Belinda Nieves
Margate,FL
Summary
To ensure maximization of revenue and cash flow while compiling and analyzing data, maintain the highest levels of patient and employee relations and resolve revenue cycle problems. Dedicated supervisor with experience overseeing multiple tasks and managing employees successfully. Hardworking and driven to work quickly and effectively on projects in all types of environments.
Overview
24
24
years of professional experience
Work History
Compliance And Revenue Optimization Supervisor
Memorial Healthcare System
Miramar, FL
10.2008 - Current
- Review and resolve billing and contract issues by working closely with Contracting Department and Accounts Receivable Management
- Manages staff workload to ensure all accounts are worked in timely fashion
- Developed and maintained courteous and effective working relationships with all areas of Memorial Healthcare System
- Oversee daily operations to ensure high levels of productivity
- Managed on-site evaluations, internal audits and staff productivity for all accounts aged 130/150 days
- Develop mechanisms for tracking and reporting of managed care payor performance to monitor alignment with expected outcomes and metrics.
- Develops and executes action plans working directly with leadership from payors and to resolve identified discrepancies and leads initiatives on process improvement as needed
- Conducts analysis of underpayment and denial trends by managed care payor and collaborates with leadership from Managed Care Department and other business areas to present recommendations to Memorial Executive Team for improving payment efficiencies.
- Maintains up to date expertise on healthcare industry and managed care plan billing, payment and appeal laws, policies, rules and regulations to ensure MHS and payor adherence. Alerts Department, Managed Care and Revenue Cycle Leadership of identified issues that need to be addressed to ensure compliance.
- Recruited, hired, trained and supervised staff of 25 and implemented mentoring program that offered positive employee engagement.
Provider Reimbursement and Resolution Supervisor
Health Plus PHSP
Brooklyn, NY
06.2000 - 09.2008
- Oversee pending claims process and coordinate with Claims, ITS and other departments to ensure provider records are created or updated appropriately to allow accurate claims processing in a timely fashion
- Develop reports, tests and audit tools to monitor quality of provider data and interpret provider system set up
- Establish and maintain a reimbursement template to use as an auditing tool to ensure payment arrangements are being processed by Claims department
- Assist Contracting department in preparing financial analysis of reimbursement proposals for new and existing contracts
- Assist Provider Relations' field staff in resolving provider complaints/issues/concerns
- Prepare monthly statistical summaries to track all claims related issues
- Responsible for developing staff and training materials
- Assist in monitoring the timeliness of claims processing for contracted vendors, including resolution of NYSDOH and/or SID audits, and other audits to ensure compliance with contractual mandates
- Facilitated and implemented settlement agreements by proposing resolutions and supporting effective decision-making for involved parties
- Prepared written opinions or decisions regarding cases
Quality/Systems Specialist
Health Plus PHSP
Brooklyn, NY
02.1998 - 04.2000
- Assist management in facilitating, coordinating and delivering training programs for new and existing data center staff
- Assist management in developing, maintaining all documentation including workflow, policies and procedures, and training materials
- Audit all data entries and report results to management
- Document staff performance against standards
- Assists in the ongoing evaluation of policies and procedures, and the development and implementation of new performance standards
- Assists department with staffing deficiencies, as required, by providing temporary assistance
- Interpret complex provider contracts, policy and procedures to facilitate provider set-up in systems
- Support ITS in testing to implement system upgrades and new systems
- Function as Subject Matter Expert in Facets and Cactus software systems
- Designed and implemented preventive maintenance procedures, reducing support requests 85%
- Analyzed worker process data to discover factors negatively impacting operational efficiency in 4 systems, designing remedial methods of correction
- Prepared documentation on policies and procedures for operating Facets and Cactus systems
- Trained employees in use of various healthcare and data entry system, overseeing onboarding process and verifying trainee competence
Education
Associate of Science - Health Administration
University of Phoenix
Online05.2011
High School Diploma -
Adlai E. Stevenson High School
Bronx, NY06.1995
Skills
- Decision Making
- Staff Development and Training
- Performance Management
- Team Management and Supervision
- Report Preparation and Analysis
- Complex Problem Solving
- Root Cause Analysis
- Account Reconciliation
- Attention to Detail
- Remote Work Coordination
Additional Information
Proficient in EPIC EMR System, Trizetto Facets system and MS Office.
Timeline
Compliance And Revenue Optimization Supervisor
Memorial Healthcare System
10.2008 - Current
Provider Reimbursement and Resolution Supervisor
Health Plus PHSP
06.2000 - 09.2008
Quality/Systems Specialist
Health Plus PHSP
02.1998 - 04.2000
Associate of Science - Health Administration
University of Phoenix
High School Diploma -
Adlai E. Stevenson High School