Morgan Friedman, Mha Email & Phone Number

• Create solutions to resolve issues to complex problems, questions, and concerns pertaining to reimbursement, denials, benefit verification submission, accounts receivables (AR), client barriers, audit and EOB review achieving operational excellence• Ensure Benefit Verifications results of new requests exceeding 100 per day for all insurance payers including Medicare, Medicaid, Commercial, Workers Compensation and No-Fault payers are completed within the industry standard of 48 hours• Coach and educate sales team by creating and providing reimbursement training ensuring understanding of end-to-end processes, revenue cycle, tools and reimbursement analysis specific to ICD-10 Coding, reimbursement, coverage, Benefit Verification, audit and education for sales representatives• Support all sales representatives and their Providers / Facilities by conducting individual calls to assist with coverage, coding, EOB and denial review which results in provider satisfaction and increased sales• Review all Medicare, Commercial and individual state Medicaid policies and coverage documents to remain up to date with all policies to provide timely and accurate information to Provider / Facilities and their patients along with our sales team• Collaborate monthly with executive leadership, peers, and business partners to identify objectives, business priorities and provide direction and training resulting in better collaboration and understanding of benefit verification, end-to-metrics, reimbursement cycle andsales opportunities while ensuring higher Provider and patient satisfaction• Restructure Benefit Verification Response document sent to Providers / Facilities to allow for easier understanding of information and standardized internal processing allowing for increased response time, increased sales opportunities and decreased provider claim denials

Manage all Medicaid and Manage Medicaid Accounts Receivables daily average of ~ $35M. Manage improvement towards achievement of yearly operational and financial goals.• Ensure cross organization and department communication to enable continued process improvement and workflow efficiency• Manage Department Analyst responsible for monthly reports totaling ~ $5M for 5 Manage Medicaid payers, analyze trending issues, underpayments and delay in payment accounts. • Manage staff members responsible for billing Medicaid and Managed Medicaid Claims for all Atlantic Health Facilities. Ensure claims are released in a timely manner, analyze issues, correct and implement charges to ensure proper billing based on payer and state requirements• Work directly with Patients to resolve issues/conflicts with Insurance companies to ensure the claims are processed correctly• Collaborate directly with EPIC analysts to stop inappropriate claims from being released• Ensure all accounts with credit balances are sent to payers to notify them to retract overpayments• Identify highly qualified candidates, review resumes, conduct interviews and hire new staff members• Lead contact for 3 Accounts Receivable Outsource Agencies. Facilitate communication, maintain monthly return files, review accounts, ensure proper processing and process monthly invoices to ensure appropriate and timely payments• Lead Contact/Super User for Entire Patient Financial Services throughout the implementation of EPIC and Upgrade.• Participate in webinars and meetings regarding Governmental regulation changes/updates to ensure proper compliance for the facilities. Team with departments to ensure understanding of regulations.• Collaborate directly with Physicians to register with Medicaid for Facility to receive reimbursement for services rendered• Collaborate with PA’s/physicians at individual facilities to determine if consecutive stays are considered readmissions by analyzing patient charts and diagnoses

Managed EOB Team of 18 Account Representatives, analyzed all payments received from all commercial, managed care and worker’s compensation payers. Analyzed payments received against applicable contract language to ensured proper payment on all accounts• Coordinated team activities and provided day-to-day oversight to maintain cash goals for over $200M monthly for all 5 Atlantic HealthSystem Facilities. Reviewed issues and developed plans to resolve, maintained daily backlog and assigned account representatives todifferent areas when needed to ensure balanced work activities• Analyzed and ran appropriate reports to ensure proper handling by departments and upper management• Analyzed insurance company accounts with over $1M in open balances, identify the applicable team member to verify status and payments on accounts, develop plan to resolve• Daily, ran 6 reports identifying backlog days, total account balance representing over $5M and productivity of each Account Representative. Ensured systems are working properly, assigned account representatives to different areas when needed to ensure balanced work activities.• Consistently meet credit goals per facility and analyzed insurance refund requests based on incorrect original payments to ensure accuracy of payments by managing daily work flow of account advisors, run daily HBI reports, reviewed correspondence and resolved issues in a timely manner• Verified all refund checks totaling up to $1M to ensure check requests are valid based on analysis of contracts• Collaborated / teamed with various departments to review and research multiple accounts with balances exceeding $4K in whichpatient complaints are involved. Identified issue and developed solutions to resolve efficiently• Identified system issues and addressed with other departments and developed temporary/ permanent solutions

Lead Follow-Up Team of 15 Account Representatives, analyzed claims, interacted with insurance companies, verified status of individual claims totaling over $2M each and reprocessing of short payments to ensure timely payment and reduce total account receivables (AR)• Reviewed/analyzed claim follow-up and applicable notes for all Account Representatives to ensure claims are accurate, submitted and processed properly, and payments are received in a timely manner• Created and implemented new processes, policies and procedures to standardize work flows within the department which resulted in increased productivity throughout the team• Coordinated with Payer Analysts on large payer issues and analyzed underpayments totaling over $5M and overpayments totaling $3M. Determined the cause and implemented plan on how staff should process plan implementing steps on processing claims internally until the payer corrects issue(s)• Created monthly reports for Account Representatives on hundreds of accounts to reduce AR and increase revenue• Coordinated the integration of Hackettstown Medical Center into Atlantic Health System• Created/implemented Atlantic’s policy and procedures at Hackettstown Medical Center Business Office• Trained Hackettstown Employees on Atlantic Health System policy and procedure• Key contact for Out Sourcing of Hackettstown to Aergo Solutions for all open AR currently totaling $35.0M and developed plans and resolved issues with claims and processed according to Atlantic’s policy’s and procedure’s• Researched accounts with multiple system issues and teamed with the ISS department to determine reason and developed a successful solution to ensure accuracy of AR and reduce manual work by Account Representatives• Verified and reviewed all Bad Debt accounts to be sent to collections to ensure accounts are sitting with correct balances and are true Bad Debt accounts and accounted for appropriately

Morristown, Nj

I previously work in the Managed Medicaid department and analyze patient accounts for charged services rendered at Morristown Medical Center, Goryeb Children’s Hospital, Overlook Medical Center, Newton Medical Center, and Affiliated Urgent Care Centers. I also analyze the accuracy of all individual class, research and determine if payment was accurate based on appropriate percentage or fee schedule specific to insurance company guidelines and contracts, negotiated with insurance companies to resolve issues and ensured payment on claims, calculate appropriate account balance, adjust patient accounts with appropriate balance due, and ensure appropriate payment or refund was processed and received. “Special Projects"I successfully analyze and process upwards to 150 weekly requests by insurance companies for invoice adjustment, refunds, billing questions or invoices disputes, revolve issues and negotiate with insurance companies to obtain consensus that no additional revenues were to be remitted to insurance companies, and analyze request, determined appropriate action, resolved issues, negotiated with insurance companies and reprocessed invoices when applicable.

Determined status on Medical Bill Payment & Medical Record to receive payment on medical bills through previous information found in the chart regarding previous phone calls from insurance companies

Master Of Healthcare Administration (M.H.A.)

Bachelor’S Degree, Bachelors Of Science Public Health

Bachelor’S Degree, Bachelors Of Arts In Business, Concentration In Organizational Management