp software as needed.
Directed the daily activities of the reimbursement team of a Patient Advocacy Company.
Established procedures for billing therapeutic procedures for children on the Autism spectrum.
Maximized reimbursements for patients using out of network providers.
Appealed denied claims for Inpatient Addiction hospitalizations.
Triaged new cases on a weekly basis.
Ensured members are satisfied with our services.
Assisted in the development of new lines of business.
Monitored and adjusted workflows to maximize staff efficiency.
Monitored the profitability of each client.
Oversee the Credentialing department and expand the use of the Intellicred/Intelliapp software.
Create reports to monitor the credentialing process.
Managed screen design of the Intellicred software.
Map applications into the intellicred/intelliapp software
Monitored and appealed claims that were not reimbursed at the contracted rate.
Payroll and evaluations
Reported to the state insurance commissioner claims that were not paid in accordance with the prompt payment act of NY.
Automated the credentialing process in preparation for delegated credentialing.
Maximized the collection activity for six clients.
Made recommendations for system enhancements on the company owned software.
Assisted with Marketing.
Assisted with clients for Northeastern Asset Recovery (Collection Agency Affiliate) as needed.
Updated staff about changes in the industry, Corporate Compliance, Correct Coding Initiatives and HIPAA
Responsible for new client setup.
Monitored and adjusted workflows to maximize staff efficiency.
Monitored the profitability of each client.
Doctors Billing Service, Ossining, NY 10562
Role: Founder
January 1998- April 2008
Evaluate and purchase credentialing software.
Installed and managed the Intelliapp software.
Managed the credentialing process of the Department of Medicine for the New York Medical College.
Created reports to monitor the credentialing process.
Responsible for the screen design to capture the credentialing data into the Intelliapp system.
Map applications into the intelliapp system
Managed all aspects of the Billing Service including Patient Registration, Charge Entry, Claims Production, Payment Posting, Collection activity, Daily and Fiscal Close for the New York Medical College Department of Medicine.
Created and analyzed reports.
Managed Credentialing of Physicians
Negotiated Managed Care Contracts for clients.
Monitored and adjusted workflows to maximize staff efficiency.
Audited payments to ensure contracted rates are being applied.
Audited claims for timely processing by the Carriers.
Monitored the profitability of each client.
Reported insurance Carriers to the NY State Insurance Dept for delinquent claims.
Reported insurance Carriers to the Medical Faculty Health Alliance IPA for failure to meet contracted obligations.
Hosted seminars to update clients on changes in industry and how they impacted on their practices.
Updated practices about Corporate Compliance, Correct Coding Initiatives and HIPAA.
Managed Payroll (PayChex) and Accounting (Quickbooks).
Westchester Medical Group PC, Rye Brook, NY 10573
Role: Associate Director of Professional Services,
July 1996 – December 1997
Supervised the credentialing of the Physicians.
Responsible for the establishment of centralized physician billing operation with multiple satellite offices throughout Westchester County.
Create a centralized call center for appointments
Establish a check in/ Check out area managing referrals and authorizations.
Established billing procedures and policies for the group.
Motivated providers to work together for the betterment of the group.
Merged existing practices into the new PC.
Payroll and evaluations
Acted as a liaison between the PC and the Insurance Carriers.
Monitored and adjusted workflows to maximize staff efficiency.
Managed all Computer Networks and acted as a liaison to the Network Vendor.
Medical Business Associates, Elmsford, NY 10523
Roles: Account Representative, Data Control Coordinator, Staff Liaison, Director of Operations
January 1988 – June 1996
Responsible for the credentialing process for all providers.
Responsible for operations of the centralized billing service.
Prepared and analyzed all fiscal reports utilizing IDX: PCX, BAR, DBMS, PCS.
Supported and maintained all system applications, hardware, and software.
Interviewed, hired, evaluated, and if necessary, terminated staff.
Created and compiled productivity reports and standards for evaluating staff.
Implemented and maintained electronic appointment scheduling system.
Analyzed collection activity by user.
Established training procedures and evaluation standards.
Supervised new account startups.
Created and monitored fee schedules for new providers.
Monitored and adjusted workflows to maximize staff efficiency.
Supervised and scheduled all software upgrades.
Implemented Medicare payment posting tape process.
Implemented registration interface with the Westchester Medical Center.
Trained staff.
New account startup, collections, and management.
Supervision of data processing staff
Interviewed and evaluated staff.
Acted as a liaison between Physicians and Insurance Carriers.
Coded and enter charges, payments, and rejections
Appealed improper payments and rejections.
Performed collection activities on delinquent accounts.
Payroll and evaluations
St. Vincent’s Hospital and Medical Center, Harrison, NY 10528
Roles: Assistant Accounts Representative, Account Representative, Senior Patient Accounts Representative, October 1984– January 1988
Responsible for all phases of inpatient hospital and outpatient billing.
Assisted with Medicaid applications.
Analyzed statistical logs.
Manual and computerized billing and collections.
Inpatient hospital billing.
Heavy collection activity
Ambulatory billing.
Statistics
Supervised cashiers
Education:
Pace University, Pleasantville, NY - Accounting and Computer Sciences
Westchester Community College, Valhalla, NY - Liberal Arts
Skills:
Knowledge of
Team leading
Payroll:
eClinicalworks, Wound expert, Healow App implementation, Healow Tele visits setup
MBA, Intellicred, EPACES
Athena’s IDX: BAR, PCS, SCHED, DBSM, SEC, PCX, IDSEXP, MGR, AND CMSR.
Medical Manager, Scheduling, Report Writer, Collection Module, Laboratory interface
Visio, Excel, Word, Word Perfect, Outlook, Publisher, Omni form, QuickBooks
CPT, ICD-10, HCPCs coding
Sales Force
Specialties:
Behavioral Health
Cardiology
Critical Care
Endocrinology
Emergency Medicine
Gastroenterology
General Surgery
Geriatrics
Hematology
Hyperbaric Medicine
Infectious Disease
Internal Medicine
Nephrology
Neurology
Oncology
Occupational Therapy
Pain Management
Physical Therapy
Otolaryngology
Orthopedic Surgery
Rehabilitation Medicine
Plastic Surgery
Psychiatry
Pulmonology
Speech Therapy
Thoracic Surgery
Urology
Weight loss management
Contact this candidate