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Professional Summary
Seasoned Healthcare consultant with over 20 years of experience in healthcare and medical billing. Extensive experience in customer service, administration and financial accounting. Continually exceeds expectations by maintaining calm under pressure and works well with people at all levels of the organization, including stakeholders, patients and vendors.
  • Accounting Procedures Consultant
  • Financial Reporting
  • Customer Relations
  • Multi-line Phone Operation Proficiency
  • Exceptional Workflow Management
  • Data Entry & Invoice Coding
  • Accounting Operations Professional
  • Leadership & Training
  • Budget Analysis
  • Strong Communication Skills
  • Workers Compensation
  • Administrative Functions
Work History
PBX Operator, 05/2016 to 11/2017
UPMC Pinnacle Lancaster Regional Hospital Lancaster , PA
  • Answering and completing telephone, pager and other communications efficiently adhering to hospital and departmental policies and procedures.
  • Assisting managers and director with administrative duties as well as maintaining appropriate communication links with the department manager, co-workers, physicians, and other hospital personnel with excellent customer service skills.
  • Greeting customers and visitors in-person and via telephone calls; corresponding with clients through email, telephone or postal mail; directing calls to the person or department they are seeking as well as demonstrating skillful multi-phone line abilities.
  • Interacting with vendors, contractors, and professional services personnel to receive orders, direct activities and communicate management instruction.
  • Carrying out other clerical, secretarial or receptionist duties as required such as keyboarding and data entry, bill filing and photocopying.
  • Preparing documentation and reports for office meetings, distribution, and filing as well as monitoring and screening visitors to verify accessibility to interoffice personnel.
  • Coordinated travel accommodations for staff and out-of-town visitors, including vouchers, agendas, and transportation.
  • Handling an extremely high volume of calls per day as well as functioning as the emergency on-call person for all scheduling conflicts.
Patient Access Representative/Patient Account Representative, 10/2015 to 11/2015
WY-West Park Hospital Cody , WY
  • Organizing inpatient and outpatient claims for electronic or hard copy mail and forwards to appropriate third party payers.
  • Reviewing and verifying medical bills and invoices with accounts receivable ledger and patients and ensuring record accuracy, follows up, and making necessary revisions.
  • Identifying problem accounts with payors; investigating and correcting errors, follow-up on missing account information, and resolves past-due accounts.
  • Performing various collection actions including contacting patient by phone, correcting and resubmitting claim to third party payers as well as preparing reviews and sending patient statements.
  • Processing changes in information system to support accurate and efficient billing process and financial close including following proper medical and insurance claim processes.
  • Answering inquires by phone regarding past-due accounts and insurance guidelines including handling inbound patient, insurance company and internal calls regarding billing inquiries, customer complaints and eligibility.
  • Processing credit card payments and preparing reports to identify and resolve accounts receivable.
Consultant/Medical Reimbursement Specialist, IA Medicaid, and Credit Analyst, 07/2015 to 10/2015
Wycross Christian Health Wycross , NJ
  • Determining the extent to which patients' insurance covers their treatments, reviewing appropriateness of coding and determining if care provided corresponds to the charges submitted.
  • Ensuring compliance with Federal and State regulations and company policies that govern Medicare and state payment systems as well as identifying fraudulent non-plan billing practices and assisting the legal department with litigation preparation.
  • Performing administrative duties; such as managing financial and medical records including transcribing medical reports, greeting new patients and scheduling appointments.
  • Providing accurate documentation of all services in order to assure accurate reimbursement from all payor sources.
  • Reviewing invoices for completeness and accuracy according to company and department billing guidelines and insurance process as well as preparing invoices and patient insurance information to be entered into claims filing software.
  • Establishing and maintaining required billing records and patient insurance information according to Medicare, HIPAA and other department guidelines.
Team Lead/Travel, 02/2015 to 07/2015
Mercy Hospital Des Moines , IA
  • Planning, managing and executing major tasks for consulting projects, company-wide activities and business development.
  • Maintaining work plans and timelines, preparing status reports, and ensuring effective coordination with clients and team members.
  • Conducting quantitative and qualitative analyses as well as supporting performance improvement efforts, including process assessment, data collection and reporting, and development of dashboards and scorecards.
  • Overseeing billing, payroll, AP, and AR and verified that proper procedures were followed as well as establishing implementation of an effective budgeting and accounting system that improve efficiency and reduce costs.
  • Assisting in the development of proposals, project deliverables, white papers, and other business materials including meeting with assigned supervisor, executive members, and clients to maintain good communication regarding project work, goals, challenges, and expected outcomes.
  • Performing complete analyses within the scope of the project, structuring methodologies, analyzing, summarizing the findings, and applying the findings to the project. 
  • Improving total company performance and lead multiple engagements for the client over time.
Frazier Healthcare (travel-intrim) Consulting Specialist, 06/2014 to 11/2014
Frazier Healthcare consultant (travel-intrim)- CHI Hospital
  • Following up on insurance, A/R clean-up, resolving claims, working denials, researching, customer service, phones and resolving insurance discrepancies.
  • Processing medical records request, preparing documents for scanning, adjustments, verify coverage and data entry.
Expeditative Healthcare Consultant / Insurance Billing, 02/2012 to 02/2013
Carroll Health Group
  • Insurance Follow Up (Medicare, Medicaid and Commercial plans), A/R clean-up, claims resolution, work denials, researching, appeals, customer service, phones, resolving insurance discrepancies.
  • Processing medical records request, preparing documents for scanning, adjustments, verify coverage, data entry, setting up payment plans and posting payment.
Office Manager, 11/2007 to 12/2012
Joseph Eisenberg, PhD
  • Coordinating billing and collecting/posting payments for 2-provider offices, Insurance Follow Up (Medicare, Medicaid and Commercial, Workman Comp plans), A/R clean-up, claims resolution, work denials, research, appeals, customer service, phones, resolve insurance discrepancies.
  • Processing medical records request, preparing documents for scanning, prepping court documents for attorneys, adjustments, verify coverage, data entry, setting up payment plans and  posting payment.
Billing-Patient Account Representative, 05/2005 to 11/2007
Sinai Hospital
  • Mental Health Claims-Insurance Follow Up (Medicare, Medicaid and Commercial plans) , referral coordinator (obtaining pre-cert/authorizations), A/R clean-up, claims resolution, work denials, research, appeals, customer service, phones, resolve insurance discrepancies.
  • Processing medical records request, preparing documents for scanning, adjustments, verify coverage, data entry, setting up payment plans and posting payment.
Business Administration College of Baltimore Community College - Baltimore , Maryland

