Christiana L. Harris is seeking part-time employment to supplement her income and has over 15 years of experience in professional office positions including medical billing, collections, and customer service roles. She has strong computer skills and experience with various medical billing software programs. Her background includes billing and collections work for anesthesia groups, oral surgeons, home health agencies, dental practices, and clinics.
Hospital Workers’ Compensation Claims: Strategies for Successitduediligence
Workers’ compensation claims typically account for only 3-5% of a hospital’s revenue, but require an inordinate amount of effort to bill and collect in a compliant manner. On the surface, workers’ compensation claims may appear to be similar to claims from any other payer. The patient is registered, insurance coverage is identified, the patient is treated, and bills are submitted. Any denials are addressed and ultimately cash is posted after confirming proper reimbursement. Hospitals have processes in place to deal with these functions every day. As demonstrated in this white paper, however, each step in the revenue cycle related to a workers’ compensation claim involves unique challenges.
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
There are three main strategies for billing: becoming credentialed as a provider, obtaining preauthorization before submission, and submitting the claim without prior authorization. If a pharmacist is credentialed with the insurance carrier, he or she is already authorized to submit claims to the insurance company for those patients using the pharmacist’s program.
Hospital Workers’ Compensation Claims: Strategies for Successitduediligence
Workers’ compensation claims typically account for only 3-5% of a hospital’s revenue, but require an inordinate amount of effort to bill and collect in a compliant manner. On the surface, workers’ compensation claims may appear to be similar to claims from any other payer. The patient is registered, insurance coverage is identified, the patient is treated, and bills are submitted. Any denials are addressed and ultimately cash is posted after confirming proper reimbursement. Hospitals have processes in place to deal with these functions every day. As demonstrated in this white paper, however, each step in the revenue cycle related to a workers’ compensation claim involves unique challenges.
Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance.
There are three main strategies for billing: becoming credentialed as a provider, obtaining preauthorization before submission, and submitting the claim without prior authorization. If a pharmacist is credentialed with the insurance carrier, he or she is already authorized to submit claims to the insurance company for those patients using the pharmacist’s program.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
Medical billing outsourcing assists health care entities through it’s revenue cycle management services, thus making the process smoother than ever. Medical billing outsourcing generally from USA improves revenue collection and ensures a smooth and consistent cash flow.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services.
GoTelecare Medical Billing & Coding ServicesGoTelecare
GoTelecare is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain. We deliver proprietary technologies, workflow and business processes to cater to various medical billing & coding requirements of our clients. We specialize in turnkey Revenue Cycle Management services, account receivables recovery & clean-up, DME billing and a complete range of billing & coding services for pharmacies, physicians, hospitals, nursing homes, urgent care centers, drug rehab centers and more.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
Healthcare Industry Highlight: Revenue Cycle ManagementCascadia_Capital
In our most recent Healthcare Industry Highlight Report on Revenue Cycle Management, we outline the trends driving consolidation and increased market activity and make predictions on the outlook and future of the RCM ecosystem.
Medical billing outsourcing assists health care entities through it’s revenue cycle management services, thus making the process smoother than ever. Medical billing outsourcing generally from USA improves revenue collection and ensures a smooth and consistent cash flow.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services.
GoTelecare Medical Billing & Coding ServicesGoTelecare
GoTelecare is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain. We deliver proprietary technologies, workflow and business processes to cater to various medical billing & coding requirements of our clients. We specialize in turnkey Revenue Cycle Management services, account receivables recovery & clean-up, DME billing and a complete range of billing & coding services for pharmacies, physicians, hospitals, nursing homes, urgent care centers, drug rehab centers and more.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
PYA Presentation: “Thorny Issues in FMV and Commercial Reasonableness"PYA, P.C.
PYA Principals Jim Lloyd and Lyle Oelrich presented "Thorny Issues in Fair Market Value and Commercial Reasonableness" at the Greater Kansas City Society of Healthcare Attorneys, Wednesday, April 16, 2014.
Siliconchips Services focuses on providing high-quality and cost-effective end-to-end capabilities in the business of knowledge process outsourcing. Siliconchips Services helps you to create, manage and deliver the content either for reusing or repurposing or delivery in multiple platforms.
Jane Doe455-484-6500Plum StreeLewis ,Georgia 585412Email .docxsleeperfindley
Jane Doe
455-484-6500
Plum Stree
Lewis ,Georgia 585412
Email:
[email protected]
Over 15 years experience in the health care industry and insurance finance including insurance billing, collections, tracking research, accounts receivable and customer service. I am proficient in the use of computerized billing payment systems.
Highly dependable, supportive team player who meets challenging deadlines.
Punctual, energetic and willing to learn and accept feedback. Ability to prioritize workload to ensure efficient task completion.
