Dolores Poole
Boca Raton,FL
Summary
High performing, enthusiastic, administrative leader, 10 + years experience in medical environment. Detail oriented, driven expertise, problem solving, billing office functions, strength managing multiple projects simultaneously while fostering a cohesive staff. Extensive Workers Comp / PIP / Liability knowledge. Remote experience 5 plus years.
Overview
18
18
years of professional experience
Work History
Revenue Management Specialist
IRISE Spine and Joint Institute
Boca Raton, Florida
09.2019 - Current
- Revenue Management, medical claims processing, insurance verification
- Precertification Specialist obtaining claim and authorization information for PIP, WC, HI resolving escalated issues and boosted retention rates by 85%
- Direct contact with WC, PIP adjusters, WC Nurse Case managers regarding specific claim authorization for Orthopedic spinal surgeries, Chiropractic treatment, Imaging, Orthopedic pain management injection submission of medical documentation as required
- Worked directly with 18 office locations, direct contact with Orthopedic Surgeons, Pain management physicians, Chiropractic, and Physician Assistants regarding clinical documentation
- Contact with numerous attorneys and case managers, regarding information for PIP and WC claim information
- Performed claim auditing practices regarding resubmission of claims and documentation, for revenue billing review and payment
- Report to V.P. - Revenue Supervisor.
- Improved overall financial reporting by streamlining control processes and reporting structures.
- Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
- Established and checked coding procedures, monitored reports and updated internal files.
- Supported Revenue Supervisor with special projects and additional job duties.
Bookkeeping and Inventory Administrator
Hilton Q-shop Ft Lauderdale
01.2019 - 09.2019
- Under general supervision, contributed and maintained accounting records using Quick Books Online
- Reconciled vendor accounts, interfaced with accounting experts QB pro-advisor consultants
- Initiated setup of accounting created and maintained vendor records, contracts, payment terms, delivery information
- Customized company invoicing vendor forms, cc, and room charges
- Processed banking deposits, verification of bank drafts, charges, resolved banking errors
- Reporting of payroll taxes, processed business tax payments to state, federal facilities
- Processing of payroll checks
- Performed miscellaneous job-related duties as assigned
- Merchandise purchases and sales increased by 30%
- Excellent knowledge of Microsoft Office, Windows operating systems
- Attention to detail, and time management
- Ability to work independently
- Reviewed inventory to eliminate unnecessary expenses and provide optimal stock levels
- Checked prices and calculated totals for accurate invoice processing
- Addressed internal supply problems head-on and developed creative solutions to prevent delays and missed targets
- Worked with supervisors and team members to understand supply needs and bring levels within desired tolerances
- Strategized, introduced and updated purchasing procedures and objectives to adapt to shifting customer demand
- Kept documentation and records accurate and up to date with latest data to prevent errors in processing or delivery
Medical Billing Specialist / Accounting Specialist
SNI
Ft Lauderdale, FL
03.2018 - 11.2018
- A/P A/R reconciliation
- Specific Accounting management for 120 vendors.
- Verification processing invoices, expense reports submitted for reimbursement
- Maintained accurate up-to-date vendor files
- GL Coding
- Examination of vouchers for payment from vendors
- Generating checks and initiating electronic (ACH) payments
- Prepared month-end general ledger reconciliations
- Annual State Tax payments for SNF facilities in New Jersey and Florida
- Medical Billing analysis re; Hospice Patients-Enteral Feeding
- Medicare Billing pediatric and senior hospice patients
- Obtained approval of EF for Skilled Nursing Facilities
- Posting of Medicare payments
- Temp position
Medical Billing Specialist
Gulfstream Outsourcing
Palm Beach Gardens, FL
09.2016 - 02.2018
- Responsible for medical payment posting insurance adjustments, including cash pay, attorney settlement checks, Credit Card payments extensive banking experience
- Extensive Excel spreadsheet experience with investigation into discrepancies for multiple locations regarding open claims Inventory 60 days after submission
- Managed, supervised trained staff regarding correct coding ICD 9-10, procedure codes, modifiers, medical records submissions and appeal requests
- Taught importance of communication with Insurance adjusters regarding status of claims, documentation escalated issues
- Examination of patient demographics, claims auditing, authorizations, insurance information, re-submission of claims, for reimbursement
- Successfully increased business revenue
- Lead for educational, training instruction, for out of state locations, correct coding, modifiers, billing procedures, ensuring high importance of intake information
- Collaborated with physicians, office managers regarding importance of clinical documentation, including diagnosis, coding, modifiers, while implementing best medical business practices.
