Cheryl Sylvia
Middleboro,Ma
Summary
A SME expert in the Revenue Cycle of Health Care. 28 years of experience in a health care setting. My abilities are recognized as a results-oriented and solution-focused individual. Areas of strength include: Excellent Interpersonal Skills, A Team Player , Adhering to billing compliance and procedures. Contract analysis and interpretation. Interpreting and implenting payer policies and guidelines. Process improvement ideas that result in time saving workflows and increased revenue. Excellent time managment. Identifying 837 claim and 835 remittances issues and implementing corrections.
Overview
29
29
years of professional experience
Work History
Payment Variance, Cape Cod Healthcare
01.2018 - Current
- Intricate part of the contract builds in the Epic hospital launch resulting in 94% accuracy
- Identifying and recouping underpayments, reporting, and resolving overpayments
- Process improvement ideas involving, claims, credits, audits, and payment variances
- Daily intervention of proper observation billing per industry standards
- Weekly and monthly variance reporting
- Supporting the audit management program with monthly analysis of audits based upon payer guidelines
- Point person to guide the audit analysts on payer and hospital policies and procedures
- Providing patient estimates per CMS and hospital guidelines.
Accounts Recovery Analyst
Jordan Hospital/BID Plymouth
01.2011 - 01.2018
- Developed and maintained a denials database for tracking and reporting on all hospital denials
- Responsible for underpayment Excel reports and appeals to third-party payers for corrected payment per contract review
- Management of weekly denial database for interdepartmental communication and follow-up on authorization, med necessity and level of care denials
- Identifying incorrect service reporting as well as billing errors
- Creating and maintaining issues grid for payer resolution
- Provide daily support for proper denial follow up, for all the hospital staff
- Tracking and logging of all interdepartmental appeals
- Initiate and implement process improvement procedures to reduce denials
- Consumer pricing requests for services provided utilizing Nthrive.
Patient Account Representative
Jordan Hospital
01.2002 - 01.2011
- Review and analysis of billing, follow-up, accounts receivable adjustments for third party and self-pay accounts
- Ensured all billing time limit requirements are followed for necessary appeals process
- Batch and scan financial documents to optical imaging system
- Established monthly budget on self-pay accounts
- Follow up on outstanding accounts through appeals and/or write –off requests for unattainable recoveries
- Professional follow-up with departments, patients, and insurance companies for account resolution.
Patient Account Representative
Brockton Hospital
01.2000 - 01.2002
- Review and analysis of billing, follow-up, accounts receivable adjustments for third party and self-pay accounts
- Ensures all billing time limit requirements are followed for necessary appeals process
- Batch and scan financial documents to optical imaging system
- Established monthly budget on self-pay accounts
- Follow up on outstanding accounts through appeals and/or write –off requests for unattainable recoveries
- Professional follow-up with departments, patients, and insurance companies for account resolution.
Patient Account Analyst
Community Counseling of Bristol County
01.1994 - 01.2000
- Registration, charge entry and claim submission of a multi service psychiatric facility
- Obtain authorization for all services
- Provide coverage for all office support staff on daily tasks when needed
- Follow up on all outstanding claims, file appeals for any denials and report on the status of AR to the upper management team.
Education
Certificate in Insurance Billing Specialist - undefined
Massasoit Community College
2011
Certificate In Medical Office Assistant -
New Directions
1994
Skills
- Computer skills
- Epic
- Soarian Financials
- STM Billing
- Change Health Care
- Microsoft Office
- NThrive
- Medi-Tech
- Experian
- Hyland On-base Scanning
- SSI/Billing Audit Management
- Craneware
- Waystar
Timeline
Payment Variance, Cape Cod Healthcare
01.2018 - Current
Accounts Recovery Analyst
Jordan Hospital/BID Plymouth
01.2011 - 01.2018
Patient Account Representative
Jordan Hospital
01.2002 - 01.2011
Patient Account Representative
Brockton Hospital
01.2000 - 01.2002
Patient Account Analyst
Community Counseling of Bristol County
01.1994 - 01.2000
Certificate in Insurance Billing Specialist - undefined
Massasoit Community College
Certificate In Medical Office Assistant -
New Directions
Similar Profiles
Madison LewisMadison Lewis
Assistant Director of Environmental Services at Crothall Healthcare - Cape Cod HealthcareAssistant Director of Environmental Services at Crothall Healthcare - Cape Cod Healthcare
Amy SullivanAmy Sullivan
Registered Nurse at Cape Cod HealthcareRegistered Nurse at Cape Cod Healthcare
ELIZABETH STPIERREELIZABETH STPIERRE
Behavioral Health Coordinator at Cape Cod HealthcareBehavioral Health Coordinator at Cape Cod Healthcare
Joshua BowerJoshua Bower
Inside Sales Representative at FW Webb CompanyInside Sales Representative at FW Webb Company
Casandra KennedyCasandra Kennedy
Bracks at Haley BrackBracks at Haley Brack