Lisa Miller has over 30 years of experience in healthcare IT, programming, and website building. She holds several certifications including PMP, PM, CAPM, and CBAP. She has experience with many healthcare applications such as EMR, billing/accounts receivable, imaging, order entry, and more. Miller has worked in various roles for hospitals and healthcare organizations, including as an IT consultant, revenue integrity nurse, clinical financial specialist, and director of nursing. Her experience includes project management, billing audits, utilization review, case management, and staff training.
MEC Consulting Service Group designed and implemented a cost accounting module for a local healthcare institution to help control costs. The project involved (1) optimizing key software modules, (2) developing standard cost structures for procedures based on direct, indirect and overhead costs, and (3) designing reports to measure expected costs, variances, and medical staff and patient profitability to influence decision making. The new cost accounting system provides the institution with accurate and timely data to negotiate reimbursements with medical plans and identify opportunities to increase profitability.
This document outlines data requirements and plans for a care management program. It discusses:
1) Required data for care management, benchmarking, and CMS reporting including patient identification, clinical information, and staffing/budget details.
2) CMS quarterly reporting requirements including process/outcome measures and organizational/operational measures.
3) Plans for benchmarking the program by comparing patients receiving care management to matched controls using all-payer claims databases.
4) Demonstration of the TrackVia care management software and formation of a new data committee to help coordinate requirements.
The document discusses Microsoft Dynamics CRM and its applications for healthcare organizations. It describes how CRM can help with outreach, case coordination, and case management. This includes using CRM for tasks like managing patient relationships; tracking outreach campaigns, community education events, and donor relationships; coordinating care among clinicians, departments, and organizations; and proactively managing chronic conditions through automated communications and education. The document provides examples of how healthcare organizations can use Dynamics CRM to improve patient satisfaction and care while increasing efficiency.
Utilization Management is an integral part of the US healthcare ecosystem used by health insurers or Pharmacy Benefit Managers (PBMs) to evaluate the appropriateness, medical necessity, and efficiency of healthcare services rendered to patients.
Daniel Sarmiento has over 5 years of experience as a data analyst and project manager at hospitals. He has experience presenting data to hospital administration and facilitating regulatory surveys. He is knowledgeable in statistical process control and six sigma methodologies. At his current role at Loma Linda University Medical Center, he provides data analysis and support, manages organizational data, and facilitates guidelines and pathways. Previously, he collected and analyzed data regarding incidents and physician performance at Pomona Valley Hospital Medical Center. He has a Master's in Healthcare Administration and a Bachelor's in Psychology.
The document provides information on an individual's experience and qualifications for a management role. In over 20 years, they have launched and managed large-scale programs and projects to implement strategic goals. They have extensive experience in transformation programs, technology implementations, organizational growth, and mergers and acquisitions. They also enjoy focusing on team growth and efficacy in management roles.
This document contains the resume of Sena Joliffi, a 25-year healthcare professional with experience in claims processing, administrative roles, and quality assurance. She currently works as a Claims Supervisor at Molina Healthcare, where her responsibilities include monitoring claims guidelines, resolving issues, and ensuring production and quality standards are met. Previously she held roles such as Quality Coding Auditor, Ancillary Products Manager, Coder, and Patient Management Coordinator. She has extensive skills in areas like Medicare, coding, claims processing, and software programs.
Monica Wright has over 20 years of experience in insurance billing, collections, customer service, and administration. She currently works as a Billing Trainer for Emory Healthcare, where her responsibilities include training staff, processing insurance claims, working with patients on billing and payments, and managing billing operations. Previously, she held roles in medical billing and worked as a Referral Coordinator at Emory Healthcare. She aims to provide superior customer service and uses various software programs to perform her duties.
MEC Consulting Service Group designed and implemented a cost accounting module for a local healthcare institution to help control costs. The project involved (1) optimizing key software modules, (2) developing standard cost structures for procedures based on direct, indirect and overhead costs, and (3) designing reports to measure expected costs, variances, and medical staff and patient profitability to influence decision making. The new cost accounting system provides the institution with accurate and timely data to negotiate reimbursements with medical plans and identify opportunities to increase profitability.
