Desha Spencer
Bridgeport,CT
Summary
- Professional, motivated individual with 15 years' supervisory and customer service, Business Manager Experience
- Organized with the ability to handle multiple projects under extreme time constraints
- Able to quickly incorporate and implement new procedures
- Hard working…. Reliable...Responsible….Fast Learner
- Highly motivated….Excellent attendance record
- Detail-oriented and performance driven
Seasoned Business Office Director well-versed in budget administration, financial investigations and insurance collaboration. Excellent relationship-builder and conflict manager with a detail-oriented approach. Pursuing a new professional challenge with a growth-oriented organization. Focused on optimizing accounting, payment collection, and administrative functions for high-volume operations. Well-organized and thorough leader with a disciplined approach to solving problems and enhancing long-term business operations. Seasoned Office Manager offering leadership experience in administrative positions. Well-versed in industry practices and procedures. Top-notch management abilities in financial, personnel and clerical areas. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Hardworking and passionate job seeker with strong organizational skills eager to secure entry level position. Ready to help team achieve company goals. Focused on optimizing accounting, payment collection, and administrative functions for high-volume operations at Linda Manor. Well-organized and thorough leader with a disciplined approach to solving problems and enhancing long-term business operations. Focused on optimizing accounting, payment collection, and administrative functions for high-volume operation. Well-organized and thorough leader with a disciplined approach to solving problems and enhancing long-term business operations.
Overview
19
19
years of professional experience
Work History
Business Office Director / Human Resources/Assistant Payroll Manager
Linda Manor Extended Care Facility
01.2023 - Current
- Implemented an effective filing system, greatly improving document organization and retrieval times.
- Conducted market research to inform strategic planning efforts within the company.
- Provided guidance and support to employees during challenging situations or periods of change within the company.
- Spearheaded the transition to new software systems, increasing efficiency and reducing errors in data management.
- Set and administered budgets with detailed tracking.
- Collaborated with executive leadership on long-term goal setting initiatives for continued success.
- Hired, trained, and motivated well-qualified staff.
- Established strong relationships with key stakeholders through clear communication and timely follow-up on requests or concerns.
- Monitored inventory levels for office supplies; proactively ordering when necessary.
- Completed assessments of bad debt, labor costs, operating expenses and other areas of importance. Collected 250,000 from Medicaid
- Communicated with insurance providers to resolve payment and coverage issues.
- Developed office policies that promoted a professional atmosphere while also fostering teamwork among staff members.
- Coordinated meetings and events for both internal staff and external clients or partners.
- Facilitated training sessions for employees, ensuring they had the necessary skills to excel in the roles within the organization.
Business Office Manager
Stonington Institute
11.2020 - 01.2023
- Responsible for the day to day residents census, billing and trust to ensure regulatory compliance, efficient in maximized collection Tricare VA, VA , Medicaid, private insurance , pending application, accurate billing and cash collection activity and ensuring full compliance of claims and Authorization, insurance at all times
- Perform end of month reconciliation of census/revenue, accounts receivable
- Hiring /Firing, payroll, Credentialing for providers and facility
- Interviewing, some training depending on position
- Responsibilities Include, working old accounts that were denied / rejected insurance and healthcare claims Tricare claims, VA claims
- I've accomplished collecting 2018 claims and present denied claims
- Able to get a Medical Lic
- Up and running for the facility less than three months of hire
- Read provider notes billed claim with correct rev, cpt hcpcs code etc
- Received payments for one month of medical services
- Were able to provide facility with correct rev code to bill for positive covid cases
- Troubleshoot claims issues, multitasking, and prioritizing claims and correspondence responsibilities by age, complexity, and urgency
- Manage accounts receivable for assigned accounts through regular reports
- Maintain knowledge of insurance and billing practices and procedures
- Prioritize accounts and claims for follow up and adjudication
- Record all check and cash payments received on Cash Journal
- Post payments to clients accounts
- Process credit card payments and post to clients accounts
- Prepare bank deposit weekly and at month's end
- Make payment adjustments to patient's account as needed
- Process self-pay/co-pay invoices from Medseries 4 Prepare letter to accompany invoice for past-due accounts and document within Medseires
- Reports, AR report, Billing Summary, End of month report.