• Demonstrated capability of communicating to customers in a timely, polite manner
• Track record of meeting targets for staff and unit performance
• Typing speed: 60 wpm, 10 key proficiency
• Substantial knowledge of medical terminology, CPT codes and ICD-9 codes
CORE COMPETENCIES
General Accounting
GE/IDX Billing System
Medical Law & Ethics
REALMED
Medical Coding & Terminology
All scripts Healthcare
Solution
s
Medical Transcription
MYSIS Billing System
Patient Service Technician
Medical Management Billing Software
Epic
ICD-9, ICD-10
Microsoft Word
Excel
Power Point
Medical Management
Education
Long Community College
Ruff School
General Studies/Office Automation Studies
Medical Office Administration
Lewistown, Maryland
21015
Rest, Maryland
21252
September 1994-May 1996
September 1999-January 2001
Drexel University
DrexelUniversity
Associates Degree Healthcare Management
Pursing Bachelor of Healthcare Management
4220
Square Drive #200
4220
Square Drive #200
Hopefell, MD 21238
Hopefeel, MD 21238
July 2012-December 2014
December 2014-Present
References upon Request
Professional Experience
XXXXXXXXXX
Plain , Maryland June 2010- Present
Payment Specialist /Lead Cashier
·
Payment reconciliation of receivables for all major health care payers
·
Reconcile payment discrepancies from multiple parties
·
Perform charge entry and AR/AP data entry information
·
Assist in Month End book closing
·
Support the reconciliation of the medical hospital financial initiatives
·
Update supervisor of any discrepancies in payments from payers
·
Training new hires and current employees to make sure that they are current on company policies.
·
Post manual and electronic payment for all major insurance carriers
·
Completing insurance verifications for patient coming into the office for a same day visit and future visits
·
Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
·
Researches claim overpayments and requests funds
XXXXXXXXXXXX
Tiny York, Maryland July 2008 – June 2010
Reimbursement Specialist & Payment Poster
·
Post manual and electronic payment for all major insurance carriers
·
Insurance collections with all manage care organizations and commercial insurance.
·
Actively working patient billing and collections using MYSYS and Real Med.
·
Completing insurance verificat.
Common Revenue Cycle Management Challenges and How to Overcome Them
charris2016
1. Christiana L. Harris
206 Farnham Street Lawrence, MA 01843
Phone: 339.293.9313
Email: jazzkittin@gmail.com
OBJECTIVE: To work as part of a team, accomplishing the same goal:
satisfying the customer/client; seeking part-time employment to supplement income.
QUALIFICATIONS
5+ years restaurant/food service experience
15+ years’ experience in Professional Office positions.
13+years’ experience in a Physician/Dental Billing & Medical Insurance Office:
Anesthesia billing and collection services for large anesthesia physician groups and individual practitioners alike;
Payment posting experience, good communication skills, strong PC and data entry skills, with strong attention to detail;
Knowledge of HIPPA compliance and regulations, reimbursement practices, a working knowledge of automated billing
and payment posting systems.
COMPUTER/OFFICE SKILLS
Typing speed: 90+ WPM, 10-key proficient, Microsoft Windows 95/98/2000/XP/Vista/7, Microsoft Access, Microsoft
Word, Microsoft Excel, Microsoft Office, Microsoft Front Page, Microsoft Net-meeting, Microsoft Outlook Express,
Microsoft Works, Open Office, Epic, LMR, IDX, SSI, FACS, Meditech, Citrix, McKesson Star, ePremis, Basic HTML,
Data/File archiving, Document/Image scanning, PC troubleshooting/support, Internet/Email.
EDUCATION
2010-2013 Bachelors of Science; Healthcare Administration/Health Information Systems, University of Phoenix
2008-2010 Associates of Arts in Business, Axia College University of Phoenix
1990-1991 General Education, Miramar Community College
1988-1990 Telecommunications, San Diego City Community College
1984-1988 High School Diploma, Mira Mesa High School
EMPLOYMENT
2014 – 2015 Massachusetts General Hospital Assistant Billing Manager Anesthesia Charlestown, MA
Reporting to the Manager of the Group Practice Management Department, the BM Assistant supports the Billing
Managers the management of the PBO’s client relationship Work with a specific set of clients/practices to provide high
quality client support Provide research support to the Billing Manager related to AR management, patient/customer
service complaints and Third Party Requests for information Run reports from IDX (standard/AES) for the Billing
Manager/Client Assists Billing Manager in completing tasks including, but not limited to: report review and distribution,
billing account inquiries, charge batch research and procedure code dictionary maintenance. Reads and summarizes
incoming information regarding coding and billing requirements. Disseminates information to the appropriate Billing
Manager and maintains reference files. Works with the Billing Manager to analyze information on trends for practice
groups; may involve account research and/or inputting information into spreadsheets. Provides research and follow-up
for inquiries from Customer Service. Assists Billing Manager Team Leader in noting trends in service inquiries.
