Barbara Calamia-Lozano
Middletown,NY
Summary
Dedicated revenue cycle supervisor with 20 years of experience overseeing insurance denials operations, billing, and collections processes. Skilled in improving efficiency and knowledge of government/non government insurance providers. Strong communicator adept at fostering cross-departmental collaboration to drive organizational success.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Revenue Cycle Denials Supervisor
Good Samaritan Hospital Medical Center
Suffern, NY
07.2013 - 04.2024
- Conducted performance reviews, coaching, and disciplinary action as needed.
- Collaborated with other departments to streamline processes and improve efficiency.
- Prepared weekly reports summarizing departmental operations and progress against goals.
- Reviewed employee timesheets for accuracy prior to submitting payroll information.
- Established key performance indicators for measuring success within the department.
- Recruited qualified candidates to fill open positions within the organization.
- Identified process improvements that could be made in order to increase productivity.
- Maintained a positive work environment by encouraging team building activities.
- Facilitated communication between supervisors and employees regarding job expectations.
- Assigned work and monitored performance of project personnel.
- Reviewed completed work to verify consistency, quality and conformance.
- Supervised and monitored the daily operations of Denial Team to ensure accuracy, completeness, and timeliness of provider payments.
- Resolved provider queries related to billing issues or payment discrepancies in a timely manner.
- Investigated disputes regarding unpaid claims and worked with providers to resolve them in an amicable manner.
- Monitored and evaluated existing processes to identify areas of improvement in the revenue cycle.
- Interacted with insurance companies to obtain authorization for medical services rendered by providers.
- Performed root cause analysis when discrepancies occurred in order to determine corrective action.
- Coordinated with other supervisors, combining group efforts to achieve goals.
- Evaluated revenue cycle processes and established actionable methods to increase productivity and efficiency.
- Provided revenue cycle process support to all clinical personnel, including resolving procedure challenges.
- Delegated work to staff, setting priorities and goals.
Denial Management Representative
Good Samaritan CBO
Warwick, NY
01.2004 - 06.2013
- Review for clinical appeals, justify medical necessity, coding edits and rebill each case when appropriate, per contract between provider and payer.
- Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.
- Leverage knowledge of Medicare, state Medicaid, HMO plans, and LCDs for claim resolutions.
- Send appeals when appropriate and/or provide the requested medical documentation.
- Review accounts for all technical denials.
- Verify validity and collectible balance of accounts.
- Timely follow-up/resolution on all outstanding A/R.
- Manage daily work queue to prioritize high dollar claim balances.
Skills
- Operations Management
- Staff Development
- Business Administration
- Active Listening
- Written Communication
- Goal Setting
- Performance Evaluations
- Organizational Skills
- Hiring and Training
- Employee Coaching and Mentoring
- Good Judgment
- Team building
- Attention to Detail
- Interpersonal Relations
- Decision-Making
- Team Leadership
- Multitasking
- Adaptability and Flexibility
- Problem-solving aptitude
- Task Delegation
- Analytical Thinking
- Excellent Communication
Certification
- EPIC Certified Trainer
- Facilitator Leadership Trainer
- Oracle Cerner Implementation
References
References available upon request.
Timeline
Revenue Cycle Denials Supervisor
Good Samaritan Hospital Medical Center
07.2013 - 04.2024
Denial Management Representative
Good Samaritan CBO
01.2004 - 06.2013
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