Accounts Receivable Provider Enrollment

Cynthia L. Moody

*** ****** ***** ****, ****** Hill, NC 27516 • 336-***-****• *************@*****.***

Dedicated Professional with over 10 years of administrative and clinical experience in documenting, reviewing medical records, and counseling, supervising, and implementing interventions to better serve patients and customers.

• Leadership/Motivation/Teamwork

• Customer Support and Satisfaction

• Education Program Development

• Problem Solving Skills

• Communication/Interpersonal Skills

• Computer Program Knowledge

• Multitasking Skills

•Time Management Skills

• Human Development and Care

PROFESSIONAL EXPERIENCE

Supervisor, Accounts Receivable, Provider Enrollment, Duke University Health System, Durham, NC - July 2022 to Present

Contribute to the achievement of the DUHS mission through the development and leadership of performance improvement activities in the operational and/or clinical arenas. Assure continual compliance with regulations and accreditation standards through monitoring activities and the design and implementation of strategies to enhance compliance. Responsible for billing and claims functions and overall management of the provider enrollment processes associated with enrolling applicable Health Systems and Physicians for all clients. Oversees and coordinates insurance collections and accounts receivable for the purpose of maximizing reimbursement, achieving A/R aging targets, minimizing avoidable/controllable write-offs, and accomplishing results as cost-effectively as possible.

A/R Management: Drive independent revenue cycle operational decisions to resolve complex issues impacting collections, patients and providers. · Prepare weekly report summarizing inventory statistics, staff productivity and collections performance, and accounts receivable aging trends · Identify deficiencies in staff performance and backlogs in inventory statistics in a timely manner, and take action to address outstanding issues · Work with Denials Analyst to monitor denial rate trends, and identify & implement opportunities to reduce post-billing denial rates · Review and approve write-off requests per policy. Provide feedback to staff if write-of requests are not in compliance with policy requirements · Review avoidable write-off trends, and identify & implement opportunities to reduce avoidable write-offs. · Pull reports to review aged outstanding insurance accounts receivable, and take necessary action to address backlogs or to identify unworked accounts · Define criteria and set up for insurance work files/worklists to ensure timely and comprehensive collection of all accounts receivable Assign staff to all insurance work files/worklists to ensure appropriate and equitable resource allocation and prioritization to outstanding workload · Review daily/weekly/monthly system reports summarizing inventory and staff performance to identify outstanding issues, including: Inventory reports, Open Denial Reports, Provider Enrollment status reports, Workgroup issue log maintenance · Research operational and system issues identified by collectors, and develop/implement solutions for performance improvement

Staff Management: Responsible for posting, recruiting, and hiring new employees. · Responsible for providing job-specific training to new and existing employees. · Responsible for completing staff mid-year and year-end performance evaluations of employees. · Review results of monthly employee quality reviews, and take action on underperforming staff results. · Ensure that all provider enrollment processes are completed in an accurate, timely manner and that credentials are up to date. · Oversee the claims billing and provider enrollment workgroup functions to ensure appropriate logic in place for revenue success. · Oversee all revalidations and verifications related to enrollment to ensure timely completion. · Responsible for oversight of completing enrollment packets for providers and groups in an accurate and timely manner. · Hold monthly team meetings to review team performance, share new policy and procedures, and keep employees informed about PRMO updates. · Identify and implement opportunities for improvement of staff morale. · Ensure compliance with all PRMO and DUHS personnel policies. · Respond to inquiries from PRMO and DUHS leadership, peers, and staff in a timely, accurate, and comprehensive manner (ie: 24-48 hours, depending on circumstances) · Adhere to all PRMO and DUHS revenue cycle policies and regulations · Respect and maintain confidentiality regarding patient/ guarantor financial data and patient medical data consistent with HIPAA standards · Validate and reassess productivity standards through observations, documenting and sharing for management review and recommend resolution/feedback. · Other duties as assigned.

Policy & Procedure and Internal Controls: Develop and maintain documentation summarizing workflow processes and operating policy & procedure for all functions handled by the team. · Complete internal controls for all operational processes, and ensure the timely completion of internal control processes.

Technical Expertise: Develop and maintain a working and effective knowledge of all functions performed by team· Develop and maintain a working knowledge of relevant payor billing requirements and reimbursement regulations · Interpret and analyze data associated with Provider Enrollment payer regulations, keeping up with all mandates · Develop and maintain a working knowledge of all core systems (Epic) and ancillary systems (Availity, SAP, ECHO, Hyland, Cognos/ReportNet) utilized by team · Develop and maintain complete understanding of all operational policies and procedures relevant to team · Develop and maintain working and proficient knowledge of personal computer software required for fulfilling management responsibilities, including: Lotus Notes, Excel spreadsheets, Word processing, Access database, Visio flowchart, PowerPoint presentation, TeamTrack Change Controls, Pillar budget, SAP, I-forms, and API PTO.

