Expert on Medicare PCR, Home Health, Intake, Auth, & Billing

Overview

Looking for full-time work (8 hours/day)

at $18.00/hour ($3,168.00/month)

Master's Degree

Last Active

December 4th, 2024 (yesterday)

Member Since

March 30th, 2018

Profile Description

• Organized compliance officer with 10+ years of experience in the US Healthcare Industry from End to End of the Revenue Cycle Management and day-to-day medical office operations such as referal coordination, admissions and intake, scheduling and staffing, welcome calls and patient outreach, prior authorization/ precert/ Medicare RCD/ADR/PCR, quality audit/chart review and process improvement, medical billing, denial management, payment posting, and appeals.
• Experience with home health, physical therapy, occupational therapy, speech therapy, mental health and substance abuse, alcohol and drug rehab, ortho, ambulance services, and autism services/ ABA therapy provider specialties.
• Excellent English Written and Communication Skills.
• Expertise and knowledge of the entire Revenue Cycle Management from end to end (Admissions/Intake, Scheduling, Authorization/Precert/RCD, Medical Billing, Denial Management, Payment Posting, Appeals).
• Successfully passed Medicare #PCR (pre-claim review) and #ADR (additional documentation request) for five different home health agencies with 100%, 98%, and 96?firmation rates during different Medicare RCD Cycles.
• Knowledge of HMOs, Medicare, Medicaid, Medicare Advantage, and Commercial Plans
• Expertise in utilizing medical insurance portals like Availity, Palmetto eServices, Optum, UMR, CareCentrix, Humana Tricare/Provider Self Service, Cigna, Value Options, My Ability, Navinet, DOL, My CGS, NGS, NH Healthy Families, WellSense, eVicore, Carelon, and Navihealth among others.
• Expertise in Medicare RCD, PCR, ADR and Precertification Processes and Requirements.
• Knowledge of ICD-10 Coding, Outcome and Assessment of OASIS, 485, and other notes.
• HIPAA Compliance.
• Office Support and Management (familiarity with filing, phone, faxing applications such as Ring Central, 3CX, Fax.Plus, and Nextiva).
• Knowledge of RCM Platforms like Trizetto, Waystar/Zirmed, Ability Ease / Inovalon, Office Ally.
• Knowledge of CRM and ERM Softwares like Salesforce, Prosperworks, Rethink, Opus, ClinicSource, Axxess, Wellsky/Kinnser, Kareo, Alora Plus, Practice Fusion, Salesforce, Home Health Notify, Aidyn, EPIC, Careport, and My EVV among others.
• Expertise in reviewing patient charts, documentation, and medical notes (OASIS Start of Care, OASIS Recert, OASIS Resumption of Care, CMS 485, Visit Notes, F2F Encounters, Physician Orders).
• Expertise in patient coordination and medical care coordination.
• Team Player with Positive Attitude and Strong Work Ethic.