This document outlines data requirements and plans for a care management program. It discusses:
1) Required data for care management, benchmarking, and CMS reporting including patient identification, clinical information, and staffing/budget details.
2) CMS quarterly reporting requirements including process/outcome measures and organizational/operational measures.
3) Plans for benchmarking the program by comparing patients receiving care management to matched controls using all-payer claims databases.
4) Demonstration of the TrackVia care management software and formation of a new data committee to help coordinate requirements.
The document discusses Microsoft Dynamics CRM and its applications for healthcare organizations. It describes how CRM can help with outreach, case coordination, and case management. This includes using CRM for tasks like managing patient relationships; tracking outreach campaigns, community education events, and donor relationships; coordinating care among clinicians, departments, and organizations; and proactively managing chronic conditions through automated communications and education. The document provides examples of how healthcare organizations can use Dynamics CRM to improve patient satisfaction and care while increasing efficiency.
Utilization Management is an integral part of the US healthcare ecosystem used by health insurers or Pharmacy Benefit Managers (PBMs) to evaluate the appropriateness, medical necessity, and efficiency of healthcare services rendered to patients.
Daniel Sarmiento has over 5 years of experience as a data analyst and project manager at hospitals. He has experience presenting data to hospital administration and facilitating regulatory surveys. He is knowledgeable in statistical process control and six sigma methodologies. At his current role at Loma Linda University Medical Center, he provides data analysis and support, manages organizational data, and facilitates guidelines and pathways. Previously, he collected and analyzed data regarding incidents and physician performance at Pomona Valley Hospital Medical Center. He has a Master's in Healthcare Administration and a Bachelor's in Psychology.
The document provides information on an individual's experience and qualifications for a management role. In over 20 years, they have launched and managed large-scale programs and projects to implement strategic goals. They have extensive experience in transformation programs, technology implementations, organizational growth, and mergers and acquisitions. They also enjoy focusing on team growth and efficacy in management roles.
This document contains the resume of Sena Joliffi, a 25-year healthcare professional with experience in claims processing, administrative roles, and quality assurance. She currently works as a Claims Supervisor at Molina Healthcare, where her responsibilities include monitoring claims guidelines, resolving issues, and ensuring production and quality standards are met. Previously she held roles such as Quality Coding Auditor, Ancillary Products Manager, Coder, and Patient Management Coordinator. She has extensive skills in areas like Medicare, coding, claims processing, and software programs.
Monica Wright has over 20 years of experience in insurance billing, collections, customer service, and administration. She currently works as a Billing Trainer for Emory Healthcare, where her responsibilities include training staff, processing insurance claims, working with patients on billing and payments, and managing billing operations. Previously, she held roles in medical billing and worked as a Referral Coordinator at Emory Healthcare. She aims to provide superior customer service and uses various software programs to perform her duties.
Mack Gouin has expertise in healthcare revenue cycle operations and process improvements focused on Epic revenue models. He has led multiple projects to reacquire missed revenue opportunities for home health agencies. Gouin also developed and implemented an outpatient appeals program that achieved over a 90% success rate and collected over $1.7 million for hospitals. Most recently, he served as the lead for a revenue cycle improvement project that audited unpaid insurance claims and collected an additional $134,917 in reimbursement for a home health agency.
This document is a resume for Jeanne Jones. It summarizes her experience in project management, client requirements analysis, healthcare claims and billing, and team leadership. Specifically, she has over 15 years of experience managing client implementations, analyzing requirements, and leading teams at Aon Corporation and Humana Healthcare. Her background also includes developing new processes, managing quality standards, and recovering over $500k for clients.
Stanley W. Robinson has over 20 years of experience in healthcare claims management and quality assurance. He has expertise in claims processing, provider reimbursement, and system implementations. Robinson has held several leadership roles where he managed claims operations, trained staff, and ensured claims were processed according to contracts, policies and regulatory requirements. He is proficient in various claims processing systems and tools.