Provider Enrollment Specialist, UNC Health Care, Chapel Hill, North Carolina, 04/2019 to 07/2022

Database Management: This position is responsible for managing the relevant provider data in ECHO. This position must take a lead role in working closely with the Office of Medical Staff Services, Clinical Department contacts, Revenue Cycle, and Clinic Practice Managers to ensure the accuracy of the provider data, clinic locations, and other relevant billing /provider information. This includes providing guidance to ensure the provider information submitted will meet the payer requirements for publication in the provider directories and loading in their billing system. These are critical steps to ensure patients can locate and select a provider in the payer directory. This position is responsible for understanding the ECHO application and being able to take the lead on system modifications and re-design when needed.

Reporting: This position is responsible for compiling monthly provider reports to submit to the contracted commercial payers. These reports can be complex due to the growing number of providers hired, providers termed, new practice location openings or practice location closings. The position must follow an efficient process to ensure all applicable data is included and accurate on the report. The accuracy and timely submission are critical steps to ensure that providers and practice location are set up in the payer systems. Errors or misrepresentation of UNC Healthcare groups and/or the individual provider could result in compliance issues, potential fraudulent claims, claim denials, reduced reimbursement, and incorrect listing in the payer directories.

This position is responsible for compiling reports for commercial payer audits. Each payer may have different data requirements and report formats which we have to comply with. The position must be able to comprehend the needs and compile a report to meet the payer specifications. This position must be able to compile other ad hoc reports as needed.

Provider Enrollment Analysis: This position is responsible for providing analytical support to the Provider Enrollment Department. They must conduct analysis of provider enrollment process status, provider enrollment claim edits and claim denials to report to Revenue Cycle leadership and others as requested. They must verify the accuracy of provider data in the payer directories. They must audit the payer provider directories for accuracy by comparing what the payer has against what has been reported to them on the Master Roster.

Revenue Management: This position works with Revenue Cycle to help resolve charges which are suspended or denied due to enrollment delays or inaccurate provider data in the payer systems. In order to adequately resolve these issues, the incumbent must have a thorough knowledge of the UNC Health Care EPIC billing system, payer rules, clinical department guidelines and HIPAA regulations. They must be able to identify the cause of the suspended or denied charges and determine the appropriate steps required to resolve. These steps may vary depending on the payer, provider type and services rendered. Once a resolution is determined communication is sent to Revenue Cycle to take the next steps to finalize the charge issue.

Payer Relations: Acts as a key liaison between UNC Health Care Revenue Cycle, physicians, practice administrators, clinical department administrators and insurance payers to resolve enrollment related issues.

Facility Enrollment and Re-Credentialing: This position is responsible for completing the initial credentialing and recredentialing applications for all UNC Health Care owned and managed entities for all payers. This would include all hospitals, practice locations, Ambulatory Surgical Centers, Skilled Nursing Facilities, Hospice Facilities, Lab Outreach Facilities, and Home Health Services. The position must have a solid understanding of the credentialing and re-credentialing requirements. Each payer and facility type may have different requirements. The position must be able to interpret, explain and follow all payer regulations. This position must gather and maintain current licenses, certificates of insurance, accreditations, and other documents for all owned and managed entities. This position must collaborate with legal, compliance and other stakeholders to review the terms of the applications.

Clinical Research Study Coordinator, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, 08/2019 to 03/2020 (Part Time)

Oversee recruitment, heavy data collection and abstraction, with patient follow-up for the coordination of oncology clinical research studies within the Office of Clinical Translational Research (OCTR) at the Lineberger Comprehensive Cancer Center. The Clinical Research Study Coordinator will collaborate with oncology staff, Principal Investigators and OCTR colleagues to meet recruitment goals and facilitate compliant research procedures per GCP guidelines. The Clinical Research Study Coordinator will be responsible for administering informed consent, HIPAA, questionnaires, coordinating bio specimen collection, accurately collecting and entering data into databases, and assisting with other administrative duties as needed.

Transplant Program Assistant, UNC Health Care, Chapel Hill, North Carolina, 01/2017 to 04/2019

Responsibilities include, complex scheduling, referrals, creating appointment letters and new patient packets, entering new or renewing lab orders, data collections, retrieving medical records from outside hospitals, clinics, and labs for records. My responsibilities also include prior authorizations and managing work queues to get patients scheduled, scanning documents, then labeling documents and sending them to HIM, utilizing interpreter services by requesting and scheduling interpreters to come to patient appointments and or calling patients to help schedule their appointments and maintaining transplant episodes by changing episodes from referral, evaluation and waitlisted etc.

Claims Coding Specialist, UNC Health Care, Chapel Hill, North Carolina, 12/2016 to 04/2017

Responsibilities are ensuring accurate and timely claims payment for claims; Conducting post payment review on claim denials, including follow-up with payers to appeal denials or underpayments. We are responsible for collaborating with clinical departments to address changes in regulations, reimbursement rules, claims documentation requirements, and inappropriate filing or documentation patterns. We are also responsible for reviewing manual claims, determining documentation and information necessary to meet third party requirements and obtaining the information and filing the claim for processing. Finally, we participate in monthly meetings with coders, analysts, clinic staff and financial counselors to ensure maximum reimbursement from insurance carriers.

