CHERYL CARTWRIGHT
USA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
18
18
years of professional experience
Work History
AR BILLING & CREDENTIALING CONSULTANT
CREDIBILITY PHYSICIAN SOLUTIONS
01.2024 - Current
- Led cross-functional teams to develop strategic recommendations and drive operational improvements.
- Facilitated workshops to gather stakeholder insights and align on project objectives.
- Managed daily accounts receivable operations ensuring accurate and timely billing and claim submissions for multiple healthcare providers and tracking credentials.
- Reduced outstanding accounts receivable through diligent followup on unpaid claims and aggressive denial management strategies.
- Resolved billing inquires and discrepancies for patient and payers via phone and email.
- Analyzed AR reports, identified trends, reconciled accounts and prepared financial statements
- Worked with multiple EMR/EHR systems, medical billing software, microsoft excel etc.
- Adherence to healthcare rules and regulations for credentialing and billing.
- Managed end to end credentialing and recredentialing process for adverse group of healthcare providers
- Verified provider credentials to ensure timely and compliant submissions.
- Ensured compliance with primary source verification to ensure qualifications are met.
- Maintained and updated provider credentialing databases, ensuring all information was accurate, current, and confidential.
- Collaborated with providers, insurance companies, and internal departments to resolve application issues and facilitate smooth onboarding.
- Tracked expiration dates for all provider licenses, board certifications, and malpractice insurance policies to avoid lapses.
- Conducted regular audits of credentialing files to ensure accuracy, completeness, and adherence to all internal and external policies.
AR BILLING SPECIALIST
ASTON HEALTH CONSULTING
06.2024 - 12.2024
- Detail-oriented expert in skilled nursing and covered multiple long-term care facilities at a time.
- Worked with PointClickCare, WayStar, Esolutions, DDE, Availity, All Payer Portals
- Billing and Claims Management: Prepare, review, and submit accurate claims to various payers, including Medicare Part A and B, Medicaid, Managed Care, and private pay, ensuring compliance with all billing regulations.
Perform daily census reconciliation and billing system updates to ensure all services are accurately captured and billed.
Manage and submit timely billing for ancillary services (e.g., therapy, lab) for all payer types. - Accounts Receivable and Collections: Conduct timely follow-up on unpaid or underpaid claims with insurance companies to resolve issues and expedite payment.
Work and review weekly or monthly aging reports to identify and prioritize outstanding balances for collection efforts.
Post and reconcile all payments, denials, and adjustments received from all payer sources.
Collaborate with residents and families to resolve private pay balances and set up payment arrangements. - Denials and Appeals Management: Investigate and resolve claim rejections and denials by identifying root causes, correcting information, and submitting appeals.
Identify denial trends and report findings to management to implement process improvements and prevent future denials. - Compliance and Reporting: Ensure all billing and collection activities are in strict compliance with CMS, state, and HIPAA regulations.
Participate in the "Triple Check" process for claim submission to ensure accuracy and reduce billing errors.
Generate and analyze accounts receivable, cash collection, and billing trend reports for review by facility administration and corporate leadership. - Interdepartmental Collaboration: Work closely with the admissions and Minimum Data Set (MDS) teams to verify patient eligibility, payer information, and clinical documentation that supports billed services.
Communicate with facility Business Office Managers (BOMs) to resolve discrepancies and facilitate information exchange
MEDICAID PLANNER
PYRAMID HEALTH GROUP
01.2024 - 05.2024
- Conducted financial interviews with residents and families to assess Medicaid eligibility for admission and continued care.
- Collected and managed all necessary documentation for Medicaid applications, renewals, and pending applications, ensuring accuracy and completeness.
- Collaborated with admissions, social work, and clinical teams to ensure a smooth and timely admission process for Medicaid-eligible residents.
- Educated residents and families on financial requirements, monthly co-payments, and the overall Medicaid process.
- Maintained current knowledge of all federal and state Medicaid regulations and facility policies.
- Coordinated with the interdisciplinary team on discharge plans to ensure residents' needs were met after their stay.
- Maintained organized and accurate resident files and managed a high volume of data in the resident database.
- Submitted all information and application for Medicaid to the state for review and decision.
- Tracked and follow up on status of application.
- Set up payment plans for copays and patient share of cost plans for each month before and after approval.
- Worked with facility team on other payers as well as ensuring proper claim processing and billing and collections.
TRACKER/MEDICAID PLANNER
APEX GLOBAL SOLUTIONS
04.2021 - 01.2023
- Managed multiple skilled nursing facilities at a time in a region.
- ensured all residents had an accurate payer and authorization in place for a clean claim.
- complete Private Pay, Income and Medicaid Pending aging reports for all facilities
- ensure eligibility is completed for all residents
- Review and update the census daily.
