Carol Hranek
Canton,NC
Summary
Detail-oriented professional with comprehensive knowledge of VA health care eligibility, cost recovery, and revenue operations. Skilled in insurance verification and discrepancies resolution, ensuring accurate billing for third-party payers. Experienced in managing workloads and instructing staff, utilizing tools like QUIC, ONTRAC, and Excel to streamline operations and enhance team efficiency.
Overview
35
35
years of professional experience
Work History
Medical Reimbursement Technician
Veterans Administration
Asheville, NC
04.2013 - Current
- Managed billing activities for inpatient, outpatient, and NonVA encounters, ensuring compliance with professional services, facility services, Medicare, and commercial insurance.
- Validates claims for billing purposes ensuring eligibility and referring questionable encounters to coding for review
- Generating claims for coded and linked encounters
- Assigning Reasons Not Billable for Non-billable encounters
- Ensured timely cancellation of claims to maintain accurate billing records.
- Working CSA rejections and claims returned on MRA work list
- Managed daily work lists for mrw, csa, and cbw to ensure claims were processed within 5 days.
- Gathers information needed to input into automated billing system in timely and accurate way.
- Able to give accurate response to inquiries and request by researching information to ensure that information is current and up to date.
- Responds to emails and quick inquiries when working with customers, accounts management and facilities in giving information they have requested on scheduled outpatient claims.
- Trained new staff on facility billing procedures, clarifying insurance billing processes and assisting in clearing rejects for timely submission to insurance.
- Protects privacy of printed and electronic files with sensitive data in accordance with HIPAA and Privacy laws
- Maintains patient confidentiality by complying with Privacy and HIPAA laws, policies and regulations applicable to healthcare
- Determines when referral to Regional Counsel or other departments is appropriate for further progression of billing
- Understands the relationship between various healthcare support departments and regularly corresponds with staff in other departmental areas via email and phone
- Ensures billable cases are identified and bills are generated.
- Initiates collections from insurance companies
- Applies payments to appropriate bills or refunds to the applicable party
- Investigate payment discrepancies, making frequent and varied account adjustments.
- Report to supervisor on performance, progress and training needs of employees
- Hours per week: 40
- Series: 0503 Pay Plan: GS Grade: 06
- Held a position within the federal government, focusing on medical reimbursement.
- Job Title: Lead Medical Reimbursement Technician
- Job Announcement Number: CBAB-10242851-18-JSPage 1
- Supervisor: Donna Rambin (828-257-3582)
- Okay to contact this Supervisor: Yes
NCOIC, Treasury Operations
United States Air Force
Hesperia, CA
01.1997 - 08.2001
- Worked in multiple locations in the DFAS San Bernardino operating site
- 1999-2001 Worked in treasury operations, where I sent out daily electronic funds payments, sent check files to Denver and made sure that payments going out and the Merged Account Financial Records, were balanced daily. Trained new airman and civilians on how to run reports and balance the daily work and any other parts of job they were learning to do at that time.
- Ensured proper fund utilization by processing recon and reports, transitioning funds from obligated to paid status, and returning excess funds to correct accounts for continued usage within the fiscal year.
- 1997-1998 Worked in obligations, ensured the form 9's were processed properly and once the hard copy contract arrived made sure that money was moved to obligated in the system so it could have correct payments processed.
- Adjusted workload by delegating tasks to others in the office to ensure deadlines were met. Ensured all priority deadlines were worked and completed in a timely manner.
- Review what needs to be completed the following day at the end of each day and organize what order things need to be completed to ensure no deadlines are missed.
- Delegated tasks and conducted training sessions for new airman and civilian employees during monthly staff meetings and individual meetings.
- Staff development and training Conducted monthly training either by myself or assigning another person in the office, trained office on jobs that we actually do and delegated training to others to ensure that the current processes were being taught.
- Review staffing to make sure that all processes are covered, make sure that assigned work is distributed to cover when someone is out of the office. Reassign workload as needed to ensure that all priority work is covered so that deadlines are not missed and are reviewed to ensure correctness of the assigned work.
