Cheryl Sylvia
Payment Variance, Cape Cod Healthcare
Middleboro,Ma
29
years of professional experience
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.
Work History
8 Years 10 Months
- 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
7 Years- 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
9 Years- 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
2 Years- 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
6 Years- 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
Certificate In Medical Office Assistant
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 - CurrentRead More
Accounts Recovery Analyst
Jordan Hospital/BID Plymouth
01.2011 - 01.2018Read More
Patient Account Representative
Jordan Hospital
01.2002 - 01.2011Read More
Patient Account Representative
Brockton Hospital
01.2000 - 01.2002Read More
Patient Account Analyst
Community Counseling of Bristol County
01.1994 - 01.2000Read More
Massasoit Community College
Certificate in Insurance Billing Specialist
Read More
New Directions
Certificate In Medical Office Assistant
Read More