Manager Sales

Elena Chertina

**** ***** ****** ******

Brooklyn, NY 11235

Tel: 347-***-****

*************@*****.***

Summary: Successful business specialist with 9 + years of experience in Healthcare industry with strong accomplishments in team projects and reorganizing functions to achieve improved internal operating efficiency and improved cash flow throughout. Well organized professional with great problem solving and efficient multi-tasking skills.

Experience:

07/2009 - Present Phoenix House Foundation, NY Billing and Collection Manager

As a billing and collection manager for ten residential and four outpatient substance abuse facilities, responsible for overseeing the day-to-day activities of the central billing office. As a team leader, provide administrative oversight and guidance to a group of ten direct reports that allow effective operations of the client billing department. Key responsibilities:

• Provide accurate and complete billing information to Medicaid and Medicare. Responsible for insurance verification, initial authorization and billing procedures. Remediate patient information problems.

• As a part of account reconciliation process, assist Finance department to generate quality assurance, productivity and financial reports.

• Review, coordinate and update all compliance issues in accordance with Federal, State and City rules and regulations.

• As a part of collection process, monitor established goals, net and gross collection percentages as well as aging of accounts receivable.

• Oversee billing and audit timeframes in accordance with local and state guidelines in order to avoid late submissions.

• Facilitate communications and review feedbacks between billing center and various substance abuse programs for proper funding source determination.

• Generate monthly aged reports for review and work to resolve Account Receivable delinquencies.

• Monitor established goals, net and gross collection percentages, and aging of accounts receivable.

• Provide recommendations and corrective action as appropriate.

• Assist finance department in reconciliation process by generating and interpreting productivity and financial reports.

As a Compliance Support Specialist responsible for implementation of Managed care contracts and coordination of all insurance compliance issues in according with Federal, State, and City rules and regulations. Key responsibilities:

• Review and comply with Medicaid Audits.

• Evaluate claim batches to flag and correct medical billing errors.

• Verify insurance information for accuracy and completeness and resolves discrepancies.

• Obtain clinical information needed for claim processing and reimbursement.

• Establish billing and collection procedures required for efficient billing and collections processes and respond to issues and concerns of Regional Director.

• Negotiate a Single case agreements and rate per diem with provider relation representatives.

• Resolve various denial issues and provide strategic advice and recommendation to the team members with regards to the policies, rules and regulations

• Ensure the accuracy of coded and abstracted information for all patients.

As a client care coordinator for substance abuse programs, provide effective utilization management and maintenance of client experience standards. Assign and direct work, coach staff. Schedule and organize work assignments. Key responsibilities:

• Implement staff training, special project review and resolution, and provides support to other departments as needed.

• Maintain staff productivity by monitoring employee performance, standards of conduct, and attendance.

• Resolve patient complaints by identifying problems and coordinating appropriate corrective action.

• Conduct performance appraisals and make recommendations on selection, promotion, merit increases and employee discipline.

09/2004 – 06/2009 Fazio, Rynsky & Associates LLP, NY Senior Collector

As a senior collector for a full service law firm, responsible for the entire accounts receivable portfolio. Negotiating payment terms with third party, following-up on delinquent accounts, and prepare ad hoc reports. Key responsibilities:

• Research and investigate corporate transactions and healthcare accounts receivable.

• Monitor legal preparation process for litigation and arbitration of no-fault matters.

• Prepare statements and other supporting documentation as requested by collection manager to generate prompt third party and customer payments.

• Review, coordinate, and update all payment options and procedures to insure accurate and timely collection of revenue.

• Perform analyses of billing errors for a medical private practice company.

• Research CPT codes to determine proper approach for obtaining payment from insurance companies.

• Document all account issues and problems to ensure proper follow-up with the correct insurance company.

• Complete PDR (Provider dispute resolution forms) accurately and efficiently.

• Establish payment arrangements, resolve denial issues and respond to insurance company inquiries regarding outstanding accounts.

• Research account information and creating spreadsheets for finance department.

04/2002 – 09/2004 Globe MRI Imaging, NY Medical Biller/Collector

As a billing coordinator for multiple locations accountable to maintain account relationships while effectively managing all past due account balances within assigned area of collection responsibility. Key responsibilities:

• Ensure all billing and follow-up is performed timely and accurately to prevent potential claim denials and to avoid issues with timely filing.

• Assist patients, team members, and clients with billing questions, complaints, and inquiries.

• Evaluate and analyze explanation of benefits that support payments from insurance carriers.

• Confirm accuracy of claims and fees billed.

• Collect payment for claims from insurance carriers, Medicaid and patients.

• Communicate with the healthcare providers to obtain accurate billing data.

• Research health plans for benefits or types of coverage.

• Review and process HCFA and UB-04 claim forms to identify errors in billing.

03/1996 – 04/2002 Central Sports, NY Sales Manager

As a sales professional responsible for targeting and developing new business prospects and accounts, selling solutions that help clients meet their short and long-term business objectives and managing the sales team, while meeting Central’s strategic business goals. Key responsibilities:

• Responsible for directing and implementing the sales & marketing functions for the store.

• Maintain telephone and floor sales, new customer growth, customer service and store merchandising.

• Oversee organized storage and keep running inventory of off season stock.

• Attain the required level of profitability and ensure that the store operates efficiently.

• Recruit, train and develop staff.

• Encourage effective performance and prepare staff for progression to new roles.

• Execute company sales strategies and meet monthly revenue goals.

• Develop customer relationships with key decision makers.

Skills:

• Knowledge of accounts receivable, charge entry, medical coding, AR management, collections, and cash applications.

• Knowledge of third party coverage rules, regulations, and detailed provisions of claim submission requirements.

• Knowledge of Health Insurance Claim Forms (HCFA-1500) and UB-04 requirements for medical billing purposes.

• Knowledge of Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance.

• Strong computer skills including Excel and Power Point Time.

• Principles and practices of supervision and personnel management.

• Strong oral and written communication skills.

• Detail oriented, account management and strong interpersonal skills.

• Teamwork oriented and ability to exercise reasonable judgment.

• Ability to work on multiple reporting systems (Accumed, Lytec, CATS)

Education:

Expected 2012 University of Phoenix. Master of Health Administration.

2008 – 2010 Kaplan University. Bachelor of Business Administration, concentrating in Management.

2006 – 2008 Kaplan University. Associate of Business Administration, concentrating in Management.

Reference:

Available upon request.

Contact this candidate