Billing/Claims Manager

Debbie A. Denton

C. 617-***-**** **********@*****.***

Summary: 26 years of broad-based experience in the medical billing and management field. Proven expertise in decreasing days in A/R and increasing revenue.

*** Project Management/Reporting *** Excellent Communication Skills

*** Analytical Skills *** Team Building Skills

Software Experience: EPIC, IDX, RESOLUTE, RESOLUTE-HYPERSPACE, FACS, Athena Net, CADENCE, NEHEN, Blue Links, eClinical, Star, PowerChart, MPF, Power Point, MS Excel, MS Word, MS Outlook, MS Access

Professional Experience:

ClaimAssist, Newton, MA 01/13 – Present

Claims/Client Manager

Manage/Supervise a Staff of Ten (10)

Manage 7 Hospitals (Clients) by overseeing the MVA, Workers Compensation, and Bodily Injury, General Liability for Massachusetts, Maine, Mississippi, Georgia, Tennessee, Florida and Vermont.

Identify trends/issues for each state and resolve

Debt Analysis for Write-Off

Staff Training

Policy and Procedure Write-Up

Payment Posting, Charge Corrections

Misapplied Cash/Payment Analysis

Management of all Appeals, Resubmission's and Issuing of Refunds

Harvard Vanguard Medical Associates, Newton, MA 01/06 – 07/12

Medical Billing Supervisor

Supervise staff of seven (7)

Commercial Payer Collections/Supervision - Aetna, Cigna, CMSP, Fallon, Healthy Start Program, HCVM, PHCS, United Healthcare, and All Behavioral Health Payer’s (PacifiCare, Beacon, Magellan, UB, CBH) etc.

Oversee Medicaid and NHP

Identify trends and problems with each payer and resolve

Payment Posting, Charge Corrections

Bad Debt write-off Analysis

Billing Guidelines write-up

Staff Training

Oversee Radiation/Oncology (Billing, Appeals, Etc.)

Senior Medicaid/NHP Appeals Analyst 12/03 - 12/05

Medicaid & NHP Edit Lists, Appeals, Resubmission's, and Referrals

Late Claim Waivers

Drug Prior Authorizations Request

Payment Posting, Charge Corrections

Bad Debt write-off Analysis

Medicaid Payment Voids Coordinator

Children’s Hospital Medical Associates, Boston, MA 11/02 - 10/03

Senior Physician Claims Appeal Analyst - (Medicaid)

Supervised staff of seven (7)

Medicaid Edit List, Appeals, Resubmission's, Referrals

Identify trends and problems with payers

Commercial Payer Collections - Aetna, Cigna, CMSP, Fallon, Healthy Start Program, HCVM, PHCS and

United Healthcare

Payment Posting, Charge Corrections

Bad Debt write-off Analysis

Staff Training, Created/Maintained IDX staff work files (This also included bringing forward any IDX system issues to the IDX Analyst for resolution).

Brigham and Women Physician’s Organization, Brookline, MA 02/00 - 10/02

Orthopedic Appeals Analyst/Team Lead - (All Payers)

Supervised staff of five (5)

Medicaid Edit List, Appeals, Resubmission's, Referrals

Identify trends and problems with each payer

Commercial Payer Collections - Aetna, BCBS, Cigna, HPHP, NHP and United Healthcare

Workers Compensation Agreements and Payment Follow-up

Payment Posting, Charge Corrections, Staff Training

Free Care write-off Analysis

Bad Debt write-off Analysis

Tufts IVF Account Manager - handled Appeals, Resubmission's and Referrals

OB/GYN Senior Appeals Analyst - (All Payers) handled Appeals, Resubmission's and Referrals

Seth L. Levine DC. Brookline, MA 07/94 - 09/00

Office Manager, Billing/Medical Records Coordinator - (All Payers)

Handled Automobile Insurance Carriers Collections

Workers Compensation Collections

Patient Intake and Discharge

Supervision of all Appeals, Resubmission's and Issue Refunds

Rosenthal Chiropractic & Rehabilitation, Mattapan, MA 09/89 - 06/94

Front Desk Supervisor

Supervised staff of four (4)

Patient Scheduling/Inquiries

Billing/Medical/Diagnostic Coordinator

Handled Automobile Insurance Carriers Collections

Workers Compensation Collections

Patient Intake and Discharge

Claims Processing, Appeals and Resubmission's

Provider Licensure (Credential) Follow-up

Temporary to Permanent Experience:

Beth Israel Deaconess Medical Center, Boston, MA 01/99 - 09/00

Patient Financial Services - (BCBS) handled Claims Processing, A/R and Age Trial Balances Reports (ATB)

Olympus Healthcare/Massachusetts Respiratory Hospital, Braintree, MA 06/98 - 12/98

HME/DME Coordinator - handled online claims submissions to BCBS and Medicare, A/R and Age Trial Balances Report (ATB)

Medi-Rents Inc., Boston, MA 04/96 - 05/98

Reimbursement Representative - (All Payers) DME Billing, Patient Calls, Collections and Issue Refunds

Education:

HVMA, Newton, MA

Medical Terminology Certificate 2004

Roxbury Community College, Boston, MA 1989 - 1990

GED Curriculum Certificate equivalent to British Graduation Certificate

Wilkins College, Fortlands, St. Kitts 1984 - 1988

British Associate Program - Business Administration, Computer Programming I, II, Accounting, Business Communications Writing, Typewriting, Gregg Shorthand, Office and Telephone Etiquette

Basseterre Senior High School, Basseterre, St. Kitts

British High School Curriculum/British Graduation Certificate

References available upon request

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