- Assist with the collection of payments and processing of payments on private pay and income bills.
- ensure all patient liability payment plans are in place for medicaid patients as well as medicaid pending.
- Worked with facility on denials or rejections and appealed when necessary.
- Conducted financial interviews with residents and families to assess Medicaid eligibility for admission and continued care.
- Educated residents and families on financial requirements, monthly co-payments, and the overall Medicaid process.
- Maintained current knowledge of all federal and state Medicaid regulations and facility policies.
- Coordinated with the interdisciplinary team on discharge plans to ensure residents' needs were met after their stay.
- Maintained organized and accurate resident files and managed a high volume of data in the resident database.
BILLING SUPPORT SPECIALIST
MATRIXCARE
12.2020 - 10.2021
- Technical Support Specialist for Software system - Tier 1 Level
- Created support tickets using sales force portal - taking incoming calls, emails or by chat
- Working knowledge of Matrixcare medical billing platform to train and support Home Health and Hospice customers nationwide
BUSINESS OFFICE MANAGER
HARDEE MANOR NURSING CENTER
05.2020 - 12.2020
- Managed all aspects of the facility's financial operations, including billing, collections, payroll, and accounts payable.
- Ensured timely collection of payments from private payers, Medicare, Medicaid, and insurance providers.
- Maintained accurate financial records, including budgeting, expense tracking, and reporting to administration.
- Managed resident trust funds and petty cash, ensuring compliance with all regulations.
- Analyzed financial performance indicators and collaborated with the Administrator to identify and implement improvements.
- Oversaw and coordinated daily business office activities and administrative staff.
- Processed resident admissions, including contract completion and census tracking.
- Maintained accurate resident and financial records, including data entry and account reconciliation.
- Served as a key point of contact for residents, families, and vendors, handling inquiries and resolving issues.
- Ensured the facility adhered to all relevant federal, state, and local healthcare regulations and policies.
- Collaborated with department heads to streamline processes and improve operational efficiency.
- Managed and trained business office staff, including recruitment and onboarding.
- Responded to audits and inquiries from regulatory agencies and insurance companies.
ACCOUNTING ASSOCIATE
SUNBULB
11.2019 - 05.2020
- Accounts Payable and Receivable: Experienced in processing invoices, payments, expense reports, and tracking overdue payments to ensure healthy cash flow.
- Financial Reporting and Reconciliation: Capable of assisting with bank statement reconciliation and preparing financial reports for management review.
- Attention to Detail: Meticulous about ensuring accuracy in data entry and financial documents to prevent errors.
- Bookkeeping and Record Management: Skilled in maintaining and updating financial records, including general and sales ledgers.
- Technical Support staff: served as point of contact for all technical issues in office
Staff Account / Payroll /AR Collection Specialist
SENIOR NANNIES HOME HEALTH
07.2018 - 11.2019
- Generate, send, and track customer invoices, ensuring timely payment.
- Monitor accounts aging reports and proactively follow up on overdue invoices.
- Negotiate payment plans with clients and resolve billing discrepancies.
- Reconcile accounts receivable ledgers and process payments.
- Maintain accurate records of all financial transactions and communications.
- Collaborate with sales and other teams to resolve client disputes and issues.
- Process and manage payroll on a bi-weekly, monthly, or other recurring basis.
- Calculate wages, including deductions, overtime, and bonuses, ensuring accuracy.
- Ensure compliance with federal, state, and local tax regulations.
- Prepare and submit payroll tax filings and reports.
- Support month-end and year-end closing processes.
- Assist in preparing financial statements, balance sheets, and other reports.
- Perform data entry and maintain accounting databases and spreadsheets.
- Collaborate with the finance team to streamline accounting processes.
ASSISTANT BUSINESS OFFICE MANAGER
POMPANO NURSING AND REHAB CENTER
05.2017 - 01.2018
- Assist with billing for all payers, including Medicare, Medicaid, private insurance, and private pay.
- Follow up on and collect outstanding accounts receivable balances.
- Process and reconcile cash receipts and deposits.
- Assist with daily business office operations, payroll processing, and financial reporting.
- Support the Business Office Manager with accounts payable functions and bookkeeping.
- Help maintain accurate financial records in compliance with federal, state, and local regulations.
- Assist with resident trust accounting and ensure security of patient funds.
- Communicate with residents and families regarding financial matters.
- Partner with admissions to verify resident financial documentation.
- Ensure compliance with all relevant regulations.
- Assist with month-end closing procedures and bank reconciliations.
- Answer telephones and manage general office administrative tasks.
- Support other department leaders with financial aspects of their operations.
