Denise Moore
Gray,TN
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
Work History
Compliance Mannager
D & J Medical
Forest Hill, MD
01.2013 - 09.2022
- Developed and implemented policies and procedures to ensure compliance with applicable laws, regulations, standards, and best practices.
- Maintained detailed records of all compliance related activities.
- Assisted with the development of training materials for employees regarding compliance requirements.
- Provided support in developing strategies for mitigating risks associated with non-compliance.
- Ensured effective communication of changes in regulations or policies throughout the organization.
- Completed internal and external audits according to established procedures.
- Organized initiatives, drafted documentation and enforce compliance with best practices.
- Investigated complaints from customers regarding violations of company policy or applicable law and regulation.
- Conducted internal audits to identify areas of non-compliance and recommend corrective actions.
- Executed successful compliance monitoring and risk assessment programs.
- Created reports outlining compliance activities for executive leadership review.
- Performed research on current industry trends and developments in order to remain up-to-date on best practices.
- Assisted with investigations into allegations of fraud or misconduct within the organization.
- Served as a primary contact with regulators during external audit reviews.
- Monitored changes in relevant legislation and adjusted operations accordingly.
- Created and managed training classes to educate new hires and existing employees about compliance concerns.
- Designed systems to track compliance performance metrics across the organization.
- Reviewed customer issues, company processes and other operational areas to check compliance.
- Completed quarterly and yearly audits.
Payment Poster
D&J Medical
Forest Hill, MD
08.2014 - 08.2015
- Documented payment denials in appropriate billing system and updated account managers swiftly.
- Followed up on pending claims that have not been paid by third-party insurers within specified timeframes.
- Handled all electronic and manual payments and adjustments, ensuring that data was accurately posted.
- Balanced daily cash postings with deposits to ensure accuracy of information entered into the system.
- Ensured adherence to HIPAA guidelines when handling confidential information.
- Supervised and oversaw large volumes of data with extreme accuracy each day.
- Reviewed refund requests and forwarded information to analyst.
- Reviewed denials received from payers and communicated findings with billing staff.
- Maintained a working knowledge of industry regulations pertaining to healthcare billing practices.
- Assisted in resolving payment issues, such as rejections or delayed payments due to incorrect coding or missing information.
- Posted payments and sent reviews and denials.
- Prepared, distributed and reviewed insurance payments and recorded in corporate database.
- Processed incoming payments from patients and insurance companies in a timely manner.
- Communicated effectively with internal teams about any changes or updates made to patient accounts during the posting process.
- Assisted in training new team members on proper procedures for posting payments and reconciling accounts receivable ledgers.
- Verified accuracy of statements sent to customers for payment reconciliation purposes.
- Maintained accurate records of all payments posted in an organized filing system.
- Reviewed overpayments and processed refunds to be sent to patients and insurance companies.
- Collaborated with various departments within the organization to ensure efficient workflow processes related to payment posting activities.
- Updated patient accounts with current information after verifying accuracy of data entered into the system.
- Performed audits on accounts receivable transactions for compliance with company policies and procedures.
- Posted payments for insurance companies, including Medicare and Medicaid, by accurately entering data into the system.
- Provided customer service support to patients regarding inquiries related to account status and payment history.
- Researched discrepancies between patient accounts and remittance advice received from insurance carriers.
- Participated in departmental meetings concerning improvements in existing payment processes.
- Received payments from insurance providers, handled Medicare packages and completed immediate processing.
- Downloaded, printed and batched electronic funds transfers and remits.
- Evaluated open accounts to look for past-due balances and pursue collection strategies.
- Monitored customer account details to minimize or rectify non-payments, delayed payments and other irregularities.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Performed various accounts receivable functions, handled cash receipts posting, updated cash flow reports and researched chargebacks and write-offs.
- Processed new customer forms to set up accounts in system.
- Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
- Answered customer questions to maintain high satisfaction levels.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Performed insurance verification, pre-certification and pre-authorization.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
- Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
Education
Diploma of Nursing - Nursing Education
Maryland General School Of Nursing
Baltimore, MD01-1985
Associate of Arts - Early Childhood Education
Villa Julie
Stevenson, MD05-1982
Skills
- Information Gathering
- Investigative Skills
- Quality Controls
- Document Reviews
- Conducting Investigations
- Data Evaluation
- Internal Audits
- Documentation Review
- Compliance Monitoring
- Training Coordination
- Protocol Review
- Provider Enrollment
- Credentialing requirements and verification
- Strong Background DME, Orthotics and Prosthetics
- License Regulation and verification
- Training Delivery
- Analytical Thinking
- Risk Assessment
- Staff Training
- Training Development
References
References available upon request.
Timeline
Payment Poster
D&J Medical
08.2014 - 08.2015
Compliance Mannager
D & J Medical
01.2013 - 09.2022
Diploma of Nursing - Nursing Education
Maryland General School Of Nursing
Associate of Arts - Early Childhood Education
Villa Julie