Reimbursement Manager Resume Samples

Description :

1. Managed all aspects of the revenue cycle for a home infusion/specialty medication pharmacy.
2. Managed Care, HMO, and Commercial insurance plans.
3. Responsible for posting cash in excess of $1 million per month to open AR accounts.
4. Performed daily and monthly cash reconciliation to balance the computer system with accounts receivable.
5. Investigated all overpayments and underpayments to determine validity.
6. Performed refunds including preparing all necessary paperwork.
7. Conducted monthly AR meetings to review all aged accounts.
8. Assessed patient's credit to determine indigence.
9. Responsible for meeting all cash, aged AR and bad debt reserve goals established by our corporate office.

Experience

10+ Years

Level

Senior

Education

Master Of Business

Description :

1. Managed all aspects of the revenue cycle for a home infusion/specialty medication pharmacy.
2. Responsible for posting cash in excess of $1 million per month to open AR accounts.
3. Performed daily and monthly cash reconciliation to balance computer system with accounts receivable.
4. Investigated all overpayments and underpayments to determine validity.
5. Performed refunds including preparing all necessary paperwork.
6. Conducted monthly AR meetings to review all aged accounts.
7. Assessed patient's credit to determine indigence.
8. Responsible for meeting all cash, aged AR and bad debt reserve goals established by our corporate office.

Experience

10+ Years

Level

Senior

Education

Master Of Business

Description :

1. Developed all billing department's priorities, procedures, and policies.
2. Determined appropriate and effective performance metrics and staff requirements for the department to run with efficiency, accuracy and outstanding customer service.
3. Developed processes and procedures for the efficient and successful flow of interdependent information between the third party billing vendor, the receivables department and the Client billing office.
4. Designed and executed key strategies to drive the collection of earned reimbursement.
5. Developed processes and policies for exception handling, appeals and denials, and balance billing.
6. Managed the daily performance of the billing department and all accounts receivable operations.
7. Monitored all client accounts receivable activity and performance and initiates appropriate corrective measures as needed.
8. Monitored billing compliance with all third party payer regulations.
9. Ensured that customer satisfaction is achieved through courteous and effective communication, problem-solving and efficient processes.

Experience

7-10 Years

Level

Management

Education

MBA In Finance

Description :

1. Supervised and consulted with Hospital Staff for filing Medicare and Medicaid Cost Reports, and collecting the maximum appropriate amounts for services rendered.
2. Created an Excel Model for importing Hospital's Trial Balances and summarizing the data into the Cost Report Formats.
3. Assisted IT in developing automatic Medicare Bad Debt Logs.
4. Verified Medicaid eligibility to increase DHS Payments.
5. Serviced on the Closing and Transfer Committee for moving St.
6. Improved documentation on $6,000,000 of Medicare Bad Debt that was already denied in earlier Cost Reports.
7. Responsible for meeting all cash, aged ar, and bad debt reserve goals established by our corporate office.

Experience

10+ Years

Level

Senior

Education

AAS In Accounting

Description :

1. Responsible for preparing Medicare & Medicaid cost reports for four hospitals in the markets, and accounting for the amounts due to or from the programs.
2. Compiled the Medicaid eligible patient days for DSH, for Gulf Coast Division hospitals.
3. Prepared hospitals' reimbursement accounting factors, budget reimbursement factors, and logging system payment rates.
4. Responsible for handling requests of the Company's internal auditors and government program fiscal intermediary auditors.
5. Crafted electronic work paper sets for cost report work papers, year-end trial balances, and monthly exhibit models.
6. Performed quarterly on-site reviews of hospitals' exhibits and cost report related balance sheets and P&L accounts.
7. Developed proficiencies with various information systems in order to efficiently capture data needed to prepare and account for hospital cost reports.
8. Trained other Reimbursement professionals on Department systems.