A/R BILLING SPECIALIST
AVANTE GROUP
03.2016 - 02.2017
- Independently managed skilled nursing/long term care billing and collections for central business office. SNF's in Florida, North Carolina and Virginia. Maintained revenue of 100% per month for each facility for all payers in each state contracted and not contracted.
- Claim Management: Bill and follow up on claims (primary, secondary, and co-insurance) for Medicare, Medicaid, and Managed Care.
- Payment Processing: Post and reconcile payments accurately from various sources (e.g., lockbox, electronic transfers).
- Collections: Pursue and resolve outstanding accounts, including private pay and self-pay portions, and communicate with patients or their families about payment options.
- Dispute and Discrepancy Resolution: Resolve billing issues, denied claims (ADRs), and payer discrepancies to ensure timely reimbursement.
- Reporting: Generate and analyze reports, including aged trial balances, and provide status updates on outstanding claims.
- Collaboration: Work with internal teams, facility business office managers, and field accounting to ensure accurate billing and classifications.
- Compliance: Ensure all billing activities adhere to SNF and healthcare industry regulations and policies.
- Month-End Close: Assist with month-end close duties, including posting ancillaries and reconciling accounts.
CREDENTIALING TRAINING AND DOCUMENTATION SPECIALIST
PARALLON WORKFORCE SOLUTIONS
07.2015 - 02.2016
- Developed and maintained comprehensive documentation for operational processes and procedures.
- Ensured compliance with regulatory standards by conducting thorough document reviews.
- Implemented best practices for document management, improving access and retrieval efficiency.
- Trained staff on documentation protocols and software systems to enhance accuracy and consistency.
- Analyzed documentation processes, identifying areas for improvement and recommending solutions.
- Provided staff training and mentorship in preparing communication content for different media outlets.
- Increased team productivity by establishing streamlined processes for document review, approval, and publication.
- Facilitated the smooth transition of new employees through the creation of comprehensive training manuals and onboarding materials.
- Manage the end-to-end credentialing and re-credentialing process for physicians, allied health professionals, and other providers.
- Conduct primary source verification of provider licenses, certifications, and education, ensuring compliance with NCQA and Joint Commission standards.
- Perform thorough background checks and research any discrepancies in provider information.
- Monitor and track provider license, certification, and malpractice insurance expiration dates, ensuring timely renewals.
- Identify and resolve potential credentialing issues, escalating complex cases to management as needed.
DENIAL ANALYST and EDI SPECIALIST
EYE PHYSICIANS OF FLORIDA
09.2013 - 07.2015
- Analyzed and resolved denied/rejected insurance claims, prioritizing high-dollar and high-volume accounts to ensure timely payment.
- Investigated root causes of claim denials by reviewing EMR, billing, and coding information to identify patterns and trends.
- Prepared and submitted appeals to insurance companies, ensuring all necessary documentation was included to support the appeal.
- Collaborated with billing, coding, and clinical departments to streamline processes and provide education on denial prevention strategies.
- Developed and maintained denial dashboards and reports to monitor key performance indicators (KPIs), track trends, and present findings to senior leadership.
- Implemented process improvement projects based on data analysis to decrease denial rates and maximize revenue recovery.
- Researched and stayed current on payer-specific requirements, billing regulations, and appeals procedures to ensure compliance.
- Utilized EMR systems for denial management, data analysis, and claim resolution
SEGMENTATION SPECIALIST TEAM LEADER
MAKO SURGICAL CORP
05.2011 - 09.2013
- Launched segmentation department. Supervised staff of 6 employees: processed payroll, managed schedules and tracked productivity. Created and implemented training manual and policy and procedures; complete education and training of new employees. Maintained updates in the department policy and procedures. Arranged and hosted meetings with staff for weekly updates. Responsible for tracking metrics on cases. Created 3D models of femur and pelvis from CT scans and created surgical plans for hip replacement surgeries.
PROJECT COORDINATOR
INSTITUTE FOR FAMILY CENTERED SERVICES
10.2009 - 05.2011
- Managed and coordinated behavioral health programs, ensuring compliance with regulatory standards and best practices, while tracking key performance indicators.
- Facilitated staff training on new protocols and procedures, enhancing team competency and service delivery.
- Oversaw patient/client intake, ensuring accurate data entry and eligibility verification for services.
- Collaborated with external agencies to streamline referrals, improve access to care, and coordinate client-specific treatment and discharge plans.
- Implemented quality assurance measures that improved patient satisfaction scores
- Developed and maintained project documentation, including meeting materials, timelines, and action items using tools like Asana or Monday.com.
- Assisted in preparing quarterly performance reports for department heads and monitored program outcomes to drive strategic improvements.
