Brenda Evangelou
Lexington,Kentucky
Summary
30+ years of management, claims review, follow-up, billing and coding to have a maximum impact in contributing towards the growth of an enterprise.
Quick-thinking Supervisor recognized for success in guiding teams and boosting performance. Practical problem-solver with excellent issue and conflict resolution skills to drive team and organizational success. Highly effective and knowledgeable in process improvement.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Supervisor
University Of Kentucky
Lexington, KY
02.2021 - Current
- Pediatric & Internal Medicine Gastroenterology, Pediatric & Internal Medicine Pulmonary, Pediatric & Internal Medicine Cardiology, Pediatric Critical Care, Neonatology,
- Coordinated day-to-day operations, processed improvement efforts and assisted staff with troubleshooting issues
- Maintained time cards for staff. Reviewed and approved time off requests.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Evaluated employee performance and coached and trained to improve weak areas.
- Maintained compliance with company policies, objectives and communication goals.
- Set overall vision and provided team leadership.
- Developed training, task and process guidelines and communicated clear and concise directions to employees.
- Mentored newly hired employees on operating equipment and safety and developed training manual to use for reference.
- Created successful work schedules for each team member to maintain deadlines and fully staff shifts. Reassigned staffing to address volume changes as necessary to achieve productivity goals. Adjusted job assignments and schedules to keep pace with dynamic business needs, factoring in processes, employee knowledge and customer demands.
- Performed annual evaluations and reviews employees.
- Reviewed internal coding audits and rebuttals for staff
- Completed documentation for new and out-going staff
- Oriented, guided and mentored team members and support staff to help build confidence and competency in skills, knowledge & ability
- Identified documentation education opportunities for physicians, divisions and departments, provided that information to unit leadership
- Created Power Point presentations to present to all division business meetings with Chief of Staffs. This presentation was implemented across the department to be used in all business meetings
- Facilitated the training and development of Physicians, Divisions, and Coders to improve coding curves and to prepare for 2021 E&M changes. Provided training, education and audit reviews for coding staff
- Attended all monthly division Financial Meetings to present monthly billing trends, analyze coding curves, and identify any documentation deficiencies to improve Physician charge capture
- Completed and reviewed weekly productivity; provided counseling for coders who failed to meet productivity goals
- Reviewed and abstracted medical record documentation for inpatient, outpatient, procedures and technical services and assigned correct CTP, HCPCS and ICD-10-CM codes and modifiers as applicable to ensure compliant billing
- Reviewed and corrected pre-claim coding edits via Soarian and EPIC for all my divisions
- Acted as a professional coding and billing resource for staff on all coding areas to ensure accurate and effective coding
- Reviewed and resolved unbilled encounters for all divisions; Reviewed monthly denials, provided coder or physician education as needed
- Utilized applicable software systems (scheduling, registration, EMR, coding, billing) to complete coding transactions
- EPIC SuperUser; Provided ATE (at the elbow) support during the implementation of EPIC system for all UK providers.
- Proficient in EPIC, 3M360, Soarian CEWL, Soarian EBEWS, HQPM, APM, SCM, AEHR, AAPC Coder, and MedAptus
- Completed UK New Leader Academy
Team lead
University Of Kentucky
Lexington, KY
11.2019 - 02.2021
- Team Lead Gastroenterology, Pulmonary, Cardiology, Critical Care, Neonatology, Hematology, Oncology
- Provided back-up support for times when the Supervisor is out of the office including any daily/weekly/monthly tasks and staff management
- Assisted coding Supervisor in coordinating day-to-day operations, processed improvement efforts and assisted staff with troubleshooting issues
- Oriented, guided and mentored team members and support staff to help build confidence and competency in skills, knowledge & ability
- Provided back up coding coverage as needed
- Identified documentation education opportunities for physicians, divisions and departments, provided that information to unit leadership
- Facilitate the training and development of Physicians, Divisions, and Coders to improve coding curves and to prepare for 2021 E&M changes
- Attend all monthly division Financial Meetings to present monthly billing trends, analyze coding curves, and identify any documentation deficiencies to improve Physician charge capture
- Completed and reviewed weekly productivity; provided counseling for coders who failed to meet productivity goals
- Reviewed and abstracted medical record documentation for inpatient, outpatient, procedures and technical services and assigned correct CTP, HCPCS and ICD-10-CM codes and modifiers as applicable to ensure compliant billing
- Reviewed and corrected pre-claim coding edits via CEWL for IM/Peds Gastroenterology, Pulmonary, Cardiology, Critical Care and Neonatology. Reviewed and corrected possible duplicate and ECG issues in KMSF BWQ
- Acted as a professional coding and billing resource for staff on all coding areas to ensure accurate and effective coding
- Complete reversals and corrections as identified by coders.
