CYNTHIA BUTLER
Pelham,NY
Summary
20+YEARS OF HEALTHCARE FINANCE IN THE HOSPITAL, NURSING HOME AND MULTIPLE SPECIALTY SETTING, ALSO HAVING A STRONG BACKGROUND IN MEDICAL CLAIMS PROCESSING AND ANALYSIS WITH CLAIMS RESOLUTIONS.
Overview
27
27
years of professional experience
Work History
Senior Billing Manager/ Front Desk Coordinator
Metro Optics Eyewear
Bronx, NY
01.2022 - 06.2025
- Managed and billed all vision services rendered for exams, frames and lenses whether bifocal, single or progressive trifocal lenses. Submitted claims to major local carriers, Medicare and Medicaid HMO and Local Union vouchers and priced claims accordingly to the Union benefits and utilizations codes. Appealed denied claims with documents and medical necessity physician notes as corrected claim resubmission. Utilized all insurance portals -CPS, NVA as well as insurance verification, eligibility, authorizations and follow up on denied claims. Assisted and supervised front desk with collecting self-paying patients, co-pays, deductibles and coinsurance. Assisted patients with knowledge understanding of their insurance coverage and benefits.
Medical Billing Manager
NY SPINE AND SPORT MEDICAL P.C
Bronx, NY
10.2020 - 01.2022
- ALL ASPECTS OF MANAGING FRONT END STAFF IN VERIFICATIONS OF INSURANCES, OBTAINING PRIOR AUTHORIZATIONS, COLLECTION OF CO-PAYS, PAST PATIENT BALANCES, REFERRALS, MANAGE ALL STAFF INCLUDING MEDICAL ASSISTANT, AND BILLING TEAM TO MAINTAIN COURTESY AND PROFESSIONALISM @ ALL TIMES. I ALSO MANAGE BILLING TEAM ON ACCOUNTS RECEIVABLE, PROPER USAGE OF ICD 10, CPT CODES AND USAGE OF MODIFIERS AS REQUIRED. I ALSO ASSISTANT ALL STAFF WHEN NEEDED WITH SCHEDULING, PATIENTS CONCERNS VIA PHONE OR IN PERSON AND INSURANCE POLICIES AND PROCEDURES IN RELATIONS TO FINANCIAL RESPONSIBILITY IN RELATIONS TO PAIN MANAGEMENT SPECIALTY.. POST PAYMENTS, AND ALL NECESSARY DUTIES IN FINANCIAL REVENUE.
Billing Manager
NY METROSLEEP MEDICAL P.C
10.2017 - 05.2020
- MANAGED: all aspects of front end reception area of staff to collect correct insurance info and ID cards, copay/co-ins referrals , authorizations, all past due balances, self-pay and deductible due amounts, also reviewed clinical note before claim submission utilizing CPT, ICD10 and modifier when necessary, posted payments via EFT/ERA's including paper EOB, cleared EDI EDITS via CLEARINGHOUSE, resubmitted claims and corrected claims, also managed A/R. PROVIDED CUSTOMER SERVICE TO PATIENTS VIA PHONE & FACE TO FACE FOR ALL FINANCIAL ISSUES.
Utilization Review Coordinator
CENTERLIGHT HEALTHCARE SYSTEMS
Bronx, NY
04.2015 - 10.2017
- RESPONSIBLE FOR APPROVING OR DENYING AUTHORIZATION FOR ALL MEDICALLY NECESSARY SERVICES FROM REQUESTING PROVIDERS OF SERVICES RENDERED (HOSPITALS, SPECIALTY SERVICES, NURSING HOMES, ADULT DAY CARE, OUTPATIENT RADIOLOGY SERVICE AND MORE COMPLEXED MEDICAL REQUEST WERE REFERRED TO THE MEDICAL DIRECTORS.
CLAIMS RESOLUTIONS SPECIALIST
AFFINITY HEALTH PLANS
Bronx, NY
04.2012 - 03.2015
- EXAMINED, PROCESSED, AND DETERMINE FINAL RESOLUTION OF PAYING, DENYING OR PENDED CLAIMS FOR ADDITIONAL MEDICAL DOCUMENTATION BASED ON DIAGNOSIS, PROPER CPT, ICD9 CODES & CORRECT MODIFIER USAGE FROM ALL PROVIDER OF SERVICES, ALSO ASSISTED CUSTOMER SERVICE DEPT VIA PHONE TO PROCESS CLAIMS FOR PROVIDERS IN REAL TIME.
SENIOR BILLING COORDINATOR
MOUNT SINAI MEDICAL CENTER
08.1998 - 11.2011
- AS MENTIONED PREVIOUSLY ALL ASPECTS OF REVENUE CYCLING FOR THE DEPT OF NEUROLOGY, MOVEMENT DISORDERS, HEADACHE CENTER AND PARKINSON'S DIVISION OF NEUROLOGY, ASSISTED PRACTICE MANAGER OF FUNCTIONALITY OF THE BILLING DEPT LEADING TO CLAIM SUBMISSIONS AND TRAINING OF ALL NEW STAFF, CUSTOMER SERVICE WAS PROVIDED VIA PHONE AND ALSO FOR PATIENTS FACE TO
Education
High school diploma or GED - GENERAL ACADEMICS
ST. THOMAS AQUINAS HIGH SCHOOL
Bronx, NY06.1982
Skills
- Full knowledge of all billing rules, regulations and guideline of billing and coding
- MANAGERIAL, HOSPITAL, MULTI-SPECIALTY, NURSING HOME, ADULT DAY CARE, STRONG MEDICAL TERMINOLOGY, ICD 10, CPT 4 CODING, ACCOUNT RECEIVABLE, EMR, MEDICAL CODING, BIOLOGY MAJOR, ALL MEDICAL BILLING SOFTWARE (ECLINICAL WORK, EPIC, IDX, MEDICAL MANAGER, EAGLE & MANY MORE, STAFF TRAINING (20 years)
- Experience with EHR and HIPPA Privacy ACT
- Healthcare Management
- Practice Management
- Medical Office Experience
Timeline
Senior Billing Manager/ Front Desk Coordinator
Metro Optics Eyewear
01.2022 - 06.2025
Medical Billing Manager
NY SPINE AND SPORT MEDICAL P.C
10.2020 - 01.2022
Billing Manager
NY METROSLEEP MEDICAL P.C
10.2017 - 05.2020
Utilization Review Coordinator
CENTERLIGHT HEALTHCARE SYSTEMS
04.2015 - 10.2017
CLAIMS RESOLUTIONS SPECIALIST
AFFINITY HEALTH PLANS
04.2012 - 03.2015
SENIOR BILLING COORDINATOR
MOUNT SINAI MEDICAL CENTER
08.1998 - 11.2011
High school diploma or GED - GENERAL ACADEMICS
ST. THOMAS AQUINAS HIGH SCHOOL