Pamela Ellis has over 15 years of experience in healthcare revenue cycle management, patient access, and EMR implementation. She has held various leadership roles managing revenue cycle departments and teams, improving processes, increasing collections, and ensuring regulatory compliance. Her experience spans a variety of healthcare settings including hospice, laboratories, hospitals, and academic physician groups.
Peggy Gedzyk has over 25 years of experience in healthcare operations management. She has a track record of streamlining operations, realizing cost savings, and developing new leaders. Most recently, she led a team that ensured the timely and secure transfer of over 500 million data records between prescription benefit managers. She has also held management roles overseeing medical claims departments and has a background in quality assurance testing.
Pamela Ellis has over 20 years of experience in healthcare revenue cycle management, patient access, and EMR/EPM implementation. She has held various leadership roles at healthcare organizations and consulting firms, managing teams and improving revenue cycle processes through initiatives like denial recovery, training development, and system implementations. Her background includes experience with revenue cycle assessments, interim management, and strategic planning.
Chaka Bell is an analytical and results-driven consultant with over 10 years of experience in claims systems and clinical applications implementations, with a focus on compliance and clinical reporting. She has experience as a project manager, business analyst, and operations manager supporting various health insurance clients. Her expertise includes configuration of claims, membership, provider, and medical management systems, as well as NCQA HEDIS and AHCA Florida Medicaid reporting.
Kym Wilson has over 20 years of experience in healthcare management, medical billing, collections, and compliance. She has held roles as a Recovery Audit Coordinator, Accounts Receivable Supervisor, Compliance Manager, and Appeals Analyst. Wilson has strong analytical skills and experience implementing policies and procedures to ensure regulatory compliance.
Charles B.J. has over 15 years of experience in transitions, project management, operations management, quality, and process management. He has successfully transitioned several onshore projects for different companies in various industries. Currently serving as a senior manager, his responsibilities include client relationship management, service delivery management, budgeting, transition management, and business expansion. He has extensive experience working with clients in industries such as healthcare, insurance, and pharmaceuticals.
Driving Value - Taking the Healthcare Revenue Cycle to the Next Level.pdfAGSHealth1
As hospitals and healthcare systems evolve to meet the needs of a growing and aging population, they find themselves struggling to remain financially healthy.
https://www.agshealth.com/blog/driving-value-taking-the-healthcare-revenue-cycle-to-the-next-level/
EEPAK MATHUR has over 19 years of experience in healthcare analytics and informatics. He currently serves as the Director of Healthcare Reporting and Analytics at Visiting Nurse Service of New York, where he oversees analytical teams and regulatory reporting. Prior to this role, he held several positions involving data analytics, reporting, and quality improvement at organizations like Oxford Health Plans and CIGNA Healthcare. EEPAK MATHUR has expertise in areas like SAS programming, dashboarding, data quality, and reporting to CMS and the New York Department of Health. He also has experience developing analytical strategies to increase revenue and optimize business objectives.
This document provides a summary of Frank Spencer's qualifications and experience in healthcare administration and medical coding. It includes his contact information, education history with multiple degrees, and certifications in areas such as coding, case management, and healthcare administration. The summary highlights over 15 years of experience in roles focused on medical coding, revenue cycle management, and provider education at healthcare organizations in Maine.
This document provides a summary of a medical billing and coding professional's qualifications. It includes 3 sentences summarizing her objective, education, and current role as a medical risk adjustment field auditor reviewing medical records to ensure accurate risk adjustment coding.
Cristina Gomez is an experienced health information management professional with over 25 years of experience. She has a bachelor's degree in health information management and is a certified registered health information technician. Gomez has extensive experience implementing electronic health records and other technologies to improve efficiency and compliance. She is skilled in areas such as leadership, health information exchange, and project management.
CODING CONNECTIONS IN REVENUE CYCLE MANAGEMENT WORKSHEETINSTRUCT.docxclarebernice
CODING CONNECTIONS IN REVENUE CYCLE MANAGEMENT WORKSHEET
INSTRUCTIONS: Read the AHIMA article, Coding Connections in Revenue Cycle Management by Ruth Cummins, RHIA, CCS and Julie Waddell. Complete the worksheet by answering the questions. Submit your answers by the assignment drop box.