Business Manager/Billing Specialist Manager
Bethel VNA
11.2019 - 05.2021
- Responsible for the day to day residents census, billing and trust to ensure regulatory compliance, efficient in maximized collection of applied incomes, private coinsurance receivables, assist with submission, track and resolve Medicare/ Medicaid pending application, accurate billing and cash collection activity and ensuring full compliance of residence funds at all times
- Perform end of month reconciliation of census/revenue, accounts receivable
- Hiring /Firing, payroll, Credentialing for nurses
- Interviewing, some training depending on position
- Responsibilities Include, working old accounts that were denied / rejected insurance and healthcare claims
- I've accomplished collecting 2016 claims and present denied claims
- From United Health care, VA hospital from 2016, and Medicare from 2016 claim, that had a hard denial, had Medicare to overturn denial and pay claim
- Troubleshoot claims issues, multitasking and prioritizing claims and correspondence responsibilities by age, complexity, and urgency
- Manage accounts receivable for assigned accounts through regular reports
- Maintain knowledge of insurance and billing practices and procedures
- Prioritize accounts and claims for follow up and adjudication
- Record all check and cash payments received on Cash Journal
- Forward all documents and photocopy of check for all memorial and donation payments, as well as annual Breakfast for Care, to Community Liaison
- Process credit card payments and record on Excel spreadsheet
- Prepare bank deposit weekly and at month's end
- Tally columns on Cash Journal for deposit and take deposit to the bank
- Post self-pay and EOP/EOB's received (check payments) and make payment adjustments to patient's account as needed in HealthWyse
- Process self-pay/co-pay invoices from OfficeWyse
- Prepare letter to accompany invoice for past-due accounts and document within Healthwyse
- Prepare and send invoices for employer sponsored flu vaccinations
- Re-send as needed if payment not received
- Prepare and send invoice for various town sponsored flu vaccinations (town employees, residents without health insurance, etc.)
- Reports
- Prepare monthly Emergency Preparedness reports in OfficeWyse for Clinical Services Supervisor
- Prepare quarterly reports in OfficeWyse and ReportWyse for Quality Control Supervisor
- Prepare and upload monthly CAHPS to Fazzi
- Flu Invoicing /Volunteer
- Provide flu vaccination consent forms to walk-in patients for completion
- Review consent form for accurate and insurance information
- Process credit card payment if applicable
- Assist with entering patient's consent form information onto Excel spreadsheet for each insurance provider
- Upload files/batches to Zirmed
- Reconcile/research rejected claims found in Zirmed and/or rejected via an EOB to find out why claim was denied
- Contact insurance providers as necessary
- Complete reconsideration and appeal processes for denied claims
- Open tickets and/or reconsideration requests/appeals with Zirmed and/or the insurance provider regarding any issues related to non-payment or claims processing
- If consent form was not properly completed (incomplete information, incorrect information, etc.), follow - up with patient via US mail and/or telephone to request the missing information necessary to file the claim
- All flu vaccine payments received from medicare and/or commercial providers are matched to flu consent form and EOB.
Billing Specialist/Office Manager Assistant
Greenwich Physical Therapy Center
02.2015 - 11.2019
- Implementing, billing standards, providing annual budget information, solving order and invoice disputes, overseeing bank transfers, and submitting bills in a timely manner
- Knowledge of medical coding, supervisory skills, organization, attention to detail, confidence working with numbers, spreadsheets, computer competences, and time management
- Oversee daily Billing Department functions, including medical coding, charge entry, payment posting and reimbursement management
- Assigned specific tasks and monitor progress for each employee
- Reviewed patient encounters to verify diagnoses coding and reconciled CPT coding against services rendered
- Transferred all patient visit information from the WEB PT/DB system into the accounting software for claims processing and submission
- Maintained electronic billing system, worked closely with claims clearinghouse for maximum acceptance rates and decreased turnover time
- Upheld and reinforced insurance and federal compliance laws and regulations
- Managed patient accounts, private pay collections and patient balance dispute resolution
- Coordinated front office policy to ensure maximum copay and deductible balance collection prior to physician/patient contact
- Provide exceptional reimbursement rate using Allscripts medical software
- Supervise Infusion Billing Team of 10
- Electronic claims submission, knowledge of different insurance guidelines including HMO/PPO, Medicare
- Problem solving skills to research and resolve billing discrepancies
- Provide coaching/mentoring on billing errors done by the team
- Identified trending rejections and denial
- Developed training material for trending issues
- Assisted with training new hires
- Responsible for the supervision and organization of a team of 10 employees
- Contacted multiple clients on a daily basis to ensure accurate and timely payments
- Interviewed, hired, and trained new employees
- Posted Superbills and Explanation of Benefits (EOB's) on a daily basis managed productivity, reports, supervised billers, assigned tasks, trained, researched insurance guidelines for coding, credentialing, Medicare applications , PECOS, researched denials, reprocessed/adjusted claims with correct CPT codes for maximum allowable payments
- Processed medical records requests, work with insurance companies such as Medicare, PPO, HMO, commercial insurance companies and private pay
- Familiar with coding/billing for Physical Therapy CPTs and ICD10
- Resolved any EDI, software, hardware issues
- Researched insurance policies/eligibility and educated medical receptionist/staff
- Posted and submitted claims within 24 hours of receipt
- Insured accuracy of insurance claims
- Verified correct ICD-10/CPT codes.
