Etienne Medina
Brooklyn,NY
Summary
Dynamic Revenue Cycle Specialist with a proven track record at New York Presbyterian Weill Cornell Medicine, enhancing revenue by mastering claims processing and denial management. Leveraged analytical problem-solving and leadership skills to surpass revenue quotas, achieving a significant overturn in high-dollar claims. Expert in healthcare finance. Results-driven and known for high productivity and efficient task completion. Specializing in billing, coding accuracy, and compliance regulation management. Proficient in analytical problem-solving, negotiation, and communication skills, ensuring smooth operation within revenue cycle processes. Committed to maximizing revenue while maintaining high levels of integrity and professionalism.
Overview
14
14
years of professional experience
Work History
REVENUE CYCLE SPECIALIST TRANSPLANTS AND ORGAN ACQUISITION
New York Presbyterian Weill Cornell Medicine
New York, NY
01.2023 - Current
- Dedicated revenue cycle specialist working alongside team of four to provide follow-up on outstanding and denied claims to Medicaid, Medicare and commercial HMOs for physician services billed in relation to patient care regarding transplant and organ acquisition services
- Complete claim follow-up to ensure accurate reimbursement for services rendered throughout hospital network departments for services relevant to treatment for patients undergoing transplants, pretransplant and post- transplant care
- Prepared daily excel tracker to ensure patients covered by affiliated hospital transplant network were billed appropriately through inter affiliated hospital contract
- Collaborated with external Optum global case package team to ensure that third party repricing contract was honored by enrolled HMOs for services related to kidney, liver, and BMT/Car-T cell bundled episode services
- Worked with senior and mid-level management to ensure accuracy of denial follow up resulting in increased revenue reimbursement through medical record submission and appeals
- Completed all relevant tasks associated with claim follow-up to ensure that personal assigned receivable remained under 90 days, allowing timely filing of claim appeal or resubmission for claim reprocessing and adjudication
- Attend meetings, seminars, webinars and in servicing from commercial HMOs on an ongoing basis allowing for current payer policy’s to be familiar with follow-up staff
ACCOUNT ADMINISTRATOR HEMATOLOGY/ONCOLOGY- Myeloma lead
New York Presbyterian Weill Cornell Medicine
New York, NY
01.2021 - 01.2023
- Provide billing support to the Department of Medicine’s Hematology and Oncology division, ensuring an efficient workflow in all functions related to physician billing
- Act as a support for various key tasks within the department to support department initiatives
- Reviewed, correct, and adjust charges in various Work queue’s including inpatient and outpatient claim review, patient registration Work queues, and back end follow up Work queues
- Provided billing support for inquiries forwarded for review and investigation to the billing team
- Assisted with obtaining authorization for various subdivisions of the Hematology Oncology department
- Myeloma department charge entry, including charge review, charge entry, drug invoice and nucleus review and entry for accurate billing submission
- Reviewed charges in outpatient and inpatient Work queues to ensure that all applicable components of the claim are present, verified, and coded in compliance with department standards
- OCM Medicare billing performed on a monthly basis
- Ensured complete Bone Marrow and Procedure log review, including chart analysis, charge entry and provider follow up on open encounters, to ensure that all services performed are billed in a timely fashion
- Collaborated with team members to improve department processes and functions to develop initiatives to improve workflow
- Reviewed patient encounters and notes to ensure accurate clinical documentation for billing purposes
- Acted in compliance with all HIPPA and company protocols regarding privacy procedures for sensitive patient records
- Maintained accurate electronic logs for authorization submissions, bone marrow and procedure billing records and account follow up records
HEMATOLOGY/ONCOLOGY LEAD CLAIMS ANALYST
Maimonides Medical Center
Brooklyn, NY
01.2013 - 01.2021
- Collaborated with Senior Management to maintain an efficient protocol of Cancer Center claims follow-up, ensuring that reimbursement for services rendered is accurate, and that monthly quota is surpassed
- Identified innovative methods to reduce departmental denials, adjust unsatisfied accounts, and increase revenue
- Appealed priority high dollar accounts, for which payment has been previously denied, resulting in an additional $5 million dollars for overturned claims on an annual basis
- Coordinated with senior management to analyze data trends and accounts receivable for services rendered
- Assessed and investigate open and underpaid claims generating from the Cancer Center, including Hematology, Radiation, Pet scan, Mammogram, MRI, Counseling, and Pediatric registrations
