Marianne Le Email & Phone Number

Texas, United States

Dallas–Fort Worth Metroplex, Texas, United States

* Completes quality audits to ensure RCM employees are providing the highest quality of work* Proactive communication with the RCM Manager/Director on practice data, issues and KPIs that are meaningful to our centers.* Ensure claims are adjudicated in compliance with provider contract parameters, member demographic information, and service level requirements through random and targeted claim reviews* Compile data, perform audit, interpret and report back results to management team* Conducts Audit-the-Auditor claim audits for procedural and financial accuracy* Provide monthly/quarterly/yearly feedback used for client report cards and company Key Performance Indicators (KPI)* Participate in documenting and prioritizing potential solutions to issues & fallout for system issues* Establish and implement interim workaround solutions as needed and communicates to all impacted users* Assist in establishing, updating, communicating and training new and existing policy and procedures* Accountable for analyzing and measuring results of implemented policies, changes and system modifications* Ability to meet assigned deadline and work under minimal supervision and with all levels of staff and management

Syracuse, New York, United States

• Conduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website• Monitor financial performance of contracts• Investigate and document provider changes and correspondence• Coordinate with credentialing to ensure all appropriate documentation is received• Serve as a lead for key special projects• Recommend changes in pricing subsystems• Coordinate printing of provider directories with corporate and plan level entities• Investigate and respond to complex provider related issues and initiate change of provider related database information• Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff

Seattle, Washington, United States

• Oversees all billing department operations.• Hires, onboards, and manages billing associates.• Trains billing associates on departmental best practices.• Creates billing department policies and procedures.• Investigates and resolves payment and billing issues.• Works directly with customers and clients as needed.• Collaborates with other finance department leaders.• Maintains confidentiality of all financial and personal information.• Acts as the point of contact for colleagues from other departments.

Seattle, Washington, United States

• Ensure clean claims are sent to insurance carriers in timely manner.• Rebill and work denials and conducting appeals to obtain highest possible reimbursement.• Filed and submitted insurance claims.• Meet Daily Revenue Objective (DRO) goals and ensure patient satisfaction.• Perform duties in both professional and facility billing platforms.• Maintain up-to-date understanding of insurance payment practices.• Utilize various health record indexes and storage retrieval systems, including GE Medical Systems, ScerIs, and Cerner EHR technologies.• Apply HIPAA Privacy and Security Regulations while handling patient information.• Maintain accurate and timely charge submissions utilizing electronic charge capture practices, including billing and account receivables (BAR) system and medical billing clearinghouse accounts.

Richland, Washington

• Review and analyze assigned account balances and initiates appropriate follow-up action with insurance companies to expedite the payment process.• Research insurance accounts pending third party reimbursement and contacts the insurance companies prior to contacting the patient or initiating an insurance re-bill request.• Review third party remittance voucher denials, determines response needed from selected payers for denials, disallowed or non-covered charges and acts in accordance with the denial code action form, providing the necessary support documents for all account adjustments.• Coordinate appeals process, including gathering information required by payer, preparing appeal, and petitioning payer for reconsideration of reimbursement.• Investigate billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.• Work closely with team members to deliver project requirements, develop solutions, and meet deadlines.• Apply HIPAA Privacy and Security Regulations while handling patient information.• Review accounts for insurance of patient follow-up.• Research and appeal denied bills.• Answer all patient or insurance telephone inquiries pertaining to assigned accounts.

Kennewick, Washington, United States

• Perform daily clerical tasks of processing claims, submitting accounts, and reviewing and meeting deadlines.• Maintain the facility’s human resources and department’s policies and procedures.• Contact insurance companies for collective processing applications and rules to submit claims and claim adjustments for payment.• Ability to meet and exceed expectations for tight deadlines for daily, weekly, and monthly duties and reports. • Maintain patient confidentiality and privacy. • Data entry of claims details into electronic forms for insurance processing.• Record information according to insurance company requirements to maximize insurance coverage and reduce patient costs.• Check claims for errors, corrected issues and mailed out promptly.• Access patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.• Add current information to system accounts, including demographic information and payment methods.

Kennewick, Washington, United States

• Maintain unit supplies and equipment for medical staff and patient care needs.• Prepare detailed reports and unit documentation and distributed completed files.• Communicate with patients and medical staff to convey important information and facilitate smooth unit operations.• Coordinate delivery of exceptional patient care by evaluating workflows and facilitating positive changes.• Collaborate with multi-disciplinary staff to improve overall patient care and response times.• Communicate with patients with compassion while keeping medical information private.• Manage operations in accordance with budget requirements.• Lead in planning and achievement of goals and objectives consistent with agency mission and philosophy.

Kennewick, Washington, United States

• Operate telephone switchboard to answer, screen, or forward calls, providing information, and taking messages.• Transmit information or documents through Microsoft Word/Outlook email to facility co-workers and health care providers, using computer, mail, or facsimile machine.• Maintain accounting record of payment transactions from patients. • Receive payment and record receipts for accounts for the Patient Financial Services and other facility departments.• Explain policies, procedures, or services to patients using medical or administrative knowledge.• Apply HIPAA Privacy and Security Regulations while handling patient information.• Document and manage patient information using McKesson and Paragon Health Systems.

Bachelor Of Science - Bs, Human Resources Management And Services

Activities and Societies: • WGU SHRM Student Chapter member• Human resource training designed with in-depth knowledge of employment laws.

Associate Of Arts And Sciences - Aas, Health/Health Care Administration/Management

Studies focused on outcomes to: o Analyze a health care organization from a market-based perspective. o Analyze financial issues.