Elena Chertina
Brooklyn,NY
Summary
Dynamic and results-driven healthcare finance professional with 20 + years of experience in healthcare industry with strong accomplishments in team projects and reorganizing functions to achieve improved internal operating efficiency and improved cash flow.
Overview
22
22
years of professional experience
Work History
Director of Billing & Contract
Bleuler Psychotherapy Center Inc
02.2015 - Current
- Monitors comprehensive overhaul of accounts receivable management, successfully resolving unpaid claims, invalid / rejected claims, and underpayments through strategic appeals for denied claims across diverse insurance providers, while addressing coding and contract discrepancies
- Oversaw daily credit card postings and reconciliations
- Implemented in-house collections protocols and worked on delinquent accounts
- Oversees billing department in preparation and accurate entry of day-sheet data, charge posting, payment posting, and maintaining coding accuracy for electronic charge claim submission via medical software
- Demonstrated leadership by guiding and supporting the department team in appeals, spreadsheet management, and various billing-related assignments
- Monitors failed claims & failed activities reports
- Review providers Medicare & Medicaid enrollment
- Review and comply with Medicaid Audits
- Evaluate claim batches to flag and correct medical billing errors
- Establish billing and collection procedures required for efficient billing and collections processes and respond to issues and concerns of Regional Director
- Negotiate a Single case agreements and rate per diem with provider relation representatives
- Resolve various denial issues and provide strategic advice and recommendation to the team members with regards to the policies, rules and regulations
- Ensure the accuracy of coded and abstracted information for all patients
- Provide effective utilization management and maintenance of client experience standards
- Assign and direct work, coach staff
- Schedule and organize work assignments
- Implement staff training, special project review and resolution, and provide support to other departments as needed
- Maintain staff productivity by monitoring employee performance, standards of conduct, and attendance
- Resolve patient complaints by identifying problems and coordinating appropriate corrective action
- Conduct performance appraisals and make recommendations on selection, promotion, merit increases and employee discipline.
Eligibility and Billing Analyst
VNSNY Choice
08.2013 - 01.2015
- As Eligibility and Billing Analyst monitors the Medicaid recertification process to ensure prompt and accurate completion of member recertification for submission to Human Resource Administration (HRA) for the Managed Long-Term Care (MLTC) and MLTC Plus product lines
- Oversees the day-to-day review of the Accounts Receivable as is relates to Medicaid recertification and Medicaid coverage
- Performs weekly process of rebilling when applicable and ensures that all payments are received per member per month (PMPM)
- Analyzes Medicaid Capitation payments on a regular basis and reconciles Medicaid remittances
- Follows-up to ensure timely collection of Medicaid Capitation payments and other outstanding third-party requests from internal departments
- Issues billing and payment reports and payment data to internal departments for inclusion in senior management reports
- Communicates with third party payers and governmental agencies regarding unpaid claims, billing procedures, delinquent accounts, overpayments and refunds
- Research billings rejected by Medicaid to determine source of errors
- Reviews all payment discrepancies and, if necessary, contacts Medicaid, and other insurances to resolve discrepancies
- Reviews the computerized and manual billing to Medicaid and the weekly application of payments to open receivables
- Assists with the formulation and implementation of new business procedures and interacts with other departments as applicable
- Prepares ongoing financial, membership and staffing reports related to Capitation Accounts Receivable, Medicaid Surplus Accounts Receivable, TPCCC caseloads and membership eligibility.
Manager Billing & AR
Allen Health Care Services
08.2012 - 03.2013
- As Manager of Billing & AR department oversee smooth, efficient and accurate operation of Allen Health Care Services
- Provide guidance to billing and collection supervisors to coordinate activity across organizational lines
- Review quarterly A/R reports of top delinquency accounts and conduct periodic reviews with Finance and Corporate departments
- Integration planning of a new billing program – HHA eXchange that improves billing productivity and allows for cash flow increase
- Design and implementation of new tracking system that monitors the submission of exported claims
- Steering of Billing and AR teams to resolve rejections from MDOnline and EmedNY
- Established external communications with EDI departments which lead to recovery of close to a million dollars claims rejected by MCO Emblem Health/HIP and MCO Amerigroup
- Coordinate staff efforts to comply with Federal, State and local regulations and regulatory mandates within established time frames as well as document processes and trainings
- Validate accuracy of rates, codes and timesheets
- Examine and analyze billing errors to complete un-billing
- Review prebilling and custom validation processes and make corrections to the underlying client/matter data
- Ensure that organization’s billings comply with client/third party requirements
- Direct Billing Specialists in daily functions, ensuring that organization's policies are consistent and properly applied
- Integrate solutions that guarantee organization’s invoices are prepared accurately and on a timely basis
- Train subordinates on systems and procedures
- Distribute responsibilities of Billing Specialists in an effort to handle workflow and workloads
- Prepare annual evaluations and provide performance feedback throughout the year
- Develop a healthy team environment to achieve productivity, performance and quality assurance standards and lead by example in order to create a climate that fosters high performance and job engagement.