Office Manager - Billing Specialist
Gaitway Rehab Inc
Boca Raton, FL
09.2014 - 08.2016
- Successfully credentialed provider's and facility with in-network participation with Department of Veteran Affairs, Health Net Federal Services, Multi-plan, and Medicaid, increasing business revenue
- Re-credentialing facility and providers with Medicare, CAQH, CHAMPVA, Tri-care South, Humana Military, Optum Healthcare, United Healthcare, & Cigna
- Negotiated Liability, PIP, WC claim settlements with Attorneys
- Insurance Authorization & verifications
- Maintained IT data base.
- Identified, researched and resolved billing variances to maintain system accuracy and currency.
- Generated and submitted invoices based upon established accounts receivable schedules and terms.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
- Managed efficient cash flow reporting, posted cash receipts and analyzed chargebacks, independently addressing and resolving issues.
- Performed targeted collections on past due accounts aged over 120 days.
- Executed billing tasks and recorded information in company databases.
- Managed invoicing and payment processing operations.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Remote position.
Office Manager-Billing Specialist
Verhees & Associates Inc
Delray Beach, FL
04.2005 - 02.2014
- Confidently managed this Physical Therapy group, including financial management, patient care, facility maintenance, and marketing.
- Successfully contracted providers with United Healthcare and Cigna, maintained CAQH universal data source
- Contracted providers and facility with Medicare, Blue Cross Blue Shield of FL.
- Supervised daily office operations of staff.
- Conducted revenue duties, manual/electronic posting of insurance payments, researched charge backs, bank deposits, reconciliation of discrepancies
- Analyzed unpaid, underpaid claims, resolved issues
- Verification of health insurance coverages, including WC, PIP, Slip fall, attorney demands, final demands and settlements
- Prepared locations for OSHA and Medicare, inspections ensuring medical supplies are properly maintained for quality patient care and safety
- Maintained IT database.
- Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Received and sorted mail, prepared packages for delivery and scanned documents.
- Trained and mentored new team members and managers on accounts payable systems and policies to build cohesive groups and promote operational performance.
- Disbursed petty cash by recording entries and verifying documentation.
Education
Some College (No Degree) - Business
Essex University
United KingdomFAU - Certified Medical Management
FAU Executive Education
Boca Raton08.2014
Molinari & Associates - Medicare
CMS
Pembroke Pines, FL2012
Skills
- Revenue Management
- Medical Billing
- Microsoft Office
- Problem Solving
- Organization and Prioritization
- Discrepancy Resolution
- Quality Assurance
- Business Relationship Management
- Problem Anticipation and Resolution
- Decision Making
Timeline
Revenue Management Specialist
IRISE Spine and Joint Institute
09.2019 - Current
Bookkeeping and Inventory Administrator
Hilton Q-shop Ft Lauderdale
01.2019 - 09.2019
Medical Billing Specialist / Accounting Specialist
SNI
03.2018 - 11.2018
Medical Billing Specialist
Gulfstream Outsourcing
09.2016 - 02.2018
Office Manager - Billing Specialist
Gaitway Rehab Inc
09.2014 - 08.2016
Office Manager-Billing Specialist
Verhees & Associates Inc
04.2005 - 02.2014
Some College (No Degree) - Business
Essex University
FAU - Certified Medical Management
FAU Executive Education
Molinari & Associates - Medicare
CMS