Why is it important that the MRN connect the patient documentation to the services provided? (2 point)
Answer:
Who should assign patient type to the patient? (1 point)
Answer:
Explain why coding staff should have access to source documentation. (1 point)
Answer:
Why is it a good idea to have front-line staff and coding staff working together? (2 points)
Answer:
Can the revenue cycle process be affected by coding staff? Can you give a reason? (2 point)
Answer:
In the hospital setting how are routine diagnostic services such as lab and radiology services charged to the patient? (2 point)
Answer:
How do they determine which codes belong in the charge master and not coded by a coder? (2 points)
Answer:
Why should concurrent clinical documentation management programs and query processes by implemented? (2 point)
List 2 reasons coding quality and productivity standards should be established: (1 point)
Answer:
Why do revenue integrity teams need coding professionals? (1 point)
Answer:
What are the 2 key revenue cycle components that occur in patient financial services? (1 point)
Answer:
Why is it important for HIM to have an effective DNFB Reporting tool? (1 point)
Answer:
What function do coders perform that helps to reduce the number of medical necessity denials? (1 point)
Answer:
What are OCE and CCI Edits? (1 point)
Answer:
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027450.hcsp?dDocName=bok1_027450
Coding Connections in Revenue Cycle Management
by Ruth Cummins, RHIA, CCS, and Julie Waddell
Recently, there has been a significant amount of talk in the healthcare industry about revenue cycle improvement. So what is all of the excitement about? It is about the bottom line. Specifically, how we can improve our bottom line through more effective and efficient revenue cycle management. For hospitals to maintain financial viability under the pressures of the current healthcare environment, the revenue cycle must be a significant focal point, and HIM and coding professionals should play major roles in the process. This article will highlight many of the coding connections for the key revenue cycle processes within patient access, HIM, and patient financial services.
The Coding Connection in Patient Access Services
Critical revenue cycle processes that occur in the patient access department include initial data collection (e.g., name, date of birth, insurance information, reason for admission, patient type); medical record number (MRN) assignment; and medical necessity determination. Coding connects (or needs to connect) with patient access services in the following areas: MRN, patient type, source documentation, and me ...
This document contains the resume of Cynthia Martinez, who has extensive experience in healthcare revenue cycle operations and project management, including overseeing the implementation of electronic medical records and billing systems. She is skilled in process improvement, team leadership, and ensuring projects are delivered on time and under budget.
This document contains the resume of Cynthia Martinez, who has extensive experience overseeing revenue cycle operations and implementing electronic medical record systems like Epic for various healthcare organizations. She is skilled in project management, process improvement, and financial analysis. Key experiences include directing revenue cycle functions for large multi-specialty practices and hospitals, and leading the implementation of Epic and other systems to optimize billing and collections.
Med Direct Patient Pay Solutions 12 11 09v1 (Printable Version)Agoetze
MedDirect is a patient-centric healthcare services company that focuses on delivering comprehensive revenue cycle management services to physicians and hospitals. They help increase patient payments and enhance the patient experience. MedDirect addresses complex reimbursement systems, a lack of patient education and options, and financial risks through a patient-centric software platform, call center staffed with payment experts, and multiple payment options. Their approach aims to improve operations, increase patient satisfaction and payments, and provide value to healthcare providers.
Whitney Brian is seeking a position that utilizes communication and interpersonal skills. He has a Bachelor's degree in Human Services from Touro College. Brian has over 10 years of experience in customer service roles within the healthcare industry, including at Emblem Health and HealthPlus Amerigroup. His experience includes authorizing services, handling customer inquiries, training staff, and making process changes to improve customer satisfaction. He is skilled in areas such as government relations, claims processing, cultural awareness, and Microsoft Office applications.
Christopher Greene is a healthcare IT consultant with over 12 years of experience advising Fortune 500 healthcare companies on projects valued at $200 million. He has expertise in EMR/EHR systems, clinical applications, and healthcare business systems. Greene has worked with over 50 healthcare organizations, including hospitals, insurance companies, and government agencies. He specializes in system integrations, data standards, regulatory compliance, and user training.