Provides telephone coverage to answer practice-specific questions. Attends meetings and participates on committees,
provides account follow-up, and handles special projects as needed
2010 – 2014 Massachusetts General Hospital, Billing Representative l & II, Charlestown, MA
Anesthesia and Oral Maxillofacial billing team; Perform a variety of billing functions to minimize accounts receivables;
utilizing electronic billing and medical retrieval systems as well as knowledge of medical billing and insurance rules and
regulations to resolve accounts receivable issues. Navigate patient accounts utilizing the IDX system to effectively
problem solve issues, including but not limited to reviewing relevant dictionaries to assess claim form output. Interpret
issues through effective follow-up within IDX PCS work files and requested queries. Assist in the identification of root
causes. Apply transfers and/or posting of adjustments to invoices as necessary to complete the resolution of each
invoice. Effectively handle telephone inquiries from insurance companies and other departments within the PBO. Gather
and interpret all relevant information to help resolve issues or complaints. Document issues thoroughly. Ensure that all
areas that have a direct relationship to cash flow (ie TES, claim forms, fatal and non-fatal claim edits, insurance claim
scrubber reports, and PCS work files) are worked as assigned by Team Supervisor. Maximize all features of the IDX
PCS work files to ensure thorough follow up and to trouble shoot issues. Identify and recommend adjustments to
workflows within the assigned payer/specialty specific group as it relates to current AR issues. Apply knowledge of
insurance rules and regulations to interpret new insurance/HCFA/HIPAA information and report potential impact. Make
2. recommendations and communicate trends to the Team Supervisor. Meet deadlines and productivity standards for
IDX/PCS work files, including but not limited to:
Insurance verification, Correspondence, Billing/mailing claims, Working claim edits & scrubbers, Third party follow-up
including secondary billing, Special projects.
2009- 2010 The Outsource Group, Claims Representative, Wakefield, MA
Process Motor Vehicle and Worker's Compensation claims to ensure the client (Hospital) recovers monies owed in
the most timely, efficient and confidential manner. Performed expert recovery services on all aspects of
Accident Motor Vehicle Accident and Worker's Compensation claims including: Working with Worker’s
Compensation, Motor Vehicle, and Health Insurance carriers to process for payment all related bills and to
maximize client reimbursements recovering all monies properly owed. Identify viable payer(s) and obtain all
necessary documentation to properly process the claim for payment including, when applicable, IBs, UBs,
Medical Records, POs, and EOBs when necessary. Coordinate benefits with all available payers to appropriately
maximize the client’s recovery while minimizing the patient’s personal responsibility. Review and process for
payment all claims, in which adequate billing information has been obtained, to the appropriate insurance carrier
within 24 hours of receipt of said information. Correspond with patients, employers, insurers, other parties
involved in the accident, and attorneys to obtain additional, relevant information to support the claim for monies
owed. Review status of contested claims (if applicable) and confer with attorneys and insurers regarding case
disposition. Prepare account summaries, offers of compromise, pro ration of funds, and compile other relevant
data. Remain current with all local, state and federal laws, statutes and/or fee schedules, and act within the limits
of the law. Establish and maintain constructive working relationships with insurance carriers, clients, external
business contacts and staff. Converse with insurer(s) and appeal when appropriate to guarantee that all available
benefits are recovered and that claims are reimbursed at the appropriate/maximum level(s).. Maintained the
highest level of confidentiality and comply with all HIPAA regulations.
2007-2008 Community Home Health & Hospice, Medical Billing Clerk, Longview, WA
Provide Medical Billing for the following services: Home Health/Nursing, Home Care/Bath Aide, Inpatient and Outpatient
Hospice and Uncertified Home Health services. Run edit reports for disciplines to bill monthly to Commercial Insurance,
Medicaid and Private Pay patients. Perform collection duties on accounts past due. Manage and follow up on monthly
A/R aging accounts. Perform general office and telephone duties as assigned.
2006-2007 Patient Accounts Representative, Willamette Dental, Hillsboro, OR
Provide customer service to patients by responding to phone inquiries in a professional and courteous manner. Contact
delinquent accounts, by phone or letter, to arrange payment. Follow and maintain company guidelines for ensuring
accuracy in billing for general dental and orthodontic accounts. Review orthodontic accounts with loss of insurance
coverage and prorate if applicable. Review adjustment requests and make appropriate entries on the account. Review
account credit balances and, if appropriate, request credit refund to patients and insurance company. Maintain insurance
credit balance accounts in each company and make adjustments/transfers of funds as needed. Receive and process
bankruptcy notices according to established guidelines. Make telephone calls to insurance companies, medical
providers, employers, and other outside sources to resolve questions as needed.
2005-2006 Medical Billing Specialist, Family Care Medical Clinic, Milwaukie, OR
[Temporary Position, All’s Well Health Care Services, Portland, OR]
Receive, audit, code & post payments to physician accounts; Post adjustment write-offs,
appeal to insurance companies for accurate/additional /timely payment, per written guidelines and HIPPA regulations;
process electronically received payments, prepare HCFA's ; General office/clerical duties as assigned.
2003-2005 Payment Analyst II, Anesthesiologists Associated, Inc. Beaverton, OR
Receive, code & post payments to physician accounts, audit payments for
adherence to contract terms, communicate with payers to resolve issues on problem
accounts, calculate and post adjustment write-offs, identify and bill supplemental
insurances, appeal to insurance companies for accurate / additional /timely payment,
request and issue refund checks on credit balances, per written guidelines and HIPPA
regulations, download and process electronically received payments, conduct follow up
with accounts as needed, other duties as assigned.
REFERENCES
References available upon request