Candis Alfano
Fort Myers,FL
Summary
Billing and Collections Manager with extensive experience in insurance claim resolution and compliance analysis at Surgery Center of Naples, LLC. Demonstrated success in maximizing reimbursement through effective denial management strategies and attention to detail. Committed to enhancing revenue cycle processes and ensuring accuracy in patient billing.
Overview
25
25
years of professional experience
Work History
Billing/Collections Manager
Surgery Center of Naples, LLC
Naples, FL
08.2020 - Current
- Responsible for overseeing the full revenue cycle with a focus on insurance claim resolution.
- Duties include managing and submitting medical appeals, analyzing denials, ensuring compliance with payer and regulatory requirements, coordinating with clinical and administrative staff to support medical necessity, and pursuing underpaid or denied claims to maximize reimbursement.
- In charge of supervising the billing and collections processes, tracking appeal outcomes, and implementing strategies to reduce denials and improve cash flow.
Mental Health Billing Specialist
Elite DNA Therapy Services
Fort Myers, FL
01.2019 - 08.2020
- Accountable for billing out claims for all Physicians, Mental Health Counselors/Social Workers in the Fort Myers' office and ensure that they are correct.
- Collecting insurance E-payments through the company email.
- Correcting and updating patient information and insurance plans.
- Reviewing any claims that are holding for incorrect insurance information, diagnosis codes, and/or CPT codes, and ensuring that they are corrected for the claim to be paid promptly.
- Updating and completing any patient or insurance collections.
EDI Billing Specialist
Florida Cancer Specialist
Fort Myers, FL
09.2014 - 01.2019
- Responsible for the completion of daily reports and any special projects.
- Responsible for ensuring all claims are processed and that they are correct and compliant.
- Validate all billing through claim scrubbers before processing to the clearinghouse.
- Corr noting all changes and failures within the claim.
- Attaching the proper authorizations to claims.
- Obtaining current changes with all CPT and ICD-IO updates, as well as drug polices per insurance carrier.
Intake Team Lead
Florida Cancer Specialist
Fort Myers, FL
09.2014 - 01.2019
- Responsible for training all new employees on obtaining full and OV benefits from all insurance companies and implementing the information into G4 and Relay Health.
- Updating staff on any changes to the workflow and insurance updates.
- Updating SOPS as needed.
- Auditing employees’ work.
- Working closely with the Supervisor regarding team workflow.
- Attending daily meeting with Supervisors and Dept Managers.
- Helping the team obtain benefits when needed to ensure the following day's appointment insurance benefits are loaded.
Intake/Registration Coordinator
Florida Cancer Specialist
Fort Myers, FL
09.2014 - 01.2019
- Use real-time eligibility to obtain new patient office visits and lab benefits.
- Obtain full benefits for patients who are receiving treatment (chemotherapy, injections, and radiology) in the office.
- Entering the correct insurance carrier, financial class, and allocation in Centricity/G4.
- Request new patient referrals from the PCP promptly.
- Work with insurance companies to obtain correct benefits and eligibility.
- Communicate with Financial Counselors regarding patients' insurance and referrals.
- Scanning authorizations and referrals into Onco and Centricity.
Administration Assistant
Cayuga Medical Center, Cayuga Hematology Oncology Associates
Ithaca, NY
05.2009 - 08.2014
- Performed reception & registration of patients including patient interviews, collecting/verifying demographic & financial data and accurately entering information.
- Answer multi-line phone, operate fax and copy machine.
- Schedule imaging exams, patients' appointments, update patients' charts.
- Patient billing as needed.
Office Receptionist
Northeast Pediatrics
Ithaca, NY
01.2005 - 11.2007
- Answered phones, scheduled patients.
- Updated patients chart as needed.
- Insurance referrals upon request.
- Prepared charts for upcoming new babies.
- Checked in and checked out patients.
- Scheduled necessary imaging and other testing as needed.
Medical Assistant
Northeast Surgical Group
Ithaca, NY
01.2001 - 01.2004
- Obtained weight, blood pressure, and medical history.
- Assisted in any procedures or exams.
- Scheduled patients for upcoming sclerotherapy, laser surgeries, and any in house cosmetic surgeries.
- Completed required hospital surgical consent forms.
- Gave patients surgical instructions and relayed important surgical information.
- Cleaned and sterilized surgical instruments.
- Removed stitches, staples, and drains.
- Schedule pre/post op appointment.
- Traveled with physicians to all satellite offices.
Education
CPT & ICD-9 Coding Certification -
BOCES
Ithaca, NY01.2006
High School Diploma -
Southern Cayuga Central High
Poplar Ridge, NY01.1995
Skills
- Insurance claim resolution and processing
- Medical appeals management
- Compliance analysis and regulatory adherence
- Revenue cycle oversight
- Denial management strategies
- Patient billing accuracy
- Attention to detail
Timeline
Billing/Collections Manager
Surgery Center of Naples, LLC
08.2020 - Current
Mental Health Billing Specialist
Elite DNA Therapy Services
01.2019 - 08.2020
EDI Billing Specialist
Florida Cancer Specialist
09.2014 - 01.2019
Intake Team Lead
Florida Cancer Specialist
09.2014 - 01.2019
Intake/Registration Coordinator
Florida Cancer Specialist
09.2014 - 01.2019
Administration Assistant
Cayuga Medical Center, Cayuga Hematology Oncology Associates
05.2009 - 08.2014
Office Receptionist
Northeast Pediatrics
01.2005 - 11.2007
Medical Assistant
Northeast Surgical Group
01.2001 - 01.2004
CPT & ICD-9 Coding Certification -
BOCES
High School Diploma -
Southern Cayuga Central High