Manages daily activities related to Collections and Medicare/Billing. Ensuring processes are performed efficiently and effectively. Evaluate, design and implement systems and workflows for the Government Department to maximize reimbursement within all applicable rules and regulations for all payers. Knowledgeable of all Government medical insurance practices, procedures to ensure departmental compliance with federal, state and organizational rules, regulations, policies and other guidelines. Builds and fosters team success, communicates vision and overall direction for the department. People development, manages and mediates conflicts in order to build and maintain a strong team environment.

Supervision of all functions including reception, admitting, medical records, accounts payable management and accounts receivable management. Assists Chief Finacial Officer and Chief Executive Officer in development of annual budget. Review insurance contracts to assure accurate contractual reimbursement and collections adhere to Business Office policies & procedures. Responsible for daily cash management procedures, account for all cash received in accordance to Center Policy. Prepare analysis of monthly financial & management reports. Train, develop and conduct periodic performance reviews on all business office staff employees.

Responsible for leading all daily patient access operations, site-specific oversight of medical records management activities and day-to-day oversight of the dietary function in close collaboration with the registered dietician. Prepare weekly bank deposits/scheduling/payroll. Oversee day-to-day operations of patient nutrition services in close collaboration with the registered dietician. Maintain compliance with EMTALA, DNV, HIPAA and all other hospital and government regulations applicable to admissions operations. Interview, hire, train, evaluate, and counsel patient access team members. Providing continuous training for and communicate changes to existing employees.

Assists patients with questions regarding insurance matters, current account status, billing and payment questions. Will help patients with insurance questions and pre-determination letters and will also provide insurance companies with required information for pre-authorization of procedures. Will confirm infertility benefits for all new patients and when current patients have new insurance coverage Collection of patient’s past due accounts when patient have failed to pay for the services in a timely fashion and/or has disregarded all previous requests for payment. Assists with the collection of patient’s payments for IVF, IVF/Donor, FET, and IVF/G.C. cycles before they begin their medications for their cycle. Accurately post charges for ART cycles or surgeries. Posts insurance and patient payments received from patient visit and/or received in the mail. Coordinates the billing of procedures to insurance companies when the patient’s insurance covers the procedures per business office policy. Will do follow-ups with insurances regarding wrong reimbursements, low reimbursements, and/or incorrect insurance denials.

Helps eligible patients who don't have insurance, who are underinsured, or whose health care plan won't pay for their medicine. Assist eligible patients who meet specific financial and medical criteria receive their Genentech medicines free of charge. Provides customer focused reimbursement support to patients, their families, distributors, physicians and internal sales force. Educates, informs, and assists patients and providers to navigate through the reimbursement process. Identifies barriers to reimbursement and continually identifies and recommends program efficiencies to the team to promote high quality of work. Identifies and facilitates referrals to alternative coverage options and financial assistance programs for patients who are under insured or require co-pay assistance.

Responsibilities include handling heavy call volume, escalated calls, billing patients and providers, collecting on A/R, Charge entry and charge balancing, electronic and hard copy claims editing submission to various payers. Payer follow up, payer denial review and appeals processing. Payment applications, credit balance review, resolution and patient advocacy. Medical Knowledge in CPT4, HCPC’s, ICD-9. Current Software Used: Epic/Avaya/First Data

Provide customer service within an inbound/outbound call center environment that includes educating patients on Cardiovascular Disease, resolving delinquent accounts, contacting insurance carriers to verify medical coverage eligibility, & processing insurance claims. Continuous awareness and knowledge of ICD9/CPT coding & W/C, PPO, HMO coverage, Medicare/Medicaid.

Work side by side with both analyst & department managers in reference to processing employees leave of absences (FMLA, Maternity, Medical, Industrial, etc). Process SDI (State Disability Insurance) claim forms for employees that qualified.

Inbound Call Center environment. Provided online benefit solutions for insurance brokers and carriers to create and maintain data standards that enabled the benefits industry to a useful interface. Persistently helped brokers, consultants, carriers and general agents boost their profitability through increased productivity and tighter integration. Responded to clients emails, handle phone calls and provide online troubleshooting support.

Inbound / Outbound Call Center environment. Handled online issues pertaining to warranty coverage for online purchases ranging from automobiles to consumer electronic items (ie. cell phones, laptops, cameras, DVD players, etc). Primary point of contact for all escalated issues from outside contacts to in-house customer service reps. Responded to customer emails, processed all online applications, reviewed daily reports that monitored customer service calls, & maintained a strong communication with all Ebay Sellers.

Inbound/Outbound Call Center environment. Assisted customers with any problems they had with their security alarms systems. Worked with clients whose accounts were in the process of being sent to an outside collection agency. Developed and maintained relationships with business partners who responded to customer’s needs for immediate service on their alarms.

Served as the On-Duty Supervisor on the floor by answering CSR questions as scheduled and as business needs dictated. Addressed escalated calls as scheduled. Assisted team leaders and manager(s) with call center trainings, mentoring, and served as a role model for CSRs.

Inbound Call Center environment. Received calls from diabetic patients regarding their blood glucose meters, at which point I educated them on how to properly use their blood meters, re-ordered testing supplies, & provided alternative options for monitoring their glucose levels.

Managed inventory stock, assisted with advertising and marketing, and recorded stock sales.