All-Scripts, AS400 (HMS), Passport One Source, Click on Demand (SSI), NextGen, Navinet, One Health Port, Availity and Gateway Clearinghouse, PROVIDER-ONE, Training (Basic): McKesson Star, McKesson Horizon Patient Folder-Data (HPF), C-Snap (East Coast -CMS Secure Net Access Portal for Medicare WPS) EPIC

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Professional Summary

High performing professional with 15+ years experience in revenue cycle management, health care operations, compliance and auditing.  Comprehensive knowledge of clinical workflows from appointment scheduling/front office to claim payment including EDI claims and reimbursement, eligibility verification, (NextGen) practice management systems, electronic health records, and applicable software programs. Knowledgeable with Medicare, Medi-Cal, Managed Care and various payer programs.   Ability to communicate in a professional and confident manner with board members, clinicians, executive leadership, business audiences and direct reports. Competent in areas of leadership, training and education, innovation, and workflow improvement across diverse teams.

Certifications & Memberships
  • 2010 Certified Professional Coder (CPC License: 01102335) ICD-10 Proficient
  • Member of AAPC (American Academy of Professional Coders)
  • 2016 Certified Healthcare Financial Professional
  • Member of HFMA (Healthcare Financial Management Association)
  • 2017-2018 Executive Board Member of HFMA Southern CA Chapter
  • 2016-2018 UCSF Healthforce CLI Graduate
Skills & Accomplishments
  • Reduce days in A/R by 20 Days
  • Increase revenue per visit by 90%
  • Increase front office collection rates
  • 7 yrs NextGen EPM & File Maintenance (NCP)
  • Facilitate & develop revenue cycle training
  • MS Word, Excel, PowerPoint, Outlook proficient
  • Develop and maintain policies and procedures consistent with state and federal regulations
  • Improve clinical documentation and coding to support quality measures and initiatives
  • Network with community partners to stay current with workflows and best practices
Work History
Director of Revenue Cycle Operations, 02/2016 to Current
Parktree Community Health Center Pomona, CA
  • Bring billing in-house, build and train billing department to adhere to FQHC billing standards, and create all EDI functionality (4 locations)
  • Create billing policies and procedures as well as strategic planning for current and future processes which support HRSA compliance and annual financial audits
  • Create RCM Dashboards and present to board and executive leadership  
  • Improve workflow operations to strengthen financial and clinical processes
  • Lead UDS/OSHPD annual submission
  • Prepare data for annual Medi-Cal Reconciliation & Medicare Cost Reports
Director of Legal Support Services, 08/2015 to 02/2016
Helton Law Group, APC Huntington Beach, CA
  • Support hospital and health centers in their goals to achieve optimal revenue cycle solutions by strengthening provider and payer relationships, reducing bad debt, contract negotiation, and regulatory guidance.
  • Strategic planning for current and future business development
  • Oversee pre-litigation activities and workflows, including claim dispute analysis, reviewing medical records, managed care contracts, internal correspondence with attorneys, and monitor daily progress of revenue cycle outcomes.
Senior Healthcare Consultant, 12/2014 to 08/2015
Priority Management Group Pawtucket, RI
  • Partner with community health centers across the nation to achieve their mission by optimizing various aspects of the revenue cycle, furnishing analytics, revenue cycle/billing operational assessments, medical record reviews, coding training, ICD-10 onsite boot camps and WebExs, fee schedule analysis, and other diversified principals to support community health centers and improve their financial position.Provide training to executive leadership, clinicians, front office, coders, and billing staff.
  • Speak at conferences and host national WebExs.
  • Revenue Cycle Manager, 11/2011 to 12/2014
    Shasta Community Health Center, FQHC Redding, CA
    • Specializing in revenue cycle operations, education, development and quality management supporting 4 medical clinics and 3 dental clinics.
    • Responsible for EDI submission (837i & 837p) claims and payment processing
    • File Maintenance - Maintain current ICD, CPT, HCPCS, RVU, NDC