- Reviewed claims to ensure that expected payments were consistent and followed specific policies and rules
- Received and reviewed 3rd party information to ensure payments collected and payments paid were done with contract and regulations
- Identified areas of workloads were distributed and balanced between subordinates to meet the goals and deadlines that had been established per the office.
- Coordinated team training sessions to enhance understanding of interrelated processes, fostering a collaborative work environment and improving overall operational efficiency.
- Provided individual training for new people or refresher training to make sure that everyone knew all current processes and changes before starting new projects
- Collaborated with peers and subordinates to clarify policy changes, updating regulations weekly to ensure all personnel were informed of the latest compliance requirements. Distributed changes to personnel it would have biggest impact on.
- Reported to supervisors on performance, progress of current and new employees (airman) and made sure they knew of any training needs of the office.
- Job Title: Lead Medical Reimbursement Technician
- Job Announcement Number: CBAB-10242851-18-JSPage 4
Accounts Control
United States Air Force
Burlington, NJ
10.1993 - 11.1996
- 1993-1994 worked in accounts payable office. Ensured that contracts were input into the computer system and when I received a receiving report it was input against the correct contract and would hold until the invoice was received. input the invoice and scheduled the payment to pay according to the terms of the contract. Balanced Merged Account Financial Records (MAFR) daily with treasury and accounts control so the money was balanced on a daily basis.
- Worked with the base hospital accounts paying claims they were processing according to the regulations manual.
- Processed payment vouchers and conducted monthly account reconciliations to maintain accurate account postings.
- Resolved payment discrepancies through proactive communication with relevant offices, making necessary account adjustments to ensure accuracy.
- Facilitated timely communication with contractors regarding payment statuses, discounts applied, and addressed inquiries related to their accounts.
- Worked with DFAS Denver headquarters to ensure that reports balanced and corrected errors in a timely manner
- Hours per week: 40
- Job Title: Lead Medical Reimbursement Technician
- Job Announcement Number: CBAB-10242851-18-JSPage 5
Accounting and Finance
United States Air Force
Sembach Air Base, AE
10.1991 - 10.1993
- Processed accounts payable by reviewing receiving reports and invoices for accuracy and contract compliance. Translated invoices from German to English and ensured timely payments to foreign service providers.
- Worked in accounts receivable making sure that money received from the tenants on the base were correct and posted to the proper accounts.
- Ensured accurate processing of information to contracts and maintained balanced records promptly after payments were made.
- Verified bill components for accuracy, confirming all materials were accounted for and correctly billed.
- Made sure all contract requirements were met and that they were processed according to the terms set inside the contract.
- Processed payments for bills and requested refunds when necessary.
- Job Announcement Number: CBAB-10242851-18-JSPage 6
Education
Technical or Occupational Certificate - Medical Office Administration
Haywood Community College
Clyde, NC, United StatesSkills
- Claims adjudication
- Medical billing systems
- Insurance verification
- Payment posting
- HIPAA compliance
- Claims processing
- Insurance reimbursement
- Claims review
Additional Information:
- Airman Leadership School completed May 1997
- 7-LevelTraining for 6F071 completed June 2001
- On Top Dollar Team 1994-1996
- Air Force Achievement Medal
- Air Force Achievement Medal 1st oak leaf cluster
- Air Force Accommodation Medal joint service
- Supervisor from 1999-2001 when separated from Air Force
Job Related Training:
- Airman Leadership School completed May 1997
- 7-LevelTraining for 6F071 completed June 2001
- On Top Dollar Team 1994-1996
- Air Force Achievement Medal
- Air Force Achievement Medal 1st oak leaf cluster
- Air Force Accommodation Medal joint service
- Supervisor from 1999-2001 when separated from Air Force
Timeline
Medical Reimbursement Technician
Veterans Administration
04.2013 - Current
NCOIC, Treasury Operations
United States Air Force
01.1997 - 08.2001
Accounts Control
United States Air Force
10.1993 - 11.1996
Accounting and Finance
United States Air Force
10.1991 - 10.1993
Technical or Occupational Certificate - Medical Office Administration
Haywood Community College