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Well-versed and confident Revenue Cycle Specialist with 13 years of experience, who has led and managed initiatives, including those related to technology, policy development and integration engagement. Strong familiarity of the revenue cycle with the ability to adapt and execute fast-paced maximum reimbursement results by adhering to billing requirements and expertly interpreting contract language in a timely and aggressive manner. •Detail-oriented with a high level of accuracy and excellent multi-tasking skills•Strong customer service and communication skills•Ability to work well in a team environment as well as independently•Proficient knowledge of the following: Microsoft applications: Word, Excel (Pivot Tables, V-LookUps, etc), PowerPoint, OneNote, and SharePoint; Practice management systems: Eclinical, Office Ally, AdvancedMD, DrChrono, CureMD, and Aprima; EHR systems: Cerner Millennium, Falcon, and Practice Fusion; Clearing houses: Change Healthcare/Emdeon/ Relay Health, DSG, iHCFA (WC), Navicure/ZirMed/Waystar, CAQH Solutions EnrollHub, InstaMed, Optum, PNC, Availity, Trizetto, CureConnect, OfficeAlly, and EchoHealth, Zelis payments, Payspan etc•Full Revenue Cycle Billing & Collections Management experience using billing software applications via desktop, remote desktop connection, and/or cloud•3 years experience with Credentialing/Contracting•HCFA/CMS-1500 Professional Billing 837-P, Medicare’s Physician Fee Schedule •UB-04/CMS-1450 Institutional Billing 837-I, Medicare’s Diagnosis-Related Group (DRG) fee schedule and/or interpret negotiated contract terms to determine reimbursement.•End Stage Renal Disease (ESRD) - Dialysis Billing•Internal Medicine Billing•Pediatric Infectious Disease and Pediatric Cardiac Care Billing•Orthopedic Billing•Chiropractic and Massage Therapy Billing•Surgery Billing•Understand clearinghouse functionality and EFT/ERA payer enrollment process•Experience with several payers and multiple lines of business: Medicare Part A&B, Medicare Advantage plans, Medicaid, Medicare/Medicaid Dual plans, Tricare, Commercial, BCBS, UHC, Workers Comp, and Medigap/Supplemental plans.•Expert in signing up for admin access for insurance website provider portals.•Managed 14+ employee
Clearsight Billing Solutions
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Billing SpecialistClearsight Billing Solutions Sep 2018 - Present•Manage 10+ clients located in CO, MO, and AZ on 5 different billing systems: AdvancedMD, Eclinical, Office Ally, Aprima and DrChrono.•Oversee credentialing/contracting using CAQH and by submitting all appropriate enrollment applications, contracts and required supporting documentation for Medicare Part B, Medicaid, Medicare Advantage Plans, and Commercial Plans for payers: Anthem BCBS, Aetna, Cigna, United Healthcare, Humana, Healthnet, Multiplan, and Tricare with appropriate follow-up to ensure timely processing.•Manage and monitor billing and collections which includes billing, account receivables, cash posting payments, reversals, adjustments, and other assigned functions related to Revenue Cycle Management•Submit daily electronic and paper claims and review claims for edits and demographic errors. •Resolve and refile rejected claims•Process bi-weekly patient statements•Oversee weekly/monthly AR follow Up Spreadsheets for each client.•Provide summary report of identified payer issues after each completed client spreadsheet.•Created and maintain a well-organized, shared payer application username/password spreadsheet to maximize workflow and promote timely communication with payers and workers compensation adjusters to increase efficiency, output, and quality of service.•Specialize in training employees with no medical billing background about the revenue cycle management and how to effectively complete their assigned duties using multiple practice managements systems.
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Reimbursement SupervisorMedical Revenue Experts Aug 2017 - Dec 2017•Manage and monitor multiple practices’ credentialing, billing and collections which includes credentialing, charge entry, billing, account receivables, cash posting, self-pay, and other assigned functions related to Revenue Cycle Management while ensuring that all direct reports comply with the company’s policies and procedures and continue to hold the highest compliance standards.•Completed EFT/ERA enrollment for several payers, successfully converting the entity from paper to electronic payment processing.•Ensure proper provider enrollment takes place by identifying trends related to denials, OON, and short payments to confirm provider’s credentials and contracts are linked appropriately with each payer and participating products. •Ensure that new and existing teammates receive the appropriate training, tools, system access, and support to effectively complete their duties.•Provide monthly and other periodic reporting and/or presentations on operations and key metrics to practice officials.
