Summary
Overview
Work History
Skills
Timeline
Generic

Ericka Messia

McDonough,GA

Summary

Dedicated Payment Integrity Senior Director with a history of meeting company goals utilizing consistent and organized practices. Innovative and goal-oriented professional with successful 17-year career bringing strong comprehensive knowledge of correct coding and medical policy development, configuration, policy and revenue management, Proven results in every facet of pre-and post production with strong project management and decision making skills, Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic and fast-paced settings to uphold company vision.

Overview

24
24
years of professional experience

Work History

Senior Director, Client Policy Integration

Zelis HEALTHCARE
Atlanta, GA
10.2017 - Current
  • Instituted formal operating procedures and enforced adherence to policies and regulations that impacted bottom-line.
  • Set strategic plans and revenue optimization goals to strengthen operations and drive growth
  • Formed strategic partnerships and connected with potential clients to drive business development
  • Prioritized and allocated valuable resources to meet business targets.
  • Formed strategic partnerships and connected with potential clients to drive business development.
  • Partnered with financial and customer operations teams to drive business transactions using customer data and Lean concepts.
  • Met with department supervisors and provided staff support to attain organizational goals.
  • Led projects to boost sales productivity using change methodologies to increase sales revenue by 35% and sales productivity by 75%.

Client Policy Manager

COTIVITI HEALTHCARE
Atlanta, GA
08.2013 - 10.2017
  • Applied effective time management techniques to meet tight deadlines
  • Paid attention to detail while completing assignments
  • Resolved problems, improved operations and provided exceptional service
  • Participated in team projects, demonstrating an ability to work collaboratively and effectively
  • Used critical thinking to break down problems, evaluate solutions and make decisions
  • Proved successful working within tight deadlines and a fast-paced environment
  • Strengthened communication skills through regular interactions with others
  • Adaptable and proficient in learning new concepts quickly and efficiently
  • Learned and adapted quickly to new technology and software applications
  • Excellent communication skills, both verbal and written
  • Managed time efficiently in order to complete all tasks within deadlines
  • Demonstrated leadership skills in managing projects from concept to completion

Policy Manager, Recovery Audit Contractor

IHealth Technologies
Atlanta, GA
07.2012 - 08.2013
  • Promoted to Recovery Audit Contractor (RAC) Policy Manager after 1.5 years of working in Medical Policy Department as Medical Research Analyst (Medicaid/Government Policy Specialist)
  • Responsible for researching, reviewing and interpreting coding/billing guidelines of SSA, CFR, NCDs, LCAs, LCDs, IOM, OCE
  • NCCI AHA AMA , etc., to identify opportunities for potential aberrant billing practices (medical necessity, frequency of service, utilization guidelines, dosage , etc.) that may have resulted in claims being paid in error
  • Ensure identified references are highly defensible to develop improper payment algorithms (SQL) while partnering with Finance Team to obtain data mining reports and claims analyses (total number of claims in question, dollar amounts per state , etc.) to support development of Recovery Audit Contractor new issue packages
  • Develop and configure edit parameters for medical policy library claim edits in Oracle database to reprocess previously paid claims to identify overpayments and underpayments
  • Conduct audits to ensure all policies developed and in production are compliant according to Medicare guidelines.
  • Liaised with clients to identify and target inefficiencies in areas of risks and business controls, process gaps and workflow discrepancies
  • Addressed compliance issues by developing and implementing corrective action plans
  • Analyzed and identified risk areas to determine compliance with applicable laws and regulations
  • Implemented effective compliance policies and procedures to meet regulatory requirements
  • Developed compliance training initiatives and materials, educating staff on regulations
  • Consulted with clients on best practices and served as project manager for all process improvements and regulatory initiatives
  • Delivered subject matter expertise for internal and external customers on compliance best practices and quality control

Medical Policy Research Analyst (Medicaid/Government Specialist)

IHealth Technologies
Atlanta, GA
08.2010 - 06.2012
  • Recruited by Corporate Recruiter as Medicaid Research Analyst after position elimination at Gentiva Health Services due to acquisition with Linacre Inc
  • Developed procedures, guidelines, training material and manuals to acclimate new team members
  • Selected a Lead Medicaid Trainer (SME) to travel to Hyderabad & Pune, India; facilitate d training workshops and on-going coaching for offshore Medicaid Policy Research Team via on-line applications
  • Ensured medical policy library of claim edits are consistently revised with all ICD-9, CPT, and HCPCS quarterly, semi-annual and annual industry updates
  • Reviewed and interpreted coding and billing guidelines of Medicare Local Coverage Determinations (LCDs), Outpatient Claim Edits (OCEs), Internet Only Manuals (IOMs), Uniform Bill Editors (UBEs), governmental regulations and other industry publications to develop new medical policy edits and revise existing edits
  • Effectively completed written communication for new policy edit parameters, configuration and revisions as needed
  • Completed ongoing claims analyses to ensure edits are applied appropriately; completed synopsis of findings with recommendations for Medical Director review and client communication
  • Create test scenarios to ensure claims will adjudicate properly prior to production

Lead, Medical Equipment and Infusion Therapy Billing

Gentiva Home Healthcare
Atlanta, GA
02.2007 - 06.2010
  • Vice President one month after completing Medical Billing and Coding Program at Lincoln Technical College (Promoted 2x within 3.5 years)
  • Responsible for individual and team claim audits to effectively resolve all Days of Sales Outstanding (DSO) (0, 30…90….180 , etc.) on assigned accounts
  • Utilized online applications (or called as needed) to determine beneficiary eligibility status, validate insurance coverage status and review/validate medical necessity documentation
  • Reviewed patient Explanation of Benefits (EOB) to determine, identify reasons for denial or incorrect reimbursement and make appropriate corrections for claim resubmission to Medicaid, BCBS or Medicare reopening, redeterminations, reconsiderations and escalated to ALJ as needed
  • Reviewed and downloaded daily claim rejection reports to identify, research and resolve claim adjudication issues
  • Facilitated on-going training workshops with assigned staff and provider locations review and resolve top reason for claim rejections and/or denials.

Vice President – Client Experience Director

JPMorgan
Atlanta, GA
11.1997 - 06.2006
  • Effectively managed revenue growth ($145M +) of 29 JPMorgan Chase retail branches
  • Primary interface with JPMorgan Chase Learning and Development to provide guidance regarding development of sales training material necessary to increase revenue
  • Onsite audits and assessment of retail team to ensure adherence to customer engagement protocols focused on retention and expansion of bank products and services
  • Successfully passed NASD Series 6 & 63 exam and New York State Life and Health Insurance exam

Skills

  • Key Performance Indicators (KPI)
  • Business Policies and Procedures
  • Stakeholder Relations
  • Reporting Expertise
  • Collaborative Leadership
  • Policy Implementation

Timeline

Senior Director, Client Policy Integration

Zelis HEALTHCARE
10.2017 - Current

Client Policy Manager

COTIVITI HEALTHCARE
08.2013 - 10.2017

Policy Manager, Recovery Audit Contractor

IHealth Technologies
07.2012 - 08.2013

Medical Policy Research Analyst (Medicaid/Government Specialist)

IHealth Technologies
08.2010 - 06.2012

Lead, Medical Equipment and Infusion Therapy Billing

Gentiva Home Healthcare
02.2007 - 06.2010

Vice President – Client Experience Director

JPMorgan
11.1997 - 06.2006

Similar Profiles

CREATE PROFILE
Ericka Messia