Summary
Healthcare oriented specialist seeking a challenging position within a progressive healthcare organization. Professional experience of 14 years in healthcare culminating in a solid foundation of financial analysis, compliance, and management experience. Solid knowledge of medical terminology, facility and physician billing procedures, ICD-9 and CPT-4 coding, teaching and training skills, financial investigation processes, financial analysis and management, credentialing, strategic planning, marketing, and third party audit processing. Specialized operational and management knowledge within hospitals, anesthesiology, physical therapy, massage therapy, and chiropractic medical practices. Reputation as a team-oriented, self-directed professional with superior problem solving, communication, and management skills. Successful in financial management, prioritizing tasks, and organizing projects to improve departmental procedures, decreasing days in accounts receivable, increasing organizational solvency, and improving knowledge and understanding of billing and claims processing.
Experience
Medical Credentialing and Resource Experts, LLC, Fort Lee, NJ October 2008 – Current
Owner
* Complete all necessary contract documentation for in-network participation and third party reimbursement to all providers from Medicare, Medicaid, Workers Compensation, Automobile, and Managed Care Insurance organizations
* Consult with medical providers on the requirements of HIPAA, Medicare, Medicaid, CAQH, NPI, and its application to their practice
* Update medical practitioners and staff with all new information regarding billing, coding, and medical documentation requirements for compliance and maximum reimbursement of services rendered.
* Assist providers with the creation of their fee schedules for services rendered to their patients
Billing Precision, LLC/Vericle Inc., Dumont, NJ August 2007 – January 2010
Consultant – Sales, Training, Credentialing, Medical Billing and Practice Management
* Conducted on-line real time demonstrations of the organization’s medical billing system and services for prospective new clients
* Created and implementation of training materials, courses, objectives, and competency tests for all medical practice providers and staff members
* Facilitated online training and Q & A sessions with medical practices and their staff to increase knowledge and utilization of medical billing software, coding, and compliance topics
* Advised all practices of billing, coding, and medical documentation of all patients treated within their practice to maximize reimbursement
Backsmart Wellness Center, PA, Edison, NJ April 2006 – October 2008
Director of Business and Marketing
* Developed and implemented marketing strategies to increase patient referrals and generate revenue
* Responsible for all insurance contract management issues relating to credentialing, reimbursement, audits, denials, PIP arbitrations, and feasibility
* Analyzed monthly aging reports to increase collection efforts and revenues
* Initiated measures to insure compliance by the staff with all federal, state, and local statutes
* Supervised all office and clinical staff
* Initiated relationships with patients to assess, maintain, and increase patient satisfaction with the organization
Kipnis Physical Therapy and Sports Medicine, Secaucus, NJ August 2004 – January 2005
Account Manager
* Reviewed all billing and collections and reconciled bank deposits to posted payments for the clinic site
* Maintained statistical data as towards posted charges and collections on accounts
* Conducted managed care contract reviews
* Supervised all billing and collections staff
Consultants Practice Resources, LLC, East Brunswick, NJ January 2002 – April 2004
Billing Manager
* Conducted financial forecasting for anesthesia and pain management physician practices
* Developed reports to determine the fiscal position of physician practices
* Monitored all aspects of medical billing including registration, input of charges, and cash posting on all accounts
* Created and revised monthly Missed Case Accounts Audit Report to verify input of all registration and charges
* Supervised all billing and collections staff
Princeton HealthCare System, Princeton, NJ October 2001 – June 2003
Receivables Analyst
* Developed, maintained, and interpreted statistical data being compiled as it relates to receivables and used the information to change existing procedures or developed new procedures as appropriate
* Created and distributed monthly aged trial balance reports for review and completion by the Patient F...
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