- Reviewed monthly denials, provided coder or physician education as needed
- Utilized applicable software systems (scheduling, registration, EMR, coding, billing) to complete coding transactions
- Proficient in 3M360, Soarian CEWL, Soarian EBEWS, HQPM, APM, SCM, AEHR, AAPC Coder, and MedAptus
Billing Specialist
University Of Kentucky
Lexington, KY
06.2015 - 11.2019
- Presented outstanding issues to provider representatives with Wellcare, Aetna, Humana and Anthem during onsite monthly meetings with KMSF staff and other UK departments within Patient Accounts
- Identified, researched and resolved billing variances to maintain system accuracy and currency.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Maintained payer issue logs for all MCO’s, Commercial, Anthem and Contract Compliance accounts using excel spreadsheets with pivots, formulas and graphs as needed
- Reviewed denied claims for correct ICD-10 coding, CCI edits, NCD/LCD guidelines, inpatient only cpt codes and authorizations. Resubmitted corrected claims online and thru clearinghouse. Filed appeals with insurance as necessary.
- Identified internal issues and external issues with providers and supervisors
- Identified trends and reported accordingly to appropriate department or payer representative
- Verified insurance coverage thru insurance portals; added insurance and billed claims
- Knowledge of AEOS, PIC and SSI reports
- Type of claims billed: Ambulance, OP services, IP Medical & Behavioral Health
- Systems Used: AEOS, PIC, IAuth, APM, AiM, SSI, Outlook, Sharepoint, 3M, Sunrise Clinical, Excel, Word, MCO Payer Portals, Hot Key, DMS, Payspan, CGS, Availity
FINANCIAL COUNSELOR
University Of Kentucky
Lexington, KY
12.2013 - 06.2015
- Reviewed un-insured patients financial resources for financial assistance and/or insurance coverage
- Collected payments from patients and completed payment arrangement as needed. Assisted patients whose insurance had been exhausted.
- Verified insurance thru insurance portals and added insurance in systems
- Answered billing questions, charge disputes and patient complaints
- Obtained authorizations for all insurances for bone marrow transplants
- Certified Kynector
- Completed estimate requests for procedures for uninsured patients
- Systems/Programs used: CAAM, APM, AIM, Kynect, Excel, Word, Lync, Payer Portals, Outlook
Billing Specialist
Ace Clinique Of Medicine
Hazard, KY
04.2009 - 10.2013
- Verified insurance thru insurance portals
- Coded and posted physician hospital, radiology, high complexity lab and outpatient physician charges
- Posted incoming payments and adjustments
- Zirmed-Uploaded claims to clearinghouse, primary and secondary. Submitted hardcopy secondary claims as needed.
- Corrected and resubmitted denied claims thru Zirmed, Lytec and provider portals. Identified trends in denials and discussed with physicians and CEO.
- Implemented a system to balance incoming payments thru Excel. Logged and balanced all incoming checks on ExceI
- Maintained training information and updated from meetings, information received from payers
- Reviewed credit report, identified overpayments and processed refunds
- Discussed insurance options with patients during open enrollments. Assisted patients as needed in understanding their benefits, eob’s and statements
- Monthly internal chart audits
- Generated and submitted invoices based upon established accounts receivable schedules and terms.
- Services performed at facility: General practice, pain management, high complexity lab, x-ray, ultrasound, CT, MRI, nuclear radiology, facet and trigger point injections, PFT, nerve conduction studies, excisions
- Systems used: Outlook, Excel, Zirmed, Lytec, Word.
