Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nicole LeMar

Liberty,MO

Summary

5+ Years of leadership experience in medical billing, coding, and collections. Proven success in streamlining medical billing processes and decreasing billing cycle times. Extensive experience in accounts receivable and accounts payable management. Knowledge of relevant federal and state regulations and best practices regarding medical billing. Familiarity with various medical billing software programs and EHR systems including but not limited to Prognosis, Kareo, Lytec, TherapyNotes Forward-thinking Operations Specialist bringing 9+ years of expertise in revenue cycle for medical sector businesses. Cultivates rapport with individuals to optimize project goals and output, resolve complex problems and deliver innovative improvement strategies.

Overview

12
12
years of professional experience

Work History

Denial Prevention Specialist (Remote)

CND Life Sciences Inc.
10.2024 - Current
  • Responsible for working with the Back-End Billing specialist on denials and accounts receivables management.
  • Drafting written letters of appeal on various types of denied claims, contacting the insurance companies to follow up on unresolved appealed claims, aging AR, and additional projects as assigned.
  • Conduct thorough account audits to ensure integrity and accuracy within the revenue cycle workflow
  • Investigate payer denials related to referral, pre-authorization, eligibility/registration, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
  • Prepare and submit tailored appeals to payers based on meticulous reviews of medical records, adhering to Medicare, Medicaid, and third-party guidelines, as well as internal policies, ensuring accuracy and timeliness. Contacts insurance companies to follow up on appealed claims. Holds insurance company accountable for timely resolution of all appeals submitted.
  • Identify prevalent denial patterns and proactively communicate strategies to prevent future occurrences, offering education and guidance to stakeholders.
  • Process and follow up on payer denials, rebilling, or submitting adjustments as needed.
  • Respond to authorization denials by submitting retro-authorizations in compliance with payer requirements, facilitating efficient resolution.


Patient Account Follow Up Supervisor

Liberty Hospital
11.2023 - 10.2024
  • Build, manage, and develop a billing team comprised of 12-20 employees, provide coaching and mentorship, conduct performance evaluations, and establish inclusive work cultures
  • Proven track record of successfully overseeing billing and insurance claim operations in a busy medical office
  • Skilled in researching, resolving, and appealing denied claims
  • Proficient in using various practice management software, clearinghouses and patient billing systems: Kareo, TherapyNotes, Quadax, Lytec, Trizetto, Prognocis, Waystar, Advanced MD
  • Evaluate outstanding AR for trends and strategies to increase revenue and lower AR days.
  • Ensure strategies are adopted by employees timely and successfully

Billing and Credentialing Manager

A Child's Voice
08.2021 - 09.2023
  • Comprehensive knowledge of medical insurance claims processing, coding, and reimbursement
  • Developed and implemented billing and credentialing policies and procedures to ensure efficiency and accuracy
  • Conducted periodic audits of billing and credentialing activities to identify and address any inconsistencies
  • Ensured HIPAA compliance of billing and claims information
  • Analyzed data to identify trends and patterns in data sets
  • Improved average claim reimbursement from $90 to $95 by ensuring accurate billed amounts for services rendered.
  • Collaborated with cross-functional teams to ensure data integrity
  • Proven track record of success in managing and resolving a high volume of medical billing inquiries and disputes
  • Improved claim accuracy to 97%+ within 4 months by providing billing workshops and reviewing medical claim data.
  • Proficient in handling accounts receivable and resolving discrepancies
  • Skilled in assessing medical coding accuracy to ensure proper reimbursement
  • Demonstrated success in reviewing and verifying the accuracy of medical claim data
  • Strong patient services background, with excellent problem-solving skills
  • Responsible for all aspects of medical credentialing process for medical staff and providers at various medical facilities
  • Collect, verify, analyze and track all necessary information and documents to ensure accuracy of medical staff and provider applications
  • Maintain accurate and up to date records of all medical staff and providers in the credentialing database
  • Monitor and track all licensure, certifications, and other documents necessary to ensure compliance with regulatory requirements
  • Resolve any discrepancies or issues related to medical credentialing
  • Review and verify insurance contracts for assigned providers
  • Act as a liaison between the medical staff and providers and insurance companies in resolving any credentialing related issues