Billing & Collection Manager
Phoenix House Foundation
07.2009 - 08.2012
- As a billing and collection manager for ten residential and four outpatient substance abuse facilities, responsible for overseeing the day-to-day activities of the central billing office
- As a team leader, provide administrative oversight and guidance to a group of ten direct reports that allow effective operations of the client billing department
- Provide accurate and complete billing information to Medicaid and Medicare
- Responsible for insurance verification, initial authorization and billing procedures
- Remediate patient information problems
- As a part of account reconciliation process, assist Finance department to generate quality assurance, productivity and financial reports
- Review, coordinate and update all compliance issues in accordance with Federal, State and City rules and regulations
- As a part of collection process, monitor established goals, net and gross collection percentages as well as aging of accounts receivable
- Oversee billing and audit timeframes in accordance with local and state guidelines in order to avoid late submissions
- Facilitate communications and review feedbacks between billing center and various substance abuse programs for proper funding source determination
- Generate monthly aged reports for review and work to resolve Account Receivable delinquencies
- Monitor established goals, net and gross collection percentages, and aging of accounts receivable
- Provide recommendations and corrective action as appropriate
- Assist finance department in reconciliation process by generating and interpreting productivity and financial reports.
Senior Collector
Fazio, Rynsky & Associates LLP
09.2004 - 06.2009
- As a senior collector for a full-service law firm, responsible for the entire accounts receivable portfolio
- Negotiating payment terms with third party, following-up on delinquent accounts, and prepare ad hoc reports
- Research and investigate corporate transactions and healthcare accounts receivable
- Monitor legal preparation process for litigation and arbitration of no-fault matters
- Prepare statements and other supporting documentation as requested by collection manager to generate prompt third party and customer payments
- Review, coordinate, and update all payment options and procedures to insure accurate and timely collection of revenue
- Perform analyses of billing errors for a medical private practice company
- Research CPT codes to determine proper approach for obtaining payment from insurance companies
- Document all account issues and problems to ensure proper follow-up with the correct insurance company
- Complete PDR (Provider dispute resolution forms) accurately and efficiently
- Establish payment arrangements, resolve denial issues and respond to insurance company inquiries regarding outstanding accounts
- Research account information and creating spreadsheets for finance department.
Medical Biller/Collector
Globe MRI Imaging
04.2002 - 09.2004
- As a billing coordinator for multiple locations accountable to maintain account relationships while effectively managing all past due account balances within assigned area of collection responsibility
- Ensure all billing and follow-up is performed timely and accurately to prevent potential claim denials and to avoid issues with timely filing
- Assist patients, team members, and clients with billing questions, complaints, and inquiries
- Evaluate and analyze explanation of benefits that support payments from insurance carriers
- Confirm accuracy of claims and fees billed
- Collect payment for claims from insurance carriers, Medicaid and patients
- Communicate with the healthcare providers to obtain accurate billing data
- Research health plans for benefits or types of coverage
- Review and process HCFA and UB-04 claim forms to identify errors in billing.
Education
Master of Health Administration -
University of Phoenix
01.2014
Bachelor of Business Administration, concentrating in Management -
Kaplan University
01.2010
Skills
- Project Management
- Accounts Receivable Management
- Revenue Cycle management
- Staff Training
- Collections
- Customer Service Excellence
- Strategic Thinking & Implementation
- Insurance Payments Accuracy
- Delinquent Account Resolution
Timeline
Director of Billing & Contract
Bleuler Psychotherapy Center Inc
02.2015 - Current
Eligibility and Billing Analyst
VNSNY Choice
08.2013 - 01.2015
Manager Billing & AR
Allen Health Care Services
08.2012 - 03.2013
Billing & Collection Manager
Phoenix House Foundation
07.2009 - 08.2012
Senior Collector
Fazio, Rynsky & Associates LLP
09.2004 - 06.2009
Medical Biller/Collector
Globe MRI Imaging
04.2002 - 09.2004
Master of Health Administration -
University of Phoenix
Bachelor of Business Administration, concentrating in Management -
Kaplan University
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