daraschool2 att.net
Resume:
Deborah R. Anderson
Huntersville, NC *****
*****-***********@***.***
Resume
Qualifications
Bachelor of Arts and Bachelor of Science
Associates Degree General Studies
Certificate of Completion in Epic training programs Cadence, Prelude, Resolute, Ambulatory Clinical, Inpatient
JCAHO, HIPAA, HIPAA 5010, INFECTION Control
Experience
Epic Go Live Consultant Credentialed Trainer
Ochsner Medical Center June 2012- July 2012
New Orleans, LA
• Go Live Ambulatory analysis, support, assisted in training Nurses especially in E Script pharmacy.
• Designed Workflow for Nutritionist and Health Coach due to their use of only Progress Note module in Epic.
• Designed a template for Health Coach to book appointments that would relate only to their encounters.
• Trained Staff one on one to better understand their workflow.
• Assisted Physicians in the use of Note Writer, example if the ROS findings from previous note still apply, the physician can copy the information forward with one click. I demonstrated to individual physicians they can also Copy Note Writer notes from the Notes activity by selecting the note and clicking copy.
Community Health Medical Center JUNE 2012
Indianapolis, IN
• Ambulatory Go Live analysis, support and training.
• Prelude, Resolute, Cadence, and Ambulatory Physician and Nurse Support.
• Traveled to numerous sites to assist in training staff at the front desk with Registration, Insurance Cards Copy all Insurance Cards and scan into documents. Entering a copay, schedule an appointment for patient,
• Emphasize the importance of the Patient receiving their Printed AVS summary, to meet the Meaningful Use Criterion.
• Assigned Trainer to assist Physicians who were encountering an issue with their Progress notes .
Bronson Hospital May 2012
Kalamazoo, MI
• Ambulatory Go Live
• ASAP Trauma Unit
• Support Physician and Nurse in the use of the module
• Assisted Residents in the use of progress notes and to ensure they have a Physician assigned to them for Signature to sign their orders.
• Instructed physician staff on the Point of Contact, this allows the Primary Doctors to have permanent record documented in Epic the time and date the Primary Physician saw patient in Trauma Unit.
Norton Health Care March 2012
Louisville, KY
Ambulatory Go Live.
• Resolute, Prelude, Cadence, and Ambulatory support.
Norton Health
• The site I was assigned was a very unique practice. They were an Internal Practice site with four Physicians and one Nurse PR actioner.
• I trained the front desk with Registration and always following F8, to ensure they were capturing all the correct areas. The issue with this site was that they thought if at the end of Registration all the lights turned green they had completed their registration correct. This is not always the case. I retrained this staff to go into the Registration so they would verify guarantor, verify Insurance was active and the correct policy. The insurance was in correct order. This is the best way to ensure your account is complete and accurate.
• The staff with in one week had agreed their training was most beneficial. The result of a very low Front End worked, errors more related to system issues.
• The front desk was also responsible for Patients RX refills. The staff had to be trained in Ambulatory so they could continue their Job Description.
• The Practice was rated number one success with Epic at the end of Wave One.
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Moses Cone Health January – February 2012
Greensboro, NC
Ambulatory Front End Wave 1
• Black Lanyard for two sites with Moses Cone Health Heart Clinic.
• Front Desk with Registration issues (IE) entering Insurance and guarantor correctly
• I reviewed the CT charge entry issue and found the patients were not getting registered before going to their scheduled test. Escalated a ticket with Command Center to review issue.
• Assisted the Billing Staff how to use Charge Router to enter encounter details, diagnosis, hospital acct, charge codes and either Accept, ( Accept and New) Or Cancel New or Cancel.
• Assisted Billing Staff in the charge review Clinical Coding Quality worque and to understand system comment Rules.
Moses Cone Health Le Bauer Healthcare at Stoney Creek
Whitsett, NC
Ambulatory Front End Wave 1
• Front Desk, 4 staff, two were Super-Users,
• Registration, issues of insurance
• Assisted with the Super User to design a balance sheet for EOD receipts.
• Helped to understand to read ECARE response for valid insurance and when they received a lapsed insurance.
• Worked with them daily on the flow of patients, system issues that needed to be called in to Command Desk.
• Assisted in helping to set up physician schedules, not to overbook, and how to use an open space on schedule for acute appointments.
• Worked with the Nurses to Print Labels, how to go to Dar to verify patient Insurance in scanned documents for referrals, how to put a pre-cert number and authorization number in account for CT, and other specialists appointment.
• Consulted with Manager on daily basis regarding system issues that were on the Grease Board in the office as to their resolve, or discuss issues I saw coming in the system that needed to be addressed with staff, (IE) reading the insurance response from ECARE.