Mack Gouin has expertise in healthcare revenue cycle operations and process improvements focused on Epic revenue models. He has led multiple projects to reacquire missed revenue opportunities for home health agencies. Gouin also developed and implemented an outpatient appeals program that achieved over a 90% success rate and collected over $1.7 million for hospitals. Most recently, he served as the lead for a revenue cycle improvement project that audited unpaid insurance claims and collected an additional $134,917 in reimbursement for a home health agency.
This document is a resume for Jeanne Jones. It summarizes her experience in project management, client requirements analysis, healthcare claims and billing, and team leadership. Specifically, she has over 15 years of experience managing client implementations, analyzing requirements, and leading teams at Aon Corporation and Humana Healthcare. Her background also includes developing new processes, managing quality standards, and recovering over $500k for clients.
Stanley W. Robinson has over 20 years of experience in healthcare claims management and quality assurance. He has expertise in claims processing, provider reimbursement, and system implementations. Robinson has held several leadership roles where he managed claims operations, trained staff, and ensured claims were processed according to contracts, policies and regulatory requirements. He is proficient in various claims processing systems and tools.
Pamela Ellis has over 15 years of experience in healthcare revenue cycle management, patient access, and EMR implementation. She has held various leadership roles managing revenue cycle departments and teams, improving processes, increasing collections, and ensuring regulatory compliance. Her experience spans a variety of healthcare settings including hospice, laboratories, hospitals, and academic physician groups.
Peggy Gedzyk has over 25 years of experience in healthcare operations management. She has a track record of streamlining operations, realizing cost savings, and developing new leaders. Most recently, she led a team that ensured the timely and secure transfer of over 500 million data records between prescription benefit managers. She has also held management roles overseeing medical claims departments and has a background in quality assurance testing.
Pamela Ellis has over 20 years of experience in healthcare revenue cycle management, patient access, and EMR/EPM implementation. She has held various leadership roles at healthcare organizations and consulting firms, managing teams and improving revenue cycle processes through initiatives like denial recovery, training development, and system implementations. Her background includes experience with revenue cycle assessments, interim management, and strategic planning.
Chaka Bell is an analytical and results-driven consultant with over 10 years of experience in claims systems and clinical applications implementations, with a focus on compliance and clinical reporting. She has experience as a project manager, business analyst, and operations manager supporting various health insurance clients. Her expertise includes configuration of claims, membership, provider, and medical management systems, as well as NCQA HEDIS and AHCA Florida Medicaid reporting.
Kym Wilson has over 20 years of experience in healthcare management, medical billing, collections, and compliance. She has held roles as a Recovery Audit Coordinator, Accounts Receivable Supervisor, Compliance Manager, and Appeals Analyst. Wilson has strong analytical skills and experience implementing policies and procedures to ensure regulatory compliance.
Charles B.J. has over 15 years of experience in transitions, project management, operations management, quality, and process management. He has successfully transitioned several onshore projects for different companies in various industries. Currently serving as a senior manager, his responsibilities include client relationship management, service delivery management, budgeting, transition management, and business expansion. He has extensive experience working with clients in industries such as healthcare, insurance, and pharmaceuticals.
Driving Value - Taking the Healthcare Revenue Cycle to the Next Level.pdfAGSHealth1
As hospitals and healthcare systems evolve to meet the needs of a growing and aging population, they find themselves struggling to remain financially healthy.
https://www.agshealth.com/blog/driving-value-taking-the-healthcare-revenue-cycle-to-the-next-level/
EEPAK MATHUR has over 19 years of experience in healthcare analytics and informatics. He currently serves as the Director of Healthcare Reporting and Analytics at Visiting Nurse Service of New York, where he oversees analytical teams and regulatory reporting. Prior to this role, he held several positions involving data analytics, reporting, and quality improvement at organizations like Oxford Health Plans and CIGNA Healthcare. EEPAK MATHUR has expertise in areas like SAS programming, dashboarding, data quality, and reporting to CMS and the New York Department of Health. He also has experience developing analytical strategies to increase revenue and optimize business objectives.