    • Facilitate department meetings to Billing Department as well as executive leadership presenting financial analytics.
    Claims Auditor, 11/2008 to 10/2011
    American Medical Bill Review/ExamWorks Redding, CA
    • Provide bill review and support services for physician, hospital, surgery center, peer review and legal claims to facilitate the adjudication, settlement or resolution.
    • Utilize various methodologies/programs to provide accurate payment decisions based on national billing practices, coding guidelines, LCD, NCD and CCI edits
    • Deliver education and training to in-house staff and sister companies on software, coding, and company policies.
    • Responsible for processing and updating department policy and procedures as necessary.
    Medical Biller/Coder (Cardiology), 04/2007 to 11/2008
    California Physician Reimbursement Redding, CA
  • Review medical records to confirm diagnosis and subsequent procedures.
  • Post charges and balanced to daily close.
  • Developed day-to-day work plans to meet service standards and deadlines.
  • Ensure all medical claims and documentation fall within state and federal regulations.
  • Medical Billing, Scheduler, Medical Assistant, 10/2002 to 07/2006
    Dr. Steven Mendelsohn (Cardiologist) Redding, CA
  • Perform all aspects of medical billing
  • Code & bill office diagnostic testing (echo, treadmill, dobutamine stress test)
  • Complete Medi-Cal TARs for catherization, PTCA, stents
  • Assist in daily office procedures as needed such as rooming patients, scheduling appointments, answering phones, and various clerical duties.
  • Education
    Clinic Leadership Institute: 2016-2018
    University of California, San Francisco -
    MBA: Health Administration, Health Administration, Pending
    Indiana Wesleyan University - Marion
    Bachelor of Arts: Business and Human Resource Management, 2013
    Simpson University - Redding, CA

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    Professional Summary
    Experienced sales professional  focused on team building and talent development. Driven to surpass company goals while thriving in deadline-driven environments.
    • Strategic thinker
    • Staff training and development
    • Recruitment and talent development
    • Excellent time management skills
    • Strong interpersonal skills
    • Workplace Adaptability
    • Conflict Resolution
    • Excellent communication skills
    • Planning and development
    • Process improvement
    Work History
    • Healthcare Consultant
    • PharmX Universal
    • West Palm Beach, Florida
    • May 2017 to Current
    • Strategically planned methods to achieve operational goals and targets.
    • Continually maintained and improved the company's reputation and positive image in the markets served.
    • Assisted in resolving and satisfying client requests and internal operational issues.
    • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
    • Developed and achieved financial and growth goals.
    • Business Manager
    • Verizon
    • Boca Raton , Florida
    • November 2010 to May 2016
    • Exceeded sales goals by at least 170% for 8 quarters in a row.
    • Developed metrics and measured success in order to further penetrate the marketplace.
    • Analyzed key aspects of the business to evaluate the factors driving results and summarized results into presentations.
    • Developed methods to establish and clarify customer objectives.
    • Cultivated trust between Verizon and customers by consistently delivering the desired result .
    • Department Supervisor
    • Walmart Distirbution Center
    • Smyrna, Delaware
    • March 2005 to September 2010
    • Researched and updated all required materials needed for compliance.
    • Trained staff on material handling processes to reduce receiving times.
    • Redirected shipments en route in response to customer requests.
    • Led warehouse improvement initiatives to advance operational efficiencies.
    • Tracked time spent on assignments each day for productivity reporting.
    • Cleaned and maintained the warehouse in compliance with OSHA safety standards.
    • Bachelor of Science - Business Management
    • University of Phoenix
    • 2014

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    Professional Summary

    Highly organized and meticulous professional offering excellent administrative and communication skills. Meets deadlines and works with a high level of multicultural awareness and adaptability.