• Helped to understand to read ECARE response for valid insurance and when they received a lapsed insurance.
• Worked with them daily on the flow of patients, system issues that needed to be called in to Command Desk.
• Assisted in helping to set up physician schedules, not to overbook, and how to use an open space on schedule for acute appointments.
• Worked with the Nurses to Print Labels, how to go to Dar to verify patient Insurance in scanned documents for referrals, how to put a pre-cert number and authorization number in account for CT, and other specialists appointment.
• Consulted with Manager on daily basis regarding system issues that were on the Grease Board in the office as to their resolve, or discuss issues I saw coming in the system that needed to be addressed with staff, (IE) reading the insurance response from ECARE.
Northwest Community Hospital
Arlington Heights, IL May 2011-December 2011
HealthCare Consultant for: Northwest Community Hospital Arlington Heights, IL 60005
Assist staff with current billing procedures for HFS Medicaid. APL, 1500 (2360) i.e. Chemotherapy billing, Physical Therapy, Renal Dialysis, Ambulatory Surgical, Hospice; and Home Health (Medi) Revenue Cycle Analyst. Responsible for Medicaid High Dollar Accounts, Mang Pending, and Work lists for Self Pay and Workques and for Billing Actions Completed. Review HFS vouchers match Fee Schedule for accuracy of assigned level. Medicaid Billing Revenue Analyst
Review error codes for re-bill. Claims that require Paper Claims for Retroactive Eligibility from "System Date". Claims Adjudicator. Billing Claims through X Claim Med Assets System. Arlington Heights, IL 60005
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Northwest Community Hospital
Arlington Heights, IL May 2011-December2011
Ambulatory Go Live
• Go Live / XCLAIM
• Troubleshooting for the Ambulatory Hospital Billing.
• Resolved Router Issues, Charge Master Issues. APL issue.
• Billed claims for IL Medicaid. Addressed numerous billing issues that were not billing issues, they were mapping issues that caused the inability to bill for Instance Outpatient Surgery due to a name and address issue. Hospital NPI issue to be resolved...
Previous Positions
Medicaid Billing Revenue Analyst/Healthcare Consultant January 2011 – December 2011
Managed Care Lead and Third Party Collector July 2009 – January 2011
Consultant Patient Access and Clinic Coordinator August 2008 – March 2009
Consultant/Patient Access Coordinator Rush University Medical Center June 2003-December 2007 Epic Go Live Super User May 2006
Patient Services Representative Evanston Northwestern Health Care October 2002- May 2003
Epic Go Live Super User March 2003
Experience Highlights
Experience Highlights
Deborah is an Epic business system professional who has earned Certificates of Completion (Credentialed) in Cadence, Prelude, ADT/Prelude, Ambulatory, Enterprise Payment, Inpatient Registration; and Resolute Hospital and Professional Billing from three prestigious hospitals. She has 8+ years’ experience with Resolute HB PB Billing; and Pre and Post go-lives in the ambulatory clinic setting.
Her professional focus has been to provide multidimensional EMR solutions in the areas of claims, enrollment, provider relations, utilization review and others. She performs in-depth analysis of end user department workflows, data collection, report details, and other technical issues, associated with Epic software as they relate to system design; and build decisions. She is a quick thinking problem solver and is innately adept at analyzing business processes and providing and implementing innovative, concise solutions to ineffective / inefficient processes. Deborah thrives on challenge and is an outgoing team player that will have an immediate positive impact on any Epic revenue cycle implementation project.
Deborah’s experience expands over - Payment assignment by status indicator, correct Coding Edits/Initiative for Billing System, Revenue Cycle Claims Management, Hospital Billing, Physician Billing, Coding, Professional Appropriate Modifier Assignment, Down coding, Bundling, Policy Analysis. Problem Solving, Due Diligence, Adjudication of claims, Attend Seminars and Conference’s for update in IT, (HIPAA 5010 changes in CMS 1500 claim form, Evaluation and Management Billing, Medicare and Medicaid Appeals, Reimbursement, Medicare Crossover and Coding Tip & Facility charging processes, APL, and Fee Schedules. Deborah has current Digital Identity Certificate from the State of Illinois.
Under direct supervision of the department Supervisor, for using computerized Epic system applications to post payments, process, and review adjustments from insurance carriers. Within departmental guidelines, review explanations of benefits (EOBs); compare payments with charge information; and prepare and process adjustments based on review of EOBs for nonstandard Fee Schedule and for non-payment or underpayment. Maintain reporting of trends for billing errors, down-coding and other carrier specific issues.