This document provides a summary of Frank Spencer's qualifications and experience in healthcare administration and medical coding. It includes his contact information, education history with multiple degrees, and certifications in areas such as coding, case management, and healthcare administration. The summary highlights over 15 years of experience in roles focused on medical coding, revenue cycle management, and provider education at healthcare organizations in Maine.
This document provides a summary of a medical billing and coding professional's qualifications. It includes 3 sentences summarizing her objective, education, and current role as a medical risk adjustment field auditor reviewing medical records to ensure accurate risk adjustment coding.
Cristina Gomez is an experienced health information management professional with over 25 years of experience. She has a bachelor's degree in health information management and is a certified registered health information technician. Gomez has extensive experience implementing electronic health records and other technologies to improve efficiency and compliance. She is skilled in areas such as leadership, health information exchange, and project management.
CODING CONNECTIONS IN REVENUE CYCLE MANAGEMENT WORKSHEETINSTRUCT.docxclarebernice
CODING CONNECTIONS IN REVENUE CYCLE MANAGEMENT WORKSHEET
INSTRUCTIONS: Read the AHIMA article, Coding Connections in Revenue Cycle Management by Ruth Cummins, RHIA, CCS and Julie Waddell. Complete the worksheet by answering the questions. Submit your answers by the assignment drop box.
Why is it important that the MRN connect the patient documentation to the services provided? (2 point)
Answer:
Who should assign patient type to the patient? (1 point)
Answer:
Explain why coding staff should have access to source documentation. (1 point)
Answer:
Why is it a good idea to have front-line staff and coding staff working together? (2 points)
Answer:
Can the revenue cycle process be affected by coding staff? Can you give a reason? (2 point)
Answer:
In the hospital setting how are routine diagnostic services such as lab and radiology services charged to the patient? (2 point)
Answer:
How do they determine which codes belong in the charge master and not coded by a coder? (2 points)
Answer:
Why should concurrent clinical documentation management programs and query processes by implemented? (2 point)
List 2 reasons coding quality and productivity standards should be established: (1 point)
Answer:
Why do revenue integrity teams need coding professionals? (1 point)
Answer:
What are the 2 key revenue cycle components that occur in patient financial services? (1 point)
Answer:
Why is it important for HIM to have an effective DNFB Reporting tool? (1 point)
Answer:
What function do coders perform that helps to reduce the number of medical necessity denials? (1 point)
Answer:
What are OCE and CCI Edits? (1 point)
Answer:
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027450.hcsp?dDocName=bok1_027450
Coding Connections in Revenue Cycle Management
by Ruth Cummins, RHIA, CCS, and Julie Waddell
Recently, there has been a significant amount of talk in the healthcare industry about revenue cycle improvement. So what is all of the excitement about? It is about the bottom line. Specifically, how we can improve our bottom line through more effective and efficient revenue cycle management. For hospitals to maintain financial viability under the pressures of the current healthcare environment, the revenue cycle must be a significant focal point, and HIM and coding professionals should play major roles in the process. This article will highlight many of the coding connections for the key revenue cycle processes within patient access, HIM, and patient financial services.
The Coding Connection in Patient Access Services
Critical revenue cycle processes that occur in the patient access department include initial data collection (e.g., name, date of birth, insurance information, reason for admission, patient type); medical record number (MRN) assignment; and medical necessity determination. Coding connects (or needs to connect) with patient access services in the following areas: MRN, patient type, source documentation, and me ...
This document contains the resume of Cynthia Martinez, who has extensive experience in healthcare revenue cycle operations and project management, including overseeing the implementation of electronic medical records and billing systems. She is skilled in process improvement, team leadership, and ensuring projects are delivered on time and under budget.
This document contains the resume of Cynthia Martinez, who has extensive experience overseeing revenue cycle operations and implementing electronic medical record systems like Epic for various healthcare organizations. She is skilled in project management, process improvement, and financial analysis. Key experiences include directing revenue cycle functions for large multi-specialty practices and hospitals, and leading the implementation of Epic and other systems to optimize billing and collections.