- Collaborated with management to review claims proration, billing, and cash posting realization to ensure accurate and appropriate reimbursement for the medical center
- Composed detailed reviews of third-party HMO payer excel spreadsheets to report outstanding balances payable
- Acted as a liaison between Commercial Insurance programs and senior management to secure negotiations for settlements of unsatisfied receivable
- Reviewed data on cash revenue trends daily to address key issues and identify outstanding debts
- Implemented protocols and follow up guidelines that result in substantial recuperated payments
- Reviewed, rectify, adjust, and analyze claims to ensure appropriate bookkeeping
- Prepared data spreadsheets, pivot tables and charts for Senior Management to review and discuss at high level meetings with Maimonides Medical Center board members
- Partnered with outside contact persons daily to obtain medical records, coding review, high-cost drug invoices
- Formulated spreadsheets to be distributed by management, to staff members, to ensure that workflow is efficient and to target priority projects within the department
- Developed new high dollar claims tracker by implementing an Appeal Worksheet that allowed for the appropriate follow up of high dollar accounts, that resulted in the recoverable revenue by $5 million dollars in its first year, with substantial increase thereafter
ASSISTANT OFFICE MANAGER
ISLEEP MANAGEMENT LLC
New York, NY
01.2012 - 01.2013
- Implement marketing strategies, which expanded the company’s network for sleep diagnostic services
- Ensure that maximum patient capacity was scheduled nightly, to maximize the company’s revenue
- Oversee a staff of five clerical staff members and provide constant in-servicing to guarantee productive workflow
- Oversaw clerical staff work productivity, payroll, and quarterly employee assessments
- Provided continuous in servicing to staff to ensure efficient workflow
- Ensured that the diagnostic sleep lab was operating at maximum capacity on a nightly basis, to maximize revenue for services rendered
- Assisted third party billing department with obtaining any clinical information needed for claims processing
- Answered and addressed employee inquiries and concerns with respect to company protocol
- Processed credit card payments for services rendered for dental service members
- Interviewed, hired, and trained new staff members for clerical position openings
- Exemplified an enthusiastic and motivational work ethic will all colleagues to boost office morale
- Implemented the incorporation of patient referral for dental alternative treatment for sleep apnea for eligible candidates, which resulted in substantial fiscal revenue growth
PATIENT COORDINATOR
FINESTONE AND WERTENTHEIL OPTHALMOLOGY MDS
Brooklyn, NY
01.2011 - 01.2012
- Ensure that specialty Ophthalmology is run efficiently, with a strong focus on third party HMO commercial insurance claim follow up and billing
- Heavy office and outpatient ambulatory surgery scheduling for Ophthalmology practice
- Verified insurance eligibility, collected co-payments, and obtained authorizations and referrals on an as needed basis
- Maintained a professional work ethic with physicians, staff, patients, and vendors
- Prepared and maintained accurate and HIPPA compliant medical record charts
- Billed and coded claims for nursing homes patients, for ophthalmology services rendered
- Facilitated in house claim follow up, reducing use of third-party biller, reducing expenses for specialty medical practice by 20%
Education
Bachelor of Science - Health Services Administration
City Of New York School of Professional Studies
06.2026
Associate of Science - Finance Major, Accounting Major
Touro NYSCAS
High School Diploma -
FORT HAMILTON HIGH SCHOOL
Brooklyn, NYSkills
- Project launching
- Revenue Cycle Analysis
- Electronic Medical Records systems
- Revenue quotas
- Revenue cycle management
- Healthcare finance
- Claims processing proficiency
- HIPAA compliance
- Analytical problem solving
- Medical billing
- Medical billing expertise
- Denial management
- Accounts receivable management
- Claims review
- Billing and account administration support
- Leadership skills
- Bilingual
Affiliations
- Yoga Enthusiast
- Recreational Interior Design
- Event Planning
Timeline
REVENUE CYCLE SPECIALIST TRANSPLANTS AND ORGAN ACQUISITION
New York Presbyterian Weill Cornell Medicine
01.2023 - Current
ACCOUNT ADMINISTRATOR HEMATOLOGY/ONCOLOGY- Myeloma lead
New York Presbyterian Weill Cornell Medicine
01.2021 - 01.2023
HEMATOLOGY/ONCOLOGY LEAD CLAIMS ANALYST
Maimonides Medical Center
01.2013 - 01.2021
ASSISTANT OFFICE MANAGER
ISLEEP MANAGEMENT LLC
01.2012 - 01.2013
PATIENT COORDINATOR
FINESTONE AND WERTENTHEIL OPTHALMOLOGY MDS
01.2011 - 01.2012
Bachelor of Science - Health Services Administration
City Of New York School of Professional Studies
Associate of Science - Finance Major, Accounting Major
Touro NYSCAS
High School Diploma -
FORT HAMILTON HIGH SCHOOL
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