Reviews EOBs for non-standard Fee Schedule reductions and for non-payments or under payment trends based upon carrier practices that may affect reimbursement
Scope of the project: payment posting position working within EPIC patient accounting system
Top 5 Daily Responsibilities for Epic workflow for PB billing
Payment posting, Reconcile, Research. Account Analysis, Credit Card Processing and Posting. Verify Enterprise Posting of patient account. Charge router and Clinical workque.
• She performs in-depth analysis of end user department workflows, data collection, report details, and other technical issues, associated with Epic software as they relate to system design; and build decisions.
The State of Illinois is the certificate authority for all State of Illinois Internet access... IEC System Application KCAA, IEC, ILHC, ERSA, YHP.
Resume
Professional History
Understands electronic claims submission requirements, including HIPAA transaction standards, for all non-cap managed care payers. Self-Pay Specialist to establish if patient qualifies for Medicaid or may have Health Insurance that was missed at Registration, Verify Policy for current ID number, use Accruing for background checks. Applies this knowledge to Epic Claim Edit Work Claim Edit Rules, Claim Edit WQ, Charge Review Rules, and Charge Review WQ
Charge Router Reconciliation, Account Query, Transaction Query, Revenue and Usage Reports claim submission programs and /or software. Monitors health plan claim payment/and or denial trends and identifies potential problems through established insurance follow-up activities.
Research complex problems and issues and works with health plan provider representatives and /or other DMG departments to resolve them
Assist with provider profiling, working closely with Finance provider Relations, Member Services, Health Analysis and Health Services to provide reports, assist with analysis and recommend actions. Reviews quantitative analysis of various types of data including provider contracts, fee schedules, utilization and claims data needed for assessing, planning, and budgeting, cost control and contract administration, and makes recommendations for contracting rates and policies
Confirming diagnosis and procedure codes, verify credits and AP payments from Medicaid. Utilize Medi, Ndas, and Care to verify billing NPI, PL, Taxonomy codes are correct for Adult and Children’s Medicaid services. Verify Home Health claims are billed in timely manner and if a denial is received, notify Home Health of the 90-day turn around for corrected billings. Experience with AR workflow, claims, EAP and fee Schedules. Nips Verification of payments.
Adjust patient’s accounts as soon as HFS adjudicated and paid accordingly. Write off contractual, and with Crossover, adjust Medicare deductible and Co-insurance within the limit of collector allowed amount. Refer all high dollar, denials, refunds, and adjustments to Management.
Verify all payments from Medicaid /Medicare is allocated to correct patient. Refer all accounts that have posting issues directly to Management. Submit hard copy billing for denials, refunds, or adjustments To HFS in Springfield when required. Certify Mail high dollar claims for either UB/04 or 2360(NIPS).
Request Health Assist form 2432 for patients who require assistance with Medicaid unmet Spend down.
Ensure patient financial liabilities for high dollar, uncovered medical services, and Medicaid HMO’s responsibility.
Responsible for Medicaid Report follow-up on all accounts
Defines and documents user requirements
Resume
Professional History Continued...
Applies project planning and project management methodologies
Performs analysis, design, development, and maintenance of Epic’s HB/PB applications
Performs system testing, develop test plans, and prepare test data
Provide on-site user support during implementations
Authenticates end-user data
Creates, builds, and manages customized clinical integration and risk management programs for organizations in risk arrangements with third party payers
Implements processes and actions to increase insurance cash collections, while effectively utilizing staff and systems resources
Manages external vendor relationships related to claim submission and reimbursement issues
Ensures compliance with all contractual, state and federal requirements
Understands electronic claims submission requirements, including HIPAA transaction standards, for all non-cap managed care payers
Research complex problems and issues and works with health plan provider representatives and /or other DMG departments to resolve them
Establishes workarounds, makes recommendations, and communicates my findings with Managers to discuss an implementation plan that addresses the necessary process improvements
Assist with provider profiling, working closely with Finance provider Relations, Member Services, Health Analysis and Health Services to provide reports, assist with analysis and recommend actions
Reviews quantitative analysis of various types of data including provider contracts, fee schedules, utilization and claims data needed for assessing, planning, and budgeting, cost control and contract administration, and makes recommendations for contracting rates and policies
Thoroughly familiar with industry practices, standards, and protocols
Extensive knowledge of ICD-9, CPT, and HCPCS coding, and ensuring compliance with both state and federal regulatory parameters
Resume
Education
Associates Degree General Studies Northwestern University, Chicago, IL
Bachelor of Arts and Bachelor of Science Columbia College, Chicago, IL
Certificates and Training:
Certificate of Completion in Epic training programs Cadence, Prelude and Resolute from The Epic Training Center in Deerfield, IL, Evanston Northwestern Healthcare, and Rush University Medical Center
JCAHO
HIPAA
HIPAA 5010
INFECTION CONTROL
BRIDGEFRONT Healthcare Continuing Online Education
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