Summary
Overview
Work History
Education
Skills
Affiliations
Certification
Timeline
Receptionist
Erin Fernandez

Erin Fernandez

Benicia,CA

Summary

Successful and highly organized Revenue Cycle professional with over 20 years of experience in the healthcare industry. As well as being a certified professional coder, I have excellent analytical, time management and account management skills. Thorough follow-up with all projects and the ability to work independently and maintain confidentiality in all activities. Extensive knowledge of OPPS (Outpatient Prospective Payment System) IPPS (Inpatient Prospective Payment System) NCCI (National Correct Coding Initiative) CDM (Charge Description Master) CPT & HCPCS coding ICD-10 coding APC & DRG knowledge. Proficient with various systems/applications, i.e. Craneware, Optum360, Cerner, Cirius, etc.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Data Operations Lead Consultant

The Craneware Group
07.2022 - Current
  • Management of 3 consultants involved in all aspects of regulatory maintenance of Craneware's flagship application
  • Managed, reviewed and handled any cases that needed escalation via Microsoft Dynamics CRM
  • Collaborated with UX teams for various projects related to application being moved to a cloud based platform
  • Collaborated with product analysts and project managers to resolve bugs, give insight on enhancement requests, as well as input into business decisions
  • Created and implemented organizational policies and procedures
  • Prioritized projects and project tasks depending upon key milestones and deadline dates
  • Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions
  • Developed program schedules and monitored milestones, managing production flow to guide production orders to correct and timely completion
  • Collaborated with teams to define, strategize, and implement marketing and web strategies
  • Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees
  • Evaluated staff performance and provided coaching to address inefficiencies

Data Operations Consultant

The Craneware Group
09.2021 - 07.2022
  • Maintained CPT, HCPCS, modifiers, and revenue codes databases for flagship application and CDM tool on a quarterly, annual, and as needed basis
  • Provided prompt and expert responses to customer compliance inquiries through Microsoft Dynamics CRM
  • Authored various Q&A articles on COVID-19 related CPTs that were published throughout the pandemic by AMA & FDA
  • QA of applications to ensure accuracy and compliance of all databases
  • Adapted quickly to changing project priorities and job specifications with analytical thinking and task prioritization skills
  • Developed written documents and reports related to programs and operations
  • Worked well in a team setting, providing support and guidance
  • Managed time efficiently in order to complete all tasks within deadlines
  • Collaborated with manager on various projects

Manager of Revenue Integrity

NorthBay Healthcare
02.2020 - 09.2021
  • Management of 5 revenue cycle analysts and auditors
  • Responsible for the integrity of the CDM (Charge Description Master) for two facilities, an ASC, and multiple clinics
  • CDM & Strategic Pricing Management
  • Development of policy and procedures for charge capture, pharmacy maintenance and build, and observation services
  • Implemented ticketing/work flow system
  • Work directly with clinical departments to correct issues related to charge posting
  • Review daily reports (suspense, edit, etc.) from patient accounting system
  • Identify trends in errors and denials and prepare appropriate process improvement initiative
  • Find root causes of facility related denials and educate providers/departments to eliminate said denials

Director of Customer Support & Compliance

Cirius Group, Inc
01.2006 - 02.2020
  • Management of 7 compliance and technical support analysts involved in all levels of support services, as well as creating and maintaining Cirius standard edit packages
  • Presented educational webinars to various client's revenue integrity teams in regards to correct coding, charge capture, modifiers, APCs, infusion billing, and I/OCE policies
  • In-depth understanding of medical terminology and billing/reimbursement practices
  • Management and delegation of work assignments pertaining to coding and regulations for over 30 + states
  • Works closely with clients informing them of current billing regulation/policy changes that occur on a monthly, quarterly and annual basis
  • On-site client visits to review KPIs, analyze information and make recommendations to improve A/R, clean claim percentages, denial rate, reimbursement, etc.
  • In collaboration with lead consultant, helped to reduce client denials and rejections by at least 3%, 6 months after go-live
  • Helped to improve an account's DNFB charges down from 2.1 million to 1.3 million in 6 months
  • Created uplifting morale and team-building incentive program
  • Responsible for training new employees entering into compliance and/or customer support departments
  • Liaison for accounts that are new or at risk
  • Implemented and trained 15 employees on new ticketing system for customer support department

Technical Support Analyst

Cirius Group, Inc
11.2004 - 01.2006
  • Provided desktop support for multiple Cirius applications
  • On-site client visits for implementation of new software
  • Testing and review of EDI transactions to ensure HIPAA compliance
  • Offered remote support for clients via phone, email and ticketing system

Technical Support Analyst/Trainer

QMS
05.2004 - 11.2004
  • Provided desktop support for QMS application
  • On-site client visits for training and implementation of software
  • Involved in presentations for annual client seminars.

Government Biller/Team Lead

AAI
09.2002 - 05.2004
    • Responsible for billing and follow up of government accounts including Medicare and Medi-Cal
    • Collaborated with coders to ensure proper billing
    • Worked closely with client liaisons to educate doctors of changes in regulations as well as trends.

Office Manager

Epicentre
05.2001 - 08.2002
  • Performed all coding and billing for this 5 doctor practice
  • Scheduled patients, answered phones and helped with back office duties.

Education

Science of Nursing, Accelerated Program -

Maric College of Medical Careers
San Diego, CA
2001

Medical Billing & Coding Program -

Maric College of Medical Careers
San Diego
2000

Medical Assistant Program -

Maric College of Medical Careers
San Diego, CA
1999

Skills

  • Management
  • Critical thinking
  • Analytical
  • Excellent verbal communication
  • Excellent written communication
  • Staff training and development
  • Strong work ethic
  • Conflict resolution
  • Extensive payer knowledge
  • HIPAA compliance
  • Regulatory Compliance

Affiliations

Healthcare Financial Management Association

Health Care Compliance Association

National Association of Healthcare Revenue Integrity

Certification

  • CPC - Certified Professional Coder - AAPC Member ID: 01103491

Timeline

Data Operations Lead Consultant

The Craneware Group
07.2022 - Current

Data Operations Consultant

The Craneware Group
09.2021 - 07.2022

Manager of Revenue Integrity

NorthBay Healthcare
02.2020 - 09.2021

Director of Customer Support & Compliance

Cirius Group, Inc
01.2006 - 02.2020

Technical Support Analyst

Cirius Group, Inc
11.2004 - 01.2006

Technical Support Analyst/Trainer

QMS
05.2004 - 11.2004

Government Biller/Team Lead

AAI
09.2002 - 05.2004

Office Manager

Epicentre
05.2001 - 08.2002

Science of Nursing, Accelerated Program -

Maric College of Medical Careers

Medical Billing & Coding Program -

Maric College of Medical Careers

Medical Assistant Program -

Maric College of Medical Careers

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Erin Fernandez