Certified Professional Coder/Certified Medical Billing Specialist
Resume:
LISA A. MAURO, CPC, CMBS, CMBS-CA, CMBS-H
* ********* ****** ******, ** 12205
****.*****@*****.***
OVERVIEW
A highly motivated Credit, A/R, A/P, and Collections professional with a verifiable record of accomplishment spanning twelve years. Highly creative, recognized as a results-oriented and solution-focused individual. Areas of strength include:
• Problem Collections
• Organizational Skills
• Computer Literacy
• Work as Team Player
• Excellent Project Skills
• Represent the office/Institution in a positive manner
• Ability to work independently or
under minimal supervision
. Revenue Cycle Billing/Audit
Specialist
. Certified Professional Coder
. Certified Medical Billing
Specialist - Hospital • Legal Aspects of Collections
• Communication Skills
• Time Management Skills
• Research Abilities
• Close attention to detail
• Negotiate skillfully in tough situations, can win concessions without damaging relationships
• Able to work in a supervisory capacity
. Reimbursement Specialist
. Command of Medical Terminology/ICD-9/CPT
. Charge Entry Specialist/Certified Coder
. Certified Medical Billing Specialist
. Certified Medical Billing Specialist-Chiropractic
EDUCATION
Medical Administrative Assistant Program
Nassau Technical School, BOCES Adult Education
Westbury, NY
Medical Assisting Course 1992-1994
Molloy College, Medical Administrative Assistant Program – Continuing Education
Rockville Centre, NY 11575
Medical Terminology -1995
Medical Transcription I,II - 1995
Physician Billing I, II - 2000
ICD9-CM coding- 2002
CPT-4- 2002
DRG- 2002
The Roxbury Institutes for Medical Management 175-21 Wexford Terrace, Suite 1A
Jamaica Estates, New York 11432
24 hour CEU refresher course – proctor – Frank Chisena 02/05 – 03/05
Bryant and Stratton College, Professional Skills Centre, 1 Winners Circle, Colonie, NY 12205
Seminar on Chart Auditing – instructor- Lyn Noble – March 17, 2006
Power Weekend for CMBS Certification – Instructor – Victoria Snow – August 25-26, 2006
COMPUTER SKILLS
. Microsoft Access, Microsoft Excel
• WordPerfect, Microsoft Word
• Medical Manager, Mednet
• IDX, SMS
Albany Medical Center
Albany Medical College Physicians’ Group
618 Central Avenue
Albany, NY 12206
Provider Service Analyst July 1, 2007 – February 15, 2008
Position Summary – To work with Practice Departments/Division at Albany Medical Center on issue related to professional fee billing, MCPG and Practice operational processes and communications among Practice Departments/Divisions.
Act as a liaison between the Medical College physicians’ Group (MCPG) and the practice administrators, physicians and departmental representatives. Generate special ad hoc reports and facilitate the flow of information between the practice administrators and the AMC departments to resolve issues related to professional fee billing and insurance reimbursement. Provide the practice administrators, physicians, non-physician practioners and administrative staff with comparative data and information needed to make decisions impacting the financial operation of their practices.
• Act as a resource for MCPG and AMC Departments/Divisions on medical billing policy guidelines, reimbursement levels and group benefits in an effort to maximize reimbursement. Inform Physicians, non-physician providers and administrative staff of changes in insurance reimbursement policy and standards.
• Schedule regular on-sit office visits, orientations and seminars to enhance training and education to providers and their office staff. Remain familiar with office staff and identify new staff that may require orientation to MAC/MCPG policies and procedures in order to avoid delays and denials with professional fee billing.
• Respond to and resolve questions regarding professional fee issues, on an individual or global basis, from physicians, non-physician providers and administrative staff. Assist in identifying resources at MCPG to assist in answering questions or solving concerns.
• Conduct seminars and training programs as needed for departments/divisions on issues related to professional fee billing.
• Remain knowledgeable of all insurance products, policies and procedures and State and Federal mandates and legislation. Through excellent communication skills, educate the importance of such to the practice administrators, physicians, non-physicians practioners, and administrative staff and MCPG staff.
• Using spreadsheets develop matrixes and tabulate insurance payment data to establish insurance processing and payment trends. Examine insurance payment vouchers and other material to identify patterns of rejections and denials.
• Provide back-up to the provider representative in the generation and completion of provider credentialing packages for all new MAC physicians, including working with payers and the practices to insure provider numbers are assigned by payers in timely manner.
Provider Relations Payer Analyst January, 14, 2007 – July 1, 2007
Scheduling and attending monthly meetings with contracted payers.
Creating and maintaining organized agendas and meeting minutes.
Preparing and analyzing financial data related to payer reimbursement and rejections.
Work with Provider Service Representatives and credentialing to resolve provider billing issues related to contracted payers.
Compile and analyze information identified by A/R Follow up Supervisors of current and/or potential billing issues specific to outstanding receivable.
Work with Insurance Representatives in coordination in-house training on a continuous basis to ensure current payer policies are known and available to staff.
Maintain regularly scheduled meeting with MCPG staff to discuss Payer updates, training and Q&A sessions.
Maintain up to date payer libraries specific to provider manuals and resource coordination manuals.
Presenting data to appropriate parties and partnering to develop resolutions.
