A background of experience in the healthcare industry; its products and services, medical terminology, insurance complexities, as well as familiarity with clinical components the electronic health record, contracts configuration, medical billing/collections revenue cycles, personnel supervision, HIPAA compliance, and data base administration
Freedom Health Plans
- Oversee Business Configuration projects.
- Conducts gap analysis discovery between business requirements and system functionality.
- Possesses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies in a large managed care organization.
- Performs complex data modeling and database design with minimal oversight.
Mar 2008 - May 2009
•Loaded professional & institutional contracts into the Diamond System through appropriate research and provider data load activities •Performed accurate and timely provider research, verification and analysis•Loaded new providers as a result of the approved Credentialing Committee Lists•Assisted in updating payable procedure codes, price rules and fee schedules•Reviewed Hospital Contracts to ensure they can be administered•Communicated with Provider Relations when contracts can not be administered properly.•Applied a comprehensive knowledge of provider data management to the completion of assignments.
Jun 2003 - Mar 2008
National Billing Analyst
•Worked closely with the Contracts Department staff, regional Sales Representatives, and Data Management to develop and implement appropriate billing formats.•Worked closely with the Billing Analyst team to coordinate activities ensuring accurate billing across the Gentiva Health Services® and CareCentrix® network of over 350 nursing branches nationwide.•Worked proactively with the Sales organization to ensure that appropriate and deliverable billing formats are presented to prospective payers.•Reviewed payer specific billing, pricing, coding, and coverage rules during contract negotiations to ensure contracts can be effectively serviced by the system. •Ensured all information received was accurate and complete to mitigate risk of lost revenue as a result of the rate load and billing process•Coordinated with I/S Department to evaluate special billing format requests.•Provided Account ID setup/maintenance information to Data Management to ensure accurate and correctly formatted invoices. •Validated and submitted payer specific rate table changes to Data Management.
Jun 2002 - Jun 2003
- Analyzed and tracked billing errors between payers and Apria Healthcare within the contractual agreements.
- Maintained cash collection at %96 of average 90 day trailing revenue cycle according to Apria's best practices.
- Maintained revenue adjustments at or below %6 of total revenue.