Regional Compliance Coding Manager
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Ambitious results driven professional with a strong commitment to company objectives and long-term goals. Outstanding interpersonal and communication skills resulting in a strong rapport with Physicians, co-workers, insurance carrier representatives, and external contacts. Can undertake difficult mandates and meet tight deadlines.
Personal qualities include: rigorous, positive, good problem-solver, autonomous, persistent, adaptable, and driven.
Regional Compliance Coding Manager at Young Adults Institute YAI (2022-02 – Present)
Responsibilities include ensuring the accuracy of coding and the medical necessity of the providers documentation for all our Outpatient Multi-Specialty, Article 16 and Article 28, Clinical services are being met in support of appropriate reimbursement. The compiling of healthcare statistics, analyzing data, and converting HCPCS and diagnoses into accurate code values. Conduct audits, generate detailed reports, and deliver coding education to clinicians to maintain compliance and improve documentation and coding accuracy.
Verify adherence to PCMH requirements and maintain audit readiness. Collaborate with our Medical Director, Director of Nursing, and NextGen staff to identify reporting gaps, review metrics, and develop solutions aligned with practice needs. Report findings directly to senior leadership (CEO and CFO) and establish action plans to address inefficiencies in workflow.
Billing Coordinator II- Wyss Dept of Plastic Surgery at NYU Langone Medical Center (2015-10 – 2022-02)
Responsible for all aspects of correct and timely submission of office visits, minor procedures and high dollar surgical claim charges, working with our billing company, CHC, and hospital staff to ensure proper accounts receivable management. Review and complete assigned work queues. Enter reconcile and batch manual charges.
Ensure submission and account receivable follow-up is occurring on a timely basis. Responsible for advising clinicians, management and staff of local and national coding and documentation policies. Work with patients and guarantors to clarify financial responsibilities.
Explain billing procedures to patients and identify patient responsibilities. Constant interaction with our billing company to review and resolve denial issues. Work closely with management on special projects, reports, and other time sensitive material.
Revenue Integrity Analyst - Professional Billing at Mount Sinai Health System (2015-05 – 2015-10)
Conduct internal audits and review activities to improve the revenue cycle and coding integrity. Coordinate departments charge submission workflow and charge hold reports from our billing vendor, Mckesson. Perform, review and monitor statistics and key performance indicators to identify improvement opportunities. Performs various financial analyses and provide recommendations based on activities. Review monthly McKesson revenue cycle metrics for areas of improvement.
Physician analysis reports. Analyze billing errors and identify root causes. Identify front-end operation improvements and assist with training as needed. Assist with special projects on an as needed basis, as well as previous job function responsibilities.
Billing Analyst – Professional Billing at Mount Sinai Health System (2010-02 – 2015-05)
Review, assign and sequence ICD-9CM/CPT/HCPCS codes to diagnosis and procedures corresponding to EMR documented information. Educate and train Physicians and staff on applications and functionalities of Physician charge capture focused software (Patient Keeper). A track record of timely submission of all charges for Inpatient, Outpatient and off site practices ensuring full revenue capture.
Maintain all required files and statistics necessary to adhere to all Internal Audit and Compliance regulations.
Patient Access – Emergency Department/Admissions at NYU Langone Medical Center (2005-12 – 2015-10)
Obtaining/verifying all demographic and insurance information, identifying the correct insurance carrier ensuring revenue capture. Correctly admitting patients to all areas of the hospital following specific guidelines for each area. Tending to patient needs and concerns as well as assisting other areas to ensure a seamless workflow.
Patient Financial Services at Mount Sinai Health System (2008-09 – 2010-02)
Commercial, Medicare Inpatient and Outpatient billing via paper and electronic submission. With regards to Medicare, following specific guidelines to ensure correct DRG payments. Following up with other various insurance carriers to ensure timely and correct payments. Following up denials; submitting appropriate documentation for reconsideration of payment. IME billing, E.O.B and patient account adjustments along with other various administrative duties.
Registrar – Family Health Associates/Senior Care Multi-Specialty Practice at Mount Sinai Hospital Queens (2005-04 – 2008-09)
Obtained and verified patient demographic and insurance information for multi-specialty practices. Identified HMO's and TOS payments and collection of those payments when applicable. Interface extensively with patients, staff personnel and physicians.
B.S. in Business Management – St. John's University (1997-09 – 2002-07)
