JANE EATON
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
25
25
years of professional experience
Work History
Revenue Cycle Manager
Acadia Healthcare
09.2022 - Current
- Monitored and guided revenue cycle operations.
- Implemented process improvements, ensuring accurate charge capture and coding compliance.
- Provided staff with up to 6 training on revenue cycle management best practices, increasing productivity across the department.
- Completed financial reporting and analysis for billing revenue cycle.
- Streamlined workflows to minimize claim rejections and maximize reimbursement rates from insurance providers.
- Maintained a thorough understanding of regulatory requirements, ensuring compliance throughout all aspects of the revenue cycle.
- Improved revenue cycle efficiency by streamlining processes and implementing best practices.
- Conducted regular audits to identify areas for improvement in the revenue cycle process.
- Established strong relationships with payers, improving communication and resolving disputes more effectively.
- Monitored industry trends to anticipate changes impacting the organization's revenue cycle performance.
- Supported clinical team members with revenue cycle procedures and addressed issues.
- Collaborated with IT to develop new revenue cycle management software, leading to improved tracking and reporting of key financial metrics.
- Supported financial director with special projects and additional job duties.
- Established and checked coding procedures, monitored reports, and updated internal files.
- Conducted detailed audits of billing and coding practices, identifying and rectifying compliance issues.
Billing Specialist II/Grant Specialist
Acadia Healthcare
03.2020 - 03.2022
- Processing behavioral health insurance benefits and claims for outpatient substance abuse facilities across the U.S., with the use of multiple EMR and clearinghouse systems
- Generated and submitted invoices based on established accounts receivable schedules and terms.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Develop training materials for new hires
- Ensure that the team is trained and capable of performing core responsibilities and learning new processes/procedures
- Managing medical billing for patients, updating patient information, generating invoices, and identifying inconsistencies between payer and provider
- Verifying health care benefits cost breakdown for potential patients by phone or provider portal
- Create detailed estimates of patient responsibility based on insurance contribution and accumulations
- Ensured communication lines between staff and management remain fluid
- Research institutional and professional claim denials and rejections
- Resolve and submit within timely filing limits
- Understanding all regulations and guidelines set by Medicare, Medicaid, state programs, grants, and commercial payers
- Eligibility of facility database by batch and by individual with the use of government and commercial portals
- Implement grant funding contracts, create processes based on the payer system and yearly funding allotments
- Created procedures that incorporated payer and in-house processing methods.
Legal Assistant
TennCare
09.2019 - 03.2020
- Processed eligibility determination applications and additional documentation through TN managed care Medicaid Eligibility Determination System (TEDS) based on policies and processes set by CMS and the State of Tennessee
- Completed TED's training and assisted with providing site support within the application processing center
- Ensuring accuracy and efficiency when registering applications and confirming the authenticity of documentation provided by the client
- Monitored and reviewed the intake application process of call center representatives by analyzing the software platform
- Determined script integrity and actions in TEDS were accurate during the application intake process
- Participated in ongoing TEDS policy training
- Processed Medicaid eligibility applications and supporting documentation provided by the client matched the policy dictated by the state of TN Health and Human Services guidelines
- Worked alongside administrative assistants, and fellow legal assistants on complex cases and legal processes.
Data Acquisition Specialist
IBM Watson Health
01.2011 - 10.2019
- Provide a technical resource and point of escalation for hospital census data while interpreting clients' needs and introduced services to fit specific requirements
- Engage with clients to identify and resolve complex problems relating to the hospital data submissions errors
- Managed support services for providers (hospitals, rehab, and surgery centers) mandated to submit health census data to Quality Measures/CMS
- Monitor and maintain the database submitted and provide results of data quality within 24-hour turnaround. Additionally, suggested solutions to resolve data errors ensuring data complies with applicable requirements
- Tracked, maintained, and provided access to provider staff through secure sites based on PHI regulations several secure methods
- Understood specific state requirements and identifying patterns and trends in data sets
- Translate file audits and serve as a liaison between research engineers and client to effectively resolve complex issues
- Maintained, transmitted, and stored data in a confidential and secure manner in compliance with applicable state and federal regulations
- Educate and setup new clients on secure IBM products to retrieve and send data.
Care Navigator
CareNet Healthcare Services
01.2010 - 12.2011
- Managed a high volume of support service calls from enrollees and vendors throughout the client's healthcare insurance plan, while meeting objectives set by client's needs
- Maintain an exceptionally high customer service level with all enrollees, vendors, and providers by answering all calls with quality and attention to detail
- Educate, understand, and translate all materials from 15 vendor health programs
- Have additional knowledge of the vendor processes and incorporate them into processes for the enrollee to understand
- Ability to multi-task; simultaneously think, talk, and navigate phone/interface
- Research, identify, problem solve, verify eligibility of service, and route medical urgencies calls.
Registration and Verification Specialist
Renal Advantage INC
01.2006 - 01.2010
- Register new dialysis patients into patient accounting and lab systems
- Ensure the patient's insurance is verified, to ensure necessary procedures are covered
- Communicate with assigned centers, lab personnel, financial caseworkers, social workers, and other center personnel regarding completion of patient demographic entry and any needed information to complete intake
- Respond to and troubleshoot questions and issues
- Coordinate with centers to identify insurance changes that occur with patients' insurance
- Contact payers via telephone or the Internet to verify patient insurance benefits
- Coordinate with assigned centers and third-party payers to obtain needed referrals, authorizations, and pre-certifications
- Ensure all patient insurance information is accurately entered into the system before month-end billing
- Determine the appropriate insurance string based on the patients' coverage
- Document with clarity any changes or updates in patient accounts.
Billing Analyst
Affinion Marketing Group
01.2000 - 01.2006
- Responsible for coordinating the release of various e-checks (ACH) and credit card billing for life and term insurance elected through marketing products
- Schedule billing based upon financial intuitions contract criteria
- Identify, diagnose, and resolve technical problems
- Serve as a transaction processing resource/expert for clients
- Work with IT and operations to coordinate scheduling
- Recognize and resolve any issues that occur with the billing of customer accounts
- Communicate issues directly with account managers and work with them to resolve client issues.
Education
Bachelor of Science Degree in Technical Management - Health Care Administration -
DeVry University
Nashville, TN01.2015
Skills
- Revenue performance
- Data Analysis
- Critical Thinking
- Problem-Solving
- Cultural Competency
- Billing cycle expertise
- Time management abilities
- Multitasking
Timeline
Revenue Cycle Manager
Acadia Healthcare
09.2022 - Current
Billing Specialist II/Grant Specialist
Acadia Healthcare
03.2020 - 03.2022
Legal Assistant
TennCare
09.2019 - 03.2020
Data Acquisition Specialist
IBM Watson Health
01.2011 - 10.2019
Care Navigator
CareNet Healthcare Services
01.2010 - 12.2011
Registration and Verification Specialist
Renal Advantage INC
01.2006 - 01.2010
Billing Analyst
Affinion Marketing Group
01.2000 - 01.2006
Bachelor of Science Degree in Technical Management - Health Care Administration -
DeVry University