    • National Dean's List Honoree 2002, 2003
    • Colorado Alliance for Continuing Medical Education (CACME) Board Member August 2014 - June 2015.
    • Microsoft Office proficiency 
    • Excel spreadsheets
    • Self-directed
    • Results-oriented
    • Meticulous attention to detail
    • Meeting planning
    • Strong interpersonal skills
    • Quick problem solver
    Work History
    US Acute Care Solutions (formerly Ergentus, P.C) Regional Supervisor, Site Operations | Denver, CO | January 2017 - Current
    • Maintains provider malpractice insurance plan enrollments, cancellations, status changes, and renewals.
    • Provides support to Vice Presidents and regional risk management.
    • Oversees provider scheduling and performs audits to ensure completion for payroll.
    • Directs submission of non-clinical hour submission for payroll.
    • Acts as regional contact for company retirement plan, Concur, and BEA accounts.
    • Directs associate to partner conversion.
    • Manages the stroke and trauma programs for the Colorado facilities.
    • Coordinates monthly meeting agendas, publishes minutes for monthly meetings, and distributes to hospital partners.
    • Retains historical data files, contacts, etc. and performs as regional contact for legacy Ergentus (ESP) practice.
    Ergentus, P.C. (Acquired by US Acute Care Solutions) Practice Manager | Denver, CO | June 2015 - January 2017
    • Managed and processed new hires, resignations, terminations and leave of absence for all employees .
    • Established, implemented, and monitored employment policies and procedures.
    • Monitored and evaluated administrative staff performance.
      Researched and provided patient information to collection agencies as requested.
    • Provided assistance to both Ergentus providers as well as hospital medical staff to ensure timely completion of all hospital credentialing applications and reappointments.    
    • Oversaw overall administrative expenses for physicians and allied health providers.
    • Completed quality data collection and collation.
    • Directed provider access to external electronic medical records (specifically KP Health connect).
    • Reviewed and distributed current and future marketing products.
    • Planned and facilitated all company business and social gatherings.
    • Supervised charitable donations.
    SCL Health - Saint Mary's Medical Center Healthcare Consultant | Grand Junction, CO | April 2015 - June 2015
    • Served as a consultant as questions arise during the CMS re-accreditation process.
    • Performed a site visit and evaluated CME program to determine a plan of action for effectiveness.
    • Prepared and submitted self-study documentation in accordance with CMS guidelines to facilitate a successful CME re-accreditation.
    • Cooperated with CME coordinator and CME co-chairs to help facilitate the re-application process through working knowledge of CME guidelines.
    SCL Health Medical Education Coordinator | Denver, CO | September 2010 - June 2015
    • Managed and evaluated the CME programs at Lutheran Medical Center and Saint Joseph Hospital to ensure continued re-accreditation.
    • Developed, planned, and facilitated continuing medical education programs that were based on identified needs at the SCL Health - Front Range hospitals.
    • Maintained CME records for all attendees.
    • Collaborated with hospital quality departments to assist in the education of physicians on identified quality projects.
    • Facilitated working relationships with Medical Staff Members and hospital departments to design CME programs that meet assessed needs.
    HealthONE Ambulatory Surgical Centers Medical Staff Coordinator | Denver, CO | October 2004 - September 2010
    • Managed the collection and review of initial applications, reappointment applications, and additional privilege requests for approximately 1200 providers.
    • Maintained follow-up procedures and obtained missing information for credentialing files.
    • Served as the primary point of contact to meet the needs of the Administrators, Physicians, Allied Health Providers and any other customer of the Surgical Center.
    • Drafted and supplied the Medical Executive Committee and Governing Board credentialing documentation.
    • Facilitated training of Medical Directors to move toward a paperless credentialing system.
    • Collaborated with Central Verification Office to improve credentialing processes and procedures.
    Bachelor of Science Psychology University of Colorado Denver, CO | 2004 Psychology
    High School Diploma Chatfield Senior High School Littleton, CO | 2000