DENISE MOOERS
WAREHAM,USA
Summary
Accomplished in transforming healthcare revenue cycles at Optum/Change Healthcare, I excel in denial management and problem-solving, enhancing cash collections significantly. My proactive approach in data analysis and team leadership has consistently driven systemic improvements, demonstrating a strong blend of analytical prowess and collaborative skills.
Overview
30
30
years of professional experience
Work History
Client Manager
Optum/Change Healthcare
11.2019 - Current
- Current duties include Revenue Cycle Management for several hospital outpatient provider groups and individual providers.
- This includes running reports and analyzing charges, denials, and payments to identify trends that may be affecting cash collections. Provide suggestive actions on systemic or process improvements to reduce or eliminate denials, and boost cash collections.
- Duties also include backing up the management of the operations, coding, and credentialing teams to ensure they are driving results.
Payment Variance Analyst
Cape Cod Healthcare
Hyannis, MA
01.2015 - 11.2019
- Duties included running reports to track trends related to credit balances on the AR for all insurance carriers and guarantors.
- Reporting credits back to the insurance companies to ensure proper adjustments and/or sending refunds as due to the insurance carriers and guarantors in a timely manner.
- Reporting trends back to management to assist with coming up with a strategy to reduce future credits in the AR.
Senior Billing Specialist
VNS Newport/Bristol Counties
01.2005 - 01.2015
- Duties included all areas of billing and accounts receivable for home care and hospice claims, including, but not limited to, billing, posting payments, researching contracts, accounts receivable follow-up, appeals, and maintaining knowledge of all changes to the entire billing process.
- I also created a manual billing process for a diabetes training class, which I had to track monthly.
- I created our company's billing policies and training manual, and I had to update it as changes arose, as well as train all new employees.
- During my time at the VNS, I also helped to implement a new billing system, which had to be manually built in.
- I had to go for a weeklong trip to Missouri to learn about the system, and once the system was installed, I had to sit with the IT Director, the Finance Manager, and my supervisor to build in the coding and contracting in order to ensure proper billing and reporting.
Lead Billing Specialist/Supervisor
ACA Billing Management
01.2000 - 01.2005
- Obtained reports from several different Hospitals to review for follow up on AR
- Supervised a team of 2-5 people making sure productivity, accuracy, and compliance with company policy was maintained
- Served as the main training and support for this team as well as back up and for other teams as needed
- Maintained knowledge of all contracts and billing requirements for each client represented
- Answered patient phone calls and resolved complaints as necessary
Billing Specialist
Primary Care PC
01.1995 - 01.2000
- Submitted and followed up on claims for a large group of multispecialty physicians
- Maintained a working knowledge of all changes to contracts, training of new hires, and answered patient phone calls
Education
High School Diploma -
BMC Durfee High School
Fall River, MA05-1987
Skills
- Problem solver
- Denial management
- HIPAA compliance
- Insurance verification
- Payment posting
- Claims review
- Insurance collections
- Medical billing
- Work prioritization
- Claims processing
- Data analysis
- Accounts receivable management
- Insurance claims processing
Volunteer Experience
- Served on the Ethics and 401K committees for 9 years.
- Organized the children's Christmas party at the VNS.
- Developed a department Newsletter and a department billing manual.
- Served on the HIPAA compliance team in 2000.
Affiliations
- MA Licensed Real Estate Agent
- In process of Obtaining Coding Certification
Timeline
Client Manager
Optum/Change Healthcare
11.2019 - Current
Payment Variance Analyst
Cape Cod Healthcare
01.2015 - 11.2019
Senior Billing Specialist
VNS Newport/Bristol Counties
01.2005 - 01.2015
Lead Billing Specialist/Supervisor
ACA Billing Management
01.2000 - 01.2005
Billing Specialist
Primary Care PC
01.1995 - 01.2000
High School Diploma -
BMC Durfee High School
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