Experience

7-10 Years

Level

Management

Education

Bachelor Of Business

Description :

1. Managed Medicare and commercial carrier claims to include submission, correction of insurance and demographic information, claims reconciliation and denial appeals.
2. Posted all Medicare payments electronically.
3. Provided high quality customer services to all Medicare patient questions.
4. Supervise the work of the Check Out Department to ensure adherence to quality standards, proper procedures, and correcting coding errors or problems.
5. Maintained awareness and keep Providers informed of all updated CPT codes and changes in Medicare guidelines and health insurance changes.
6. Provided employees with guidance in handling difficult or complex problems and in resolving billing disputes.
7. Interpreted and communicated work procedures and company policies to staff.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Ensured all billing procedures followed according to standard operating procedures to maximize treatment center revenue.
2. Provided exemplary leadership to all billing, insurance and financial counseling staff.
3. Negotiated contracts with Insurance carriers maintaining appropriate communication with payers, sustaining positive and mutually beneficial relationships.
4. Monitored payer contract performance and provide evaluation of potential contracting opportunities.
5. Maintained positive and loyal relationships among referring specialists.
6. Maintained database files in department electronic medical record.
7. Offered and implemented continuous improvement ideas for billing and insurance areas to enhance revenue.
8. Provided support and assistance to staff encouraging optimal performance and maintain compliance with standardized operating procedures and governmental regulations.

Experience

7-10 Years

Level

Management

Education

Medical Terminology

Description :

1. Responsible for patient accounting, payment posting, and ICD9 coding processes while billing Medicaid, Medicare, HMOs and third-party payers for behavioral health service consumers collecting annual revenue of a 13 million dollar budget.
2. Responsible for all phases of revenue cycle management, familiar with EDI 5010 set up of claim testing, client registrations, maximizing account receivables, coordinating activities with billing, administrative, credentialing license staff with a variety of insurance Thivierge 2 of 3 payers, and clinical support.
3. Managed care contracts while making recommendations to management.
4. Responsible for educating and training staff on issues related to compliance regulations and some behavioral coding issues.
5. Completed credentialing apps for license staff for Medicare, Medicaid, VA Options, CHAMPUS, Federal Health Net, Optima, Magellan, VA Options, CIGNA, and VA Premier.
6. Managed the revenue cycle plus use medical coding experience related to processing a variety of insurance claims.
7. Completed Medicaid and various insurance credentialing applications plus experience with Medicare PECOS and 855 hard copy applications.

Experience

10+ Years

Level

Senior

Education

Bachelor In Health

Description :

1. Managed a coding/medical billing office, initiate, implement and monitor policies and procedures to provide maximum billing and reimbursement revenue for the section.
2. Maintained supporting documentation and ensure compliance with government, managed care, and commercial regulations.
3. Initiated and implemented charge policy recommendations relative to coding and reimbursement guidelines.
4. Conducted periodic audits of physicians and staff for proper coding and documentation.
5. Planned and scheduled work for the group ensuring proper distribution of assignments and adequate man-power, space and facilities for performance duties.
6. Supervised various personnel actions including, but not limited to hiring, performance appraisals, promotions, transfers, and vacation schedules.
7. Conducted informative and educational meetings for the staff on coding, documentation, and reimbursement issues.

Experience

7-10 Years

Level

Management

Education

Bachelors In Business

Description :

1. Managed two computer conversions in Patient Accounts and implemented electronic billing software to replace paper billing.
2. Negotiated case management rates with insurance companies including the first Infusion Services contract with Anthem Insurance Company.
3. Evaluated the financial and clinical impact of a hemophilia factor program to determine the feasibility of adding this service.
4. Conceived Customer Service Billing Team and Respiratory Services/Billing Team.
5. Facilitated for Clinical Monitoring Team and member of Marketing Team, Hospice Team, and Fixed Asset Team.
6. Worked with minimal guidance and no supervision as the direct supervisor was located in a different city.
7. Performed daily and monthly cash reconciliation to balance the computer system with accounts receivable.

Experience

2-5 Years

Level

Junior

Education

Certified Medical