Med Direct Patient Pay Solutions 12 11 09v1 (Printable Version)Agoetze
MedDirect is a patient-centric healthcare services company that focuses on delivering comprehensive revenue cycle management services to physicians and hospitals. They help increase patient payments and enhance the patient experience. MedDirect addresses complex reimbursement systems, a lack of patient education and options, and financial risks through a patient-centric software platform, call center staffed with payment experts, and multiple payment options. Their approach aims to improve operations, increase patient satisfaction and payments, and provide value to healthcare providers.
Whitney Brian is seeking a position that utilizes communication and interpersonal skills. He has a Bachelor's degree in Human Services from Touro College. Brian has over 10 years of experience in customer service roles within the healthcare industry, including at Emblem Health and HealthPlus Amerigroup. His experience includes authorizing services, handling customer inquiries, training staff, and making process changes to improve customer satisfaction. He is skilled in areas such as government relations, claims processing, cultural awareness, and Microsoft Office applications.
Christopher Greene is a healthcare IT consultant with over 12 years of experience advising Fortune 500 healthcare companies on projects valued at $200 million. He has expertise in EMR/EHR systems, clinical applications, and healthcare business systems. Greene has worked with over 50 healthcare organizations, including hospitals, insurance companies, and government agencies. He specializes in system integrations, data standards, regulatory compliance, and user training.
Similar to Miller Lisa Master Resume 2016 PDF (20)
1. Lisa Anne Miller, IT Specialist, PMP
Owner of Memphis Life Force
Seattle, WA
lmillerrn@gmail.com
Professional Summary
Over 30 Years of Experience in Healthcare, IT, Programming, and Website Building
Certifications
PMP Certification
PM Certification
CAPM Certification
CBAP Certification
Application Experience
Billing and Accounts Receivable (B/AR)
Imaging and Therapeutic Services (ITS)
Enterprise Medical Record (EMR)
Bedside Medication Verification (BMV)
Patient Care System (PCS), Quality Management (QM), Case Management (CM)
Physician Care Manager (PCM) I & II
Computerized Provider Order Entry (CPOE)
Order Entry (OE)
Operating Room Module (ORM)
Microsoft Office, including Excel, PowerPoint, and Project
Payor Websites
Meaningful Use, Stage I & II
Emergency Department Management (EDM)
Assisted with MIS and M-Site
2. Non-MEDITECH Interfaces (FormFast, Zynx, DFM, Drager)
Provation and Zynx Care Plans and Order Sets
MEDITECH (Magic, C/S, 5.64, 6.0, 6.06, 6.1)
MEDITECH Upgrade Management and DTS Testing
Midas+ Care Management
Milliman and InterQual Care Guidelines
Encoder Pro and 3M
ICD-10
CM, QM, RM Modules
PMMC
Highlights
Expertise in Utilization Review, Case Management, billing account resolution, CCI edits, quality
assessments, front and back business office workflow, process improvements, quality management,
regulatory compliance and reporting, performance evaluations, policy and procedure creation, protocol
development, claims. appeal and denial processes, coding and billing special projects, business office
collections, billing, and staff training
Work Experience
• Owner of Memphis Life Force, 2010-present; prior IT experience at Navin Haffty & Associates
Facility: Navin Haffty & Associates, 2012-2014 and Memphis Life Force 2010-Present
Multiple Hospitals Countrywide:
Adena Health Systems, Chillicothe, Ohio
Reviewed processes to ensure claims were billed appropriately with supportive clinical documentation
Ensured claims pricing was correct based on contract terms
Documented denials trends with recommendations for improvement
Provided education on the meaning of current contract management terms
Performed Appeals and Denials for Case Management; payers included Medicaid Ohio (Permedion),
Humana Medicare, UHC, Cigna, and Blue Cross.
3. Completed Insurance Defense Audits (retrospective) and performed exits with external auditors
Reviewed UR trends and recommended processes for improvement (Inpatient Notification, Denials
Management, etc.)