Financial Counselor, UNC Health Care, Chapel Hill, North Carolina, 07/2012 to 12/2016

Serve as a mentor and train new hires. Serve as a Certified Application Counselor. Perform insurance verifications on all patients prior to all radiation oncology appointments and update the system with current benefit information. Communicate with patients in person, mail, or telephone prior to office appointments regarding financial responsibility (co-pays, deductibles, etc.) and insurance benefits. Ensure patients are prepared and understand fees and payments they are expected to make during their visits. Obtain medical, radiology, and medication authorizations. Assist in housing/transportation arrangements for radiation therapy patients. Establish and negotiate payment arrangements. Maintain strong relationships with patients despite difficult financial situations. Understand when to forgo smaller scale patient balances for larger returns for future patient treatments and balances. Coordinate all patient financial activities in a timely manner. Collect fees and deposits; generates receipts, and post payments in the system. Utilize Electronic Health Record (EHR) to effectively communicate with Physicians, Coordinators, Nurse Navigators, and Social Workers, Front Desk staff, and Billing Departments. Develop and maintain protocols.

Patient Business Associate, UNC Health Care, Chapel Hill, North Carolina, 08/2011 to 07/ 2012

Assisted department with new patient activity to ensure efficient patient access to GI and Pediatrics department. Scheduled medical appointments and/or procedures by phone for new and repeat patients. Provided general information and assistance to callers regarding hospital hours, procedures, or departments. Maintained and scheduled appointments for patients and staff for procedures requiring extensive coordination with other departments. Interpreted and applied policies and procedures to respond to situations without precedent. Maintained information systems (medical records, hard copy files, automated files) according to established rules and regulations. Distributed files from information systems in accordance with policies and procedures, such as HIPAA. Ensured that all no-show, canceled, and rescheduled appointments are properly coded in the appropriate database. Answered and completed incoming calls. Directed calls to individuals or departments in accordance with established procedures. For emergency situations, initiated procedures, notified the appropriate response teams and followed-up to ensure appropriate response occurred.

Lead Mortgage Fraud Investigator, Fortace LLC, Remote, 01/2009 to 07/2011

Performed investigations on an at home basis by re-underwriting EPD and fraudulent loans to determine deficiencies against original Investor or PMI guidelines. Responsible for generating letters to lenders explaining fraud activity found in client files. Proficient in using online fraud investigation tools such as AVM's, credit reports, MARI, Zillow, Choice point, Accurint, MERS, Real Quest and The Work Number. Ensured compliance with company/investor underwriting guidelines.

Mortgage Underwriter/Fraud investigator, Contractor Clayton Staffing, Remote, 08/2007 to 12/2009 Assigned to United Guaranty as an Underwriter / Fraud Investigator. Performed audits by re-underwriting EPD and fraudulent loans to determine deficiencies against original Investor or MI guidelines. Perform audits on all fraud identified in EPD audits and MI claim files. Proficient in using online fraud investigation tools such as AVM's, credit reports, MARI, Zillow, Choice point and The Work Number. Ensured compliance with company/investor underwriting guidelines. Responsible for the payment of claims in an efficient manner. Responsible for generating letters to lenders explaining fraud activity found in client files.

Lead Due Diligence Mortgage Underwriter/Fraud investigator, HSBC – Brandon, FL 07/2004-07/2007 Worked on weekly on-site assignments or imaged loan files to increase sales volume. Evaluate loan portfolios, credit risks and assure compliance with all required legal documents. Perform purchase reviews of first and second mortgages, ARMs and HELOC loans. Underwrite multi-million-dollar loan pools and manage the assigned team accordingly. Point of contract to facilitate and maintain client/investor relations. Assisted internal Fraud Department with extensive research on problem loans to validate fraud and potential repurchase

EDUCATION and TRAINING

High Point University – High Point, NC August 1992- May 1995

Major Area of Study - Business and Marketing

COLLABORATIVE INSTITUTIONAL TRAINING INITIATIVE (CITI PROGRAM) 2019

GCP – Social and Behavioral Research Best Practices for Clinical Research

CITI Good Clinical Practice

GCP for Clinical Trials with Investigational Drugs, Biologics and Devices Course

CITI Conflicts of Interest - Other Key Personnel (COI)

Professional Development Training and Presentations

Proficient in Epic, Phoenix, Word, Excel, Microsoft Outlook, Power-point, EHR, Patient Portal, GE Centricity 5.0, Siemens A2K, CPOE, Patient Transport Tracking, Mosaiq, Sovera, CT Vision, Kronos, Passport, and Amion Scheduling

Awards - 2014 Oncology Service Excellence Award winner

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