Highly analytical and goal-oriented professional, offering extensive experience in revenue cycle and health information technology (HIT).
Knowledgeable of medical coding systems, such as CPT-4, ICD9, and ICD10 utilized to describe medical, surgical, and diagnostic services. Skilled at identifying and troubleshooting system errors, as well as providing recommendations on necessary modifications and updates. Recognized for efficiency in working with discretion and tact, as well as outstanding work ethic. Articulate communicator and team player with well-defined analytical abilities and well-honed technical aptitudes.
Provide level I and II support to laboratory operations, including the laboratory and the Business Office to ensure continuous improvement in system performance and charge delivery.
Manage application configuration file maintenance and other required file modifications as necessary.
Demonstrate knowledge of systems analysis techniques and procedures to troubleshoot system applications based on established procedures.
Confer with laboratory operations management and other internal departments in order to provide resolution to problems.
Interface with appropriate personnel and document changes to production and/or development environments based on incidents, service requests, change control, and problem management procedures.
Play a key role as support and resource to users and other external customers by promptly applying necessary changes; answering questions; reporting and making follow-ups on problems.
Offer hands-on support to internal and external clients with the development of work flow processes based on system capabilities and enhancements.
Facilitate comprehensive training to Tricore staff by identifying billing training requirements.
Secure and properly maintain government issued regulations for billing requirements in coordination with appropriate management and/or compliance personnel.
Exemplified knowledge of electronic claims submission and retrieval, functionality of the HL7 billing messages, troubleshooting financial system errors, and documentation of the said processes despite minimal training.
Led the implementation of the ICD10 diagnosis code conversion; as well as upgrades to the financial system; served as sole financial builder for a large scale system-wide upgrade, including additions, deactivations, and modifications to test codes, reference labs, testing locations and department changes, along with extensive testing for billing for commercial payers and sponsors through interfaces.
Took charge of performing a wide range of tasks, including auditing, coding, routine and strategic pricing; along with revenue integrity analysis, revenue charge capture, and late charges.
Oversaw the maintenance and distribution of updated technical knowledge of legal and regulatory information from all appropriate jurisdictions for given clinical departments, including ICD-9, CPT-4, HCPCS, and APC updates and changes.
Provided excellent service to all PMG clinical departments in addressing daily inquiries.
Maintained active involvement in system installations and upgrades for the Revenue Department and entire organization.
Efficiently interfaced with project teams in integrating current production policies and procedures into future state on organizational upgrade.
Closely worked with key members in creating and implementing the technical/professional charge (split billing) project.
Enhanced customer service relations through successful collaboration with hospital and clinical departments.
Advanced the career from working within hospital-based to clinical-based revenue.
Received the first performance rating of 3.5 out of 4 for the department.
Expertly handled and addressed daily inquires and requests on financial statistics, billing, charging, charge master database information, and automated system interface issues.
Conducted audit of charge master using Medipac and Epic software to create charges.
Applied keen attention to detail in evaluating issues and determining solutions to be approved by the appropriate personnel prior to implementation.
Gained familiarity with medical terminology, including ICD-9, CPT-4, and HCPCS.
Obtained in-depth knowledge of healthcare finance field and revenue cycle, including patient financial services.
Succeeded in increasing revenue and workflow for the Cardiology Department.
Thoroughly assessed and validated hospital accounts with credit balances to ensure accurate posting of payments and allowances based on contractual agreements; as well as to identify the requirement of a refund or an adjustment for the resolution of account.
Prepared and submitted credit balance report and external correspondence associated with overpayments made by insurance payers or patients within established timeframes and guidelines.
Communicated with all PHS departments on discrepancies in charges, payments, and allowances inclusive to contract review posted to the accounts.
Achieved 97% accuracy with a turnaround of 21 days, enabling the attainment of savings of $50K for Presbyterian in several occasions through keen attention to detail with supporting documentation to discuss with the client.
Administered the processing of claims for Illinois, New Mexico, and Texas host business with the following requirements: claim investigation, phone calls, access on resource materials, correspondence to providers, and other Blue Cross plans.
Demonstrated skills in the utilization of several support files, including screening and editing claims data for accuracy.
Received recognition from the management for maintaining 100% quality and 97.8% productivity from April 2007 to April 2008.