Manager Registered Nurse
Resume:
Len Hales, RN, BSN, CPC
Nashville, TN 37203 Cell: 615-***-****
********@*****.***
Healthcare Management professional with a career path in healthcare administration and nursing.
Certified coding and billing manager (CPC) with 10+ years of experience in high-volume physician office and outpatient settings. Consistently achieve record-high customer satisfaction rankings, improvements to the bottom line and turnaround of underpaid claims.
Dedicated and patient-focused Registered Nurse with proven expertise in patient care, staff development, and family advocacy.
Areas of Expertise
Teambuilding & Training
Chemotherapy and other complex biological agents
Advanced ICD-9, CPT, HCPCS coding
Insurance audits (RAC, prospective and retrospective reviews, etc.)
Proficient in all areas of Electronic Health Records (EHR/EMR). Phlebotomy, Injections
Ability to maintain calm in stressful
working conditions
Cost-Reduction Strategies
Strong critical-thinking skills
Managing others while maintaining a positive working environment.
Preparing complex financial reports
Professional Experience
NASHVILLE ONCOLOGY ASSOCIATES NASHVILLE, TN 07/07 to 10/11
Coding & Billing Manager/RN
Selected Contributions:
Manage all aspects of coding, billing, and cash applications.
Dispense oral and injectable medications from in-office pharmacy.
Accurately code and post daily office charges, including IV infusions, injections, hospital charges, home health care/hospice care plan oversight, bone marrow biopsies, and pathology.
Post daily insurance payments utilizing Electronic Remittance Advices (ERA) and Electronic Funds Transfers (EFT).
Obtain all prior-authorizations for chemotherapy, injectables, and oral medications while adhering to NCCN, ASCO, and clinical trial guidelines.
Consistently research and implement updates from CMS, FDA, OIG/HIPAA, Coding newsletters, etc. in order to maintain current in all areas of coding, compliance, auditing, clinical issues, etc.
Review physicians transcription on a daily basis to check for errors in clinical documentation; communicate findings and recommendations to physicians to ensure coding compliance.
Stay abreast of and monitor practice performance in areas related to chart audits, coding accuracy, and billing.
Key player in implementation and enhancement of EHR system (Aria), including developing templates, updating ICD-9 and CPT codes, and drug regimens.
Guide practice in complex transition of practice management systems (Medical Manager > Centricity).
Accurately obtain, document, and manage patient’s medical history and medication history in EHR.
Implement process, train staff, and ensure compliance with Medicare PQRI program.
Create and administer staff training to physicians, practice administrator, clinical and clerical personnel in all areas of billing and coding.
Serve as a resource and active patient advocate; strive to understand a patient’s needs and concerns.
Prepare and analyze all financial reports, including end of month activity reports, and quality review reports to maintain optimal reimbursement and ensure practice compliance with applicable laws/regulations.
Significantly reduced outstanding accounts receivable and implemented policies to improve collections and increase cash flow.
Leonard Hales Page 2
ST. THOMAS MEDICAL GROUP NASHVILLE, TN 01/05 to 07/07
Billing & Coding Supervisor, 7/06 to 7/07
Previous Position: Coding/Billing Representative, 1/05 to 7/06
Advanced to an increasingly responsible position, culminating in management role with oversight for a team of 48 billing/coding personnel. Directed employees in appropriate coding/reimbursement for multiple specialties, including: Pulmonology, Gastroenterology, Podiatry, Internal Medicine, Urgent Care, Pediatrics, Radiology, Pathology, and Cardiology.
Selected Contributions:
Worked closely with physicians to educate them on proper documentation guidelines for E&M services as well as procedures, including: colonoscopies, bronchoscopies, thallium stress tests, cardiac tests, surgeries, etc.
Performed performance evaluations, approved time-off requests, trained new employees, and handled personnel issues.
Implemented a new work plan, redistributing tasks of all billing/coding representatives. This resulted in increased productivity and reimbursement.
Followed up with insurance carriers and patients to expedite the recovery of payment obligations.
Carefully researched and reviewed denied claims, exercising a strong working knowledge of major medical plans and leading healthcare networks.
Facilitated monthly staff meetings.
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COLIN L. HALES, M.D., P.A. PORT ARTHUR, TX 7/1996-8/03
Billing/Compliance Manager and Medical Assistant
Selected Contributions:
Efficiently managed the front desk and billing office in areas of computerized processes utilizing Medical Manager to handle scheduling, charge and payment entry, collections, medical records and insurance claims.
Assisted physician and Nurse Practitioners with examinations, suturing, routine physical examinations, and pelvic examinations.
Performed ear irrigations, pulmonary function testing, audiograms, vision screening, EKG’s, and Holter monitors.
Collected and processed blood for CBC’s and prothrombin time testing, interpreted strepscreens, urinalysis and microalbumin testing in-office.
Administered IM and SQ injections to patients and monitored for drug reaction.
Maintained day-to-day office compliance with OSHA and CLIA.
Obtained patient’s vital signs and triaged to exam rooms; applied/changed dressings.
Ensured open lines of communication and accurate charting procedures; updated computerized patient data.
Managed all aspects of accounts receivable and billing operations.
Developed and maintained practice clinical and billing procedure manual.
Reviewed A/R reports continuously to evaluate and improve collection efforts.
Prepared and deposited all payments daily.
Greeted patients at front desk, checked patients in and out as needed.
Prepared and analyzed end of month activity reports, and quality review reports.
Education and Training
American Academy of Professional Coders (AAPC) 5/07
Earned CPC certification – License # 01064375
Belmont University – Nashville, TN 8/03-12/06
Graduated with Bachelor of Science in Nursing, December 2006.
Passed NCLEX 3/07 - TN State License # RN0000158180
Leonard Hales Page 3
Professional References:
Stacey Krause, RN, OCN
Clinical Director, Nashville Oncology Associates, P.C.
351 Marlin Road
White House, TN 37188
Cindy Damon
Systems Administrator, Community Health Systems
Nashville, TN
*************@***.***
Vickie Tenry, RN, BSN
Oncology Nurse, Nashville Oncology Associates, P.C.
1405 Hilltop Drive
Mount Juliet, TN 37122
Ashley Wren-Davis
Accounts Receivable Supervisor, St. Thomas Medical Group
6852 Bridgewater Drive
Nashville, TN 37221
Personal References:
William Stull
C.P.A., YG Financial Group, PC
813 Phoenix Drive
Champaign, IL 61821
John Wireman
328 Randy Road
Madison, TN 37115
Patty Russell
907 West Cynthia Trail
Goodlettsville, TN 37072
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