BILLING CONSULTANT
LITTLE FLOWERS CLINIC
11.2008 - 06.2010
- Set up non-profit clinic on DDE system, Ky Health net and other payer portals to make compliant with non-profit guidelines
- Trained staff on verifying insurance thru portals
- Reviewed superbill for correct procedure codes
- Audited charts and reviewed information in system for compliance
- Utilized communication skills (verbal & written), organization skills and time management
Billing Specialist
Mountain After Hours Clinic
Hazard, KY
02.2008 - 04.2009
- Coded charges from daily encounter forms
- Interviewed job applicants
- Trained new employees
- Completed daily deposit
- Balanced payments in system
- Completed monthly reports using excel and balanced with company accountant
- Turned in monthly report of outstanding A/R and total payments for owners/physician monthly business meeting
- Verified insurance coverage for all payers via either online portal or phone call
- ZirmedUploaded accounts, corrected claim edits, downloaded payments for electronic posting
- Corrected and resubmitted denied claims
- Reviewed recoupments and processed refunds from credit balance report
- Reviewed authorizations
- Assisted patients as needed with questions regarding statements and insurance benefits
- Services performed at facility: General practice, Chiropractor, Rheumatologist, Lab, Rural Health Services, MRI, Mobile MRI, X-ray and ultrasound
- Systems Utilized MedInformatics, Zirmed, Microsoft Word, Excel & Outlook
Medical Billing Specialist
Appalachian Regional
Hazard, KY
11.1993 - 02.2008
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from insurance companies.
- Trained new employees on multiple medical billing programs and data entry software.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Communicated effectively and extensively with other departments to resolve claims issues. Met with registration supervisor and clerks to discuss trends in denials
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Determined prior authorizations for outpatient procedures working with UR department.
- Performed billing and coding procedures for emergency room, impatient and outpatient services, acute & psychiatric.
- Located errors and promptly refiled rejected claims. Communicated with insurance providers to resolve denied claims and resubmitted. Processed and corrected denials for Ky Medicaid. Filed appeals with insurance as necessary.
- Delivered timely and accurate charge submissions.
- Entered daily psychiatric physician charges
- Processed incoming and outgoing daily mail for medical and psychiatric centers
- Completed deposit for medical and psychiatric center
- Reviewed and distributed daily census
- Registered patients for inpatient, outpatient, and psychiatric service. Completed MSP & reviewed for ABN forms
- Precisely evaluated and verified benefits and eligibility. Verified insurance for all payers via payer portals or phone verification
- Set up Medicaid staff with access to Ky Health Net
- Claim types billed: inpatient medical, inpatient behavioral health and op claims
- Systems Utilized: McKesson Boss, McKesson Star, DDE, used excel to present reports to supervisor, used Quicken to distribute State Funds to behavioral health patients, used Word to maintain training documents for new employees
MANAGER
STAT MEDICAL EQUIPMENT
Hazard, KY
06.1993 - 11.1993
- Submitted A/R reports to regional office to senior executives showing growth of facility and goals met
- Marketed business to area physician’s offices, using communication skills to promote the company
- Yearly inventory
- Interviewed and hired candidates for open positions. Completed employee evaluations, set goals for our location. Trained employees in use of systems, completion of reports. Disciplinary action, including termination, as needed.
- Completed time keeping for payroll
- Home visits to oxygen & apnea monitoring patients
- Submitted CMN’s to physicians for completion
- Verified DME benefits with insurance companies thru insurance verification programs
- Served as liaison between staff and company leadership
- Exhibited outstanding time management, delegation and organizational skills by completing marketing, home visits and assisting on site.
Skills
- Claim Edit & Denial Resolution
- Scheduling and Coordinating
- Performance Motivation
- Administration and Reporting
- Priority Management
- Motivating Performers
- Managing Operations and Efficiency
- ICD-10 (International Classification of Disease Systems)
- Performance Tracking and Evaluations
- Employee Coaching and Motivation
- Job Assignments
- Optimizing Workflows
- Team Assignments
Certification
AAPC CPC CERTIFICATION
Timeline
Supervisor
University Of Kentucky
02.2021 - Current
Team lead
University Of Kentucky
11.2019 - 02.2021
Billing Specialist
University Of Kentucky
06.2015 - 11.2019
FINANCIAL COUNSELOR
University Of Kentucky
12.2013 - 06.2015
Billing Specialist
Ace Clinique Of Medicine
04.2009 - 10.2013
BILLING CONSULTANT
LITTLE FLOWERS CLINIC
11.2008 - 06.2010
Billing Specialist
Mountain After Hours Clinic
02.2008 - 04.2009
Medical Billing Specialist
Appalachian Regional
11.1993 - 02.2008
MANAGER
STAT MEDICAL EQUIPMENT
06.1993 - 11.1993
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