Communicated appeals statuses to external auditors, payers, Case Management, and Business Office
staff as indicated
Assisted with staff training in best practices for Denials Management
Accessed the PMMC tool and payer websites to complete appeals and retro authorization requests
Compiled reports detailing payer recoveries
Performed collection activities and monitored outcomes; details noted in Meditech B/AR
Assisted with staff education on topics such as claims modifiers
Reviewed medical records for payer audits of injections, infusions, J Code drugs, Pre-Existing
Conditions, LCDs, NCDs, and Medical Necessity
Composed rebuttal letters for denials and submitted these to payers
St. Francis Hospital, Poughkeepsie, NY
2011- Oct. 2012
MEDITECH Solutions Consultant IG, Highlights:
Implemented PCS, BMV, OE, ITS, OR, and EMR modules for Meditech 6.0 and 6.06. Assisted with EDM
and PCM integration. Created end user training manuals and provided downtime policies and
procedures for these modules. Created PCM end user training manuals. Educated clients on best
practices for the EMR build (CDS, assessments, dictionaries, etc.). Educated staffs on the charge build
and reconciliation processes. Assisted client with compliant build for OMH, DMV, CMS, and Meaningful
Use Phase I. Assisted with upgrade management including DTS testing. Updated the Project
Management Plan and Risk and Issues Logs as appropriate. Performed Meditech task management.
Assisted facility staff with a successful Go Live post module implementation.
Highline Medical Center, Seattle, WA
2011
MEDITECH Solutions Consultant IG, Highlights:
Completed Meditech and Project Management task follow-up, completed B/AR education materials,
performed one to one staff in-services on the charge reconciliation process, conducted staff meetings to
resolve Meditech system issues (LAB, B/AR, PHA, etc.)
4. HCA – Hospital Corporation of America, Denver, CO
2007 - 2010
Revenue Integrity Nurse
Promoted revenue cycle management by resolving account edits, re-billed claims for all payers when
edits were resolved, audited medical records for charge capture and completed coding special projects
Constructed charge master codes for billing
Educated nursing staff on charge systems and charge master issues
Trained all new staff
Completed concurrent, retrospective, and insurance defense audits
Performed compliance audits for Medicare
Resolved patient billing concerns.
National Healthcare Review, Hospitals Countrywide
2003 - 2011
Clinical Financial Specialist
Performed concurrent, retrospective, and insurance defense audits
Utilization Reviews and Case Management
Assisted with claims rebills
Performed Medi-Cal billing and appeals projects
Performed Medicare RAC audits
Traveled to hospitals across the US for business office special projects
Participated in a number of projects including a three year-project for insurance appeals and denials,
and a coding special project
Resolved OCE & CCI billing edits to drop clean claims, re-constructed charge master codes for all
payers including Medi-Cal, and performed in-depth charge master analysis.
Identified billing compliance issues and educated hospital COOs, CEOs, and staff on trends.
Educated staff within the hospital system on a number of issues, including: financial reimbursement
issues, billing and Medicare compliance, MEDITECH software functionality, and compliance education
5. Kittitas Valley Health and Rehabilitation
1990 – 1997 and 2002 - 2003
Multiple positions, including Director of Nursing
Performed various roles while at Kittitas, including: Rehab Nurse, Wound Care RN, Resident Care
Manager, Utilization Review, Case Management, Assistant DNS, Staff Development Coordinator,
Infection Control Nurse, Charge Nurse, Medication Nurse, and Director of Nursing
Implemented systems to ensure compliance with State and Federal regulations
Led a successful annual JCAHO survey
Audited Medical Records to ensure quality patient outcomes and participated in facility QA and QI
programs
Chinook Convalescent Center
1997 - 1998
Resident Care Manager
Completed the MDS, Care-Planning, and Resident Assessment process, as well as performing
admission assessments on new patients and managing their clinical course
Performed care management services, reviewed nursing documentation and educated staff on areas
requiring improvement
Created and assessed individualized rehab and wound care programs
Performed Utilization Review and Case Management
Harborview Medical Center
1988 - 1990
Registered Nurse
Performed the duties of a Registered Nurse on all floors, as well as in the Emergency Department