Medical Billing and Prior Authorizations Lead

Sage Neuroscience Center
10.2018 - 08.2021
  • Hired as medical billing specialist then promoted to lead biller overseeing staff, contracting, credentialing, payment posting, and audits due to proficiencies exhibited
  • Oversee and strategize billing and aging personnel
  • Collaborated with executive team to create goals for the billing department to aid in overall success the facility
  • Work with CFO to establish departmental goals and timelines and update CFO monthly on whether the goals have been met; inform CFO as soon as possible if there are barriers to meeting goals
  • Analyzes data trends affecting charges, coding, collection, accounts receivable and write-offs and takes appropriate action.
  • Created and launched track training modules to aid in personal development of billing team
  • Develop and maintain relationships with each Managed Care Organizations to ensure that payments are received and billing meets requirements
  • Ensured activities of staff are conducted to align with facility protocols
  • Managed various projects valued at $30,000 to $75,000, oversaw dynamic project teams comprised of 6+, and ensured on-time and on-budget completion
  • Coordinate with cross-functional teams to identify process gaps and develop solutions, resulting in improved copay collection, AR Aging reduction, and first time claim reimbursement
  • Ability to train and mentor staff on medical billing and coding procedures
  • Processed and reviewed behavioral prior authorization requests for intensive outpatient therapy in accordance with state and federal laws
  • Communicated with healthcare providers and insurance companies to obtain necessary documentation
  • Researched and responded to inquiries from providers and members
  • Processed online and paper appeal submissions and refund requests.
  • Corrected, completed and processed claims for multiple payer codes.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Logged charges and payments within Kareo.

Medical Billing and Collections Specialist

Medical Practice Billing
11.2016 - 10.2018
  • Processed patient accounts, including medical billing, collections, and accounts receivable for multiple facilities and cross specialties
  • Managed electronic and paper claims and accounts
  • Researched and resolved patient billing inquiries
  • Followed up with insurance companies to ensure timely and accurate reimbursement
  • Compiled daily, weekly, and monthly reports
  • Monitored and reported on accounts receivable aging and collection activities
  • Assisted in resolving coding issues and discrepancies with providers
  • Proficient in developing patient centered appeal letters in adherence to the applicable rules and regulations
  • Experience working with a variety of insurance providers to resolve denied claims
  • Knowledge of CPT and ICD10 codes and other relevant coding systems

Inbound Customer Service Contact Agent

Lowe's Home Improvement
04.2013 - 05.2016
  • Answered inbound customer service inquiries via phone, email, and chat
  • Resolved customer complaints and inquiries to their satisfaction
  • Established and maintained positive customer relations
  • Provided excellent customer service and product information as well as sales
  • Assisted customers with order processing, returns, and refunds
  • Soley Processed $400,000 in sales during 2015 fiscal year

Education

Certificate of Medical Billing and Coding -

Carrington College
Albuquerque NM
01-2017

Skills

  • Detail Orientated
  • Able to work independently or within a team
  • Excellent written and oral communication skills
  • Develops positive workplace relationships
  • ICD 10
  • HIPAA procedures
  • 10 Key

Timeline

Denial Prevention Specialist (Remote)

CND Life Sciences Inc.
10.2024 - Current

Patient Account Follow Up Supervisor

Liberty Hospital
11.2023 - 10.2024

Billing and Credentialing Manager

A Child's Voice
08.2021 - 09.2023

Medical Billing and Prior Authorizations Lead

Sage Neuroscience Center
10.2018 - 08.2021

Medical Billing and Collections Specialist

Medical Practice Billing
11.2016 - 10.2018

Inbound Customer Service Contact Agent

Lowe's Home Improvement
04.2013 - 05.2016

Certificate of Medical Billing and Coding -

Carrington College

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Nicole LeMar