- Coordinated project activities across cross-functional teams, helping to keep projects on schedule and within budget.
- Addressed and resolved health insurance issues for clients and managed their medical records.
- Worked with Staff to help develop better aging standards.
BILLING SPECIALIST
INSTITUTE FOR FAMILY CENTERED SERVICES
07.2007 - 10.2009
- Verified patient insurance benefits and processed authorizations for managed care programs to ensure accurate and timely billing.
- Reconciled patient accounts, ensuring all charges for therapy, assessments, and other services were accurately billed and payments collected.
- Collaborated with clinical staff to review treatment codes and ensure proper documentation, leading to a 10% increase in reimbursement rates.
- Managed accounts receivable, including following up on outstanding balances and resolving billing discrepancies with patients and insurance companies.
- Ensured compliance with payer-specific billing instructions by maintaining and updating the billing matrix in EHR systems.
- Maintained strict client confidentiality, adhering to HIPAA regulations in all billing and record-keeping activities.
- Managed and processed bi-weekly payroll for 100+ employees, including calculating wages, overtime, and deductions accurately.
- Ensured timely and accurate payment of employee salaries and reimbursements while complying with local, state, and federal tax regulations.
- Updated employee information in the payroll system, such as pay class and union changes, and processed miscellaneous payments.
- Addressed employee payroll inquiries and resolved discrepancies via email and phone, providing excellent customer service.
- Maintained accurate payroll records and files, including scanning and attaching employee documents to employee files.
Education
Medical Billing and Coding Certificate -
AAPC
10.2025
Notary Public - undefined
FL
01.2023
Technical Diploma Certificate - Office Administration
US Career Institute
01.2016
Technical Diploma Certificate - Medical Billing and Coding
US Career Institute
01.2008
High School Diploma - undefined
Oviedo High
01.1998
Skills
- Consistent performance under pressure
- Experience in provider account setup
- Proficient in obtaining authorizations
- Proficient in payroll and recruiting processes
- Workforce management
- Proficient in Medicaid enrollment procedures
- Provider credentialing expertise
- Healthcare software proficiency
- Proficient in Microsoft programs
- CAQH proficiency
- Claim processing expertise
- Hospice, Home Care, SNF, ABA Therapy, Behavioral Health, Hospital Inpatient, Outpatient, Vision and Orthopedic services
- Effective written communication
- Team management
- Proficient in advanced computer applications
- Comprehensive knowledge of insurance reimbursement processes
- Proficient in accounting with QuickBooks expertise
- Attention to detail
- Time management
- Problem-solving
- Work Planning and Prioritization
- AR aging reports
- Client rapport
- Quality assurance
Timeline
AR BILLING SPECIALIST
ASTON HEALTH CONSULTING
06.2024 - 12.2024
AR BILLING & CREDENTIALING CONSULTANT
CREDIBILITY PHYSICIAN SOLUTIONS
01.2024 - Current
MEDICAID PLANNER
PYRAMID HEALTH GROUP
01.2024 - 05.2024
TRACKER/MEDICAID PLANNER
APEX GLOBAL SOLUTIONS
04.2021 - 01.2023
BILLING SUPPORT SPECIALIST
MATRIXCARE
12.2020 - 10.2021
BUSINESS OFFICE MANAGER
HARDEE MANOR NURSING CENTER
05.2020 - 12.2020
ACCOUNTING ASSOCIATE
SUNBULB
11.2019 - 05.2020
Staff Account / Payroll /AR Collection Specialist
SENIOR NANNIES HOME HEALTH
07.2018 - 11.2019
ASSISTANT BUSINESS OFFICE MANAGER
POMPANO NURSING AND REHAB CENTER
05.2017 - 01.2018
A/R BILLING SPECIALIST
AVANTE GROUP
03.2016 - 02.2017
CREDENTIALING TRAINING AND DOCUMENTATION SPECIALIST
PARALLON WORKFORCE SOLUTIONS
07.2015 - 02.2016
DENIAL ANALYST and EDI SPECIALIST
EYE PHYSICIANS OF FLORIDA
09.2013 - 07.2015
SEGMENTATION SPECIALIST TEAM LEADER
MAKO SURGICAL CORP
05.2011 - 09.2013
PROJECT COORDINATOR
INSTITUTE FOR FAMILY CENTERED SERVICES
10.2009 - 05.2011
BILLING SPECIALIST
INSTITUTE FOR FAMILY CENTERED SERVICES
07.2007 - 10.2009
Notary Public - undefined
FL
Technical Diploma Certificate - Office Administration
US Career Institute
Technical Diploma Certificate - Medical Billing and Coding
US Career Institute
High School Diploma - undefined
Oviedo High
Medical Billing and Coding Certificate -
AAPC