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Revenue Cycle Supervisor/ Account ManagerDavita Kidney Care Aug 2015 - Mar 2017Denver, Co, Us•Manage and monitor multiple practices’ billing and collections which includes charge entry, billing, account receivables, cash posting, self-pay and other assigned functions related to Revenue Cycle Management while ensuring that all direct reports comply with the company’s policies and procedures and continue to hold the highest compliance standards.•Ensure that new and existing teammates receive the appropriate training, tools, system access, and support to effectively complete their duties.•Provide monthly and other periodic reporting and/or presentations on operations and key metrics to practice officials.•Train client staff on the software functionality and their specific workflows during software conversion, provided in person assistance during “Go-Live”, and offer continuing education post conversion using web-ex conferencing and How To guides.•Completed software conversion, transferring estimated 17,000 patients to a new software system.•Completed EFT/ERA enrollment for 20+ payers, successfully converting the entity from paper to electronic payment processing.•Collaborated with CureMD Software Analyst and Development Team to help enhance various modules within the system in order to create user-friendly and compatible workflows for higher claim volume.•Assisted with policy and procedure development specifically tailored to the CureMD Practice Management System.•Engineered a secure, HIPAA compliant, organizational structure within the shared drive in order to convey information across the department and maintain cohesive knowledge of policies and procedures amongst all the teammates.•Developed a New Hire Revenue Cycle Billing & Collections Training Program as well as a subsequent teammate development plan to encourage, engage, and maintain professional growth within the department.•Travel 20% annually for leadership meetings, conferences, client collaborations and training. -
Pfs SupervisorBanner Health Aug 2014 - Aug 2015Phoenix, Az, Us•Served as a main point of contact and responded to inquiries/questions from various stakeholders, internal/external customers, including analyzing data, producing reports and monitoring the claims process to ensure the coordination of effective and efficient billing practices and procedures.•Managed and monitored daily workflow and reporting to ensure business objectives were maintained and accurately reported.•Attended 50+ conference meetings a month•Assisted with building and maintaining the department’s SharePoint website which was used as a working queue for employees and a tool to trend and manage collection discrepancies.•Communicated with Managed Care (Contract Writers) to discuss implementation of new contract terms that would cease further collection issues related to contract discrepancies and to confirm correct DRG Fee Schedules, Grouper Rates, and Contract Amendments were updated timely to ensure that Banner’s staff worked their claims effectively.•Collaborated with varies payer management teams and departments to resolve contract issues and ran reports to capture effected claims in bulk.•Engineered an organizational structure within the shared drive in order to convey information across the department and maintain cohesive knowledge of policies and procedures amongst all the employees with the use of the Microsoft OneNote application.•Ensured that new and existing employees received the appropriate training, tools, system access, and support to effectively complete their duties.•Developed, trained, evaluated and coached individual and team performance on a regular basis and provided candid and timely feedback. -
Pfs Senior RepresentativeBanner Health Dec 2013 - Aug 2014Phoenix, Az, Us-Pursued and reconciled account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service representatives, provider representatives, spreadsheets and the company’s collection/self-pay policies to ensure maximum reimbursement. -Research payments, denials/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors.-Served as a primary resource in complex and/or sensitive cases. -Acted as a liaison between Banner Health and the payor by conveying identified payment issues and trends and providing spreadsheets to insurance provider representatives to educate insurance staff, correct problems, and resolve outstanding issues and/or patient concerns.-Provided leadership and training to Patient Financial Services Representatives, and acts as a knowledge resource for internal customers. -Resolved employee/patient issues that arise during shift and communicated employee issues to supervisor for follow up.-Respond to incoming calls and makes outbound calls as required to resolve billing and payment issues. -Provided assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.-Met or exceeded productivity standards. Completed daily assignments and maintained accurate production logs.
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Pfs RepresentativeBanner Health Nov 2012 - Dec 2013Phoenix, Az, Us-Pursued and reconciled account balances and payments, and/or denials, work with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company’s collection/self-pay policies to ensure maximum reimbursement. -Research payments, denials/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. -Identify trends in payment issues and prepare issues list(s) to communicate with payors’ via a provider representative to educate and correct problems. -Respond to incoming calls and makes outbound calls as required to resolve billing and payment issues. -Provided assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.
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Suspended Billing RepresentativeApria Healthcare Aug 2010 - Nov 2012Indianapolis, Indiana, Us-Researched diagnoses, reviewed insurance benefits and contract terms to ensure maximum reimbursement from each patient’s insurance company. -Performed follow-up reviews on outstanding Certificates of Medical Necessity (CMNs) and prescriptions and processed renewal CMNs/prescriptions by faxing them to physicians to be signed and evaluated in a timely manner.-Obtained authorizations for reimbursement from each patient’s insurance company for future and aged invoices and followed up on accounts through the use of suspended billing reports and communication amongst each patient’s insurance company. -Performed adjustments, partial adjustments, and re-classed to patients. -
Medical Data Entry ClerkSonora Quest Laboratories/ Laboratory Sciences Of Arizona Mar 2009 - Sep 2009Phoenix, Arizona, Us-Entered new patient’s information into the system. -Accessed the Internet, using established links, to verify patient's eligibility. -Entered medical charges into the system.
Heather B. Skills
Heather B. Education Details
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Davita AcademyRevenue Cycle Management -
Basha High SchoolGeneral Studies
Frequently Asked Questions about Heather B.
What company does Heather B. work for?
Heather B. works for Clearsight Billing Solutions
What is Heather B.'s role at the current company?
Heather B.'s current role is Billing Specialist @ Clearsight Billing Solutions | Revenue Cycle Management.
What is Heather B.'s email address?
Heather B.'s email address is bu****@****ita.com
What is Heather B.'s direct phone number?
Heather B.'s direct phone number is (949) 639*****
What schools did Heather B. attend?
Heather B. attended Davita Academy, Basha High School.
What are some of Heather B.'s interests?
Heather B. has interest in Children.
What skills is Heather B. known for?
Heather B. has skills like Healthcare Management, Process Improvement, Medical Billing, Customer Service, Microsoft Excel, Mircrosoft Onenote, Leadership, Team Building, Call Centers, New Hire Training, Quality Assurance, Video Conferencing.
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