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
Office Manager, Billing Manager, Medical Assistant, Receptionist, A/ R
COMPLETE FOOT CARE
06.2013 - 02.2015
- Reading physician notes as well as ensuring notes are the correct codes being billed to the Insurance company
- Send claims in a timely manner to insurance companies
- EOB's, remits and resent claims to insurance companies when denied by the carrier
- Collaborated with employees and physician's to strengthen interpersonal skills
- Demonstrated effective customer service via phones; faxes; face to face, letters and emails.
Claims Representative
United Healthcare
07.2005 - 06.2012
- Contribute my expertise on a Federal Medicare Reclamation Dedicated team, an Outpatient Dedicated team and an Out Patient Development Project where only top performers were selected
- Investigate, dispute and settle claims in a timely manner
- Execute daily claims transaction in a variety of specialty claims: Motor Vehicle claims, Workers Compensation claims, Outpatient claims, Physician claims, Coordination of Benefit claims, special claims such as; New Jersey Public Sector, Connecticut Public Sector, and Multiplan claims
- Investigate and interpret provider contracts to assure compliance is being met
- Resolve errors on daily report to allow proper funding of client accounts
- Develop and implement effective business solution through research and analyses of healthcare medical data
- Ensures data integrity, data security and process optimization for all related aspects of Claim system process and claim business rules
- Provide quality training related to claim analysis for Coordination of Benefits (COB)
- Responsible for the accurate processing and completion of medical claims
- Process claims that route out of automatic adjudication, within current turn around standards
- Proficiency in product lines applicable to processing unit
- Deductible, Coinsurance, Co-payments
- Recognize potential pre-existing conditions, misstatements and fraudulent claims
- Assist with training new employees
- Special projects as required such as the rewriting of the Emergency Room/Observation room policy
- Investigate and pursue recoveries and payable on subrogation claims and file management
- Processed recoveries of medical claims
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Conduct investigations to review medical history as well as monitor large claims including transplant cases.
Education
Housatonic Community College - Bridgeport, CT 06607 -
Housatonic Community College
Bridgeport, CT01.2013
NCRC (National Career Readiness Certificate) (Silver) -
Department of Labor
Bridgeport, CT01.2012
Skills
- Staff Training and Development Leadership
- Payment Processing
- Human Resources Management
- Financial Management
- Revenue reviews
- Business operations management
- Employee Onboarding
- Payroll Processing
- Account Reconciliation
- Payroll Management
- Payroll and budgeting
- Credit and collections
- Policy and procedure modification
- Human Resources
Skillsummary
- Knowledge of HMOs
- Technical expertise
- Team player with positive attitude
- Patient - Focused care Managed care contract Knowledge
- Good written communication
- HIPAA compliance
- Strong work ethic
- Medical Billing software
Timeline
Business Office Director / Human Resources/Assistant Payroll Manager
Linda Manor Extended Care Facility
01.2023 - Current
Business Office Manager
Stonington Institute
11.2020 - 01.2023
Business Manager/Billing Specialist Manager
Bethel VNA
11.2019 - 05.2021
Billing Specialist/Office Manager Assistant
Greenwich Physical Therapy Center
02.2015 - 11.2019
Office Manager, Billing Manager, Medical Assistant, Receptionist, A/ R
COMPLETE FOOT CARE
06.2013 - 02.2015
Claims Representative
United Healthcare
07.2005 - 06.2012
Housatonic Community College - Bridgeport, CT 06607 -
Housatonic Community College
NCRC (National Career Readiness Certificate) (Silver) -
Department of Labor
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