Attend Department meetings quarterly to present information that affect their practice.
A/R Follow Up Analyst-AMCPG-Corporate Finance
March 20 , 2006 – January 14, 2007
Work target files daily from Signature System for outstanding accounts greater than 30 days for all carriers, identify patterns for possible SSBL, NEIC edits, payment posting errors, work denials, back end rejections, utilize all carrier websites to obtain information in regards to claim status, appeal options, fee schedules, provider issues, coding issues all within a timely manner for proper reconsideration and reimbursement.
WINTHROP UNIVERSITY HOSPITAL – CLINICAL PRACTICE BILLING SYSTEMS
700 Hicksville Road, Ste., 204 Bethpage, NY 11714
SENIOR PHYSICIAN BILLER – APRIL 1004 – MARCH 18, 2005 PROMOTION
PHYSICIAN BILLER – MAY 2001- APRIL 2004
Inpatient and Outpatient charge entry, as well as, physician office charges through BAR IDX software program.
Line item payment posting for commercial insurance carriers, guarantor payments office co-payments, worker’s compensation, no fault, local carriers, indemnity plans, HMO, PPO, etc.
Full knowledge of Medicare guidelines, working Medicare tape remit- Medicare edi electronic posting, manual posting, contractual adjustments, charge corrections, resubmitting corrected claims, proper procedure for Medicare appeals, offsets, take backs.
Obtaining information from the CMS website in regards to NCCI guidelines, Medicare news briefs, NPI numbers, etc.
Full knowledge of Medicaid guidelines, denial codes, emergent care only, utilizations threshold authorizations through EMEVS or EPACES on line, Medicaid pending, working with the NYS Department of Health and Department of Social Services.
Full knowledge of HMO, PPO, POS guidelines, referrals, authorizations for specialty and sub specialty, radiology and anesthesia billing guidelines, hospital and ambulatory surgery, pre op and post op guidelines, global denials.
Work Claim logic reports.
Work A/R through PCS (paperless collections system) and green bar reports.
Work daily rejections on all claims while posting payments, Work monthly A/R rejections report.
Work collection reports and self payment reports.
Working with assigned insurance representative’s to resolve any discrepancies.
Working with physician practices, hospital medical records, nursing homes, to obtain information as needed
ALL ISLAND GASTROENTEROLOGY AND LIVER ASSOCIATES, P.C.
182 Earle Avenue, Lynbrook, NY 11563
Assistant to Billing Manager- Part time June, 2003- August, 2003
Enter inpatient and outpatient hospital charges for Dr. Harold Lipsky, Dr. Peter D’sa, Dr. Pradeep Bansal for services performed at Mercy Medical Center, South Nassau Communities Hospital, Franklin General Hospital and Long Beach Memorial Hospital, as well as, office charges for private practices from Lynbrook, Rockville Centre and Long Beach offices.
Assist billing Manage organizing and establishing Medical Data Management Corporation for the private practice using MDS billing software program through Medical Manager.
WINTHROP UNIVERSITY HOSPITAL – DIVISON OF GASTROENTEROLOGY
222 Station Plaza North, Ste., 428 Mineola, NY 11501
Medical Secretary II – August 26, 1997- May 2001
Front Desk Coordinator providing all secretarial support for four individuals for the private practice. Chief of Endoscopy, Chief of Gastroenterology, Director of the Women’s Health Center, and Attending Physician for Endocscopy; including all correspondence, mailings, and scheduling, patient appointments through IDX EXTEND, incoming reports, faxes, outgoing mail, and medical records.
Maintain and regulate traffic at reception area.
Daily operations for the office in regard to phones, mail sorting, copying, filing, ordering supplies
Serve as a liaison between transcription services.
Full knowledge of authorizations, referrals, Medicaid UT, all HMO guidelines for the practice and Motility Center.
Rescheduling appoints for patients and collecting co-payments.
LONG BEACH GRANDELL NURSING HOME
645 W. Broadway, Long Beach, NY 11561
Secretary to the Director of Social Services- Linda Sinowitz- 1997
Type minutes of a meeting and policy and procedure manuals for distribution.
Type medical forms for nursing staff for incoming residents.
Coordinate with Medicare for nursing home reimbursement.
Discuss financial guidelines with family members for residents and give tours of the facility.
DR. IRENE ROSENBERG, DR. ALAN NATOW, DR. IRA PION- DERMATOLOGY PRACTICE
949 Central Ave., Woodmere, NY
Medical Assistant – September 1994 – May 1997
Assist physician with biopsy procedures.
Label and records specimens for pick up.
Order supplies and stock rooms.
Prepare patient for procedures.
Clean and sterilize instruments, patient rooms according to OSHA guidelines.
Working on Medical Manager Software Program.
ACCOMPLISHMENTS
• Reduced A/R aging from an average of 87 days to 63 days in less than 7 months for outstanding accounts.
• Identified and resolved with our payer’s, high dollar claims for not paying at the correct number units billed and incorrect dollar amount according to our contracted fee schedule for our providers.
• Working with our PMMC department regarding fee schedule conflicts with our commercial carriers.
SPECIAL INTERESTS
Walking, bike riding, reading, painting, dancing, listening to music, volunteering
Contact this candidate