Janethe Hesterman
Fountain Hills,AZ
Summary
Dynamic Billing Manager with a track record of enhancing revenue cycle management at Unique Lab Services LLC. Expertise in advanced billing systems, claims processing, and regulatory compliance leads to improved collections and heightened patient satisfaction. Proven ability to drive operational efficiency through effective team leadership and training. Aiming to leverage skills in a challenging role within a growth-focused organization.
Overview
23
23
years of professional experience
Work History
Billing Manager
Unique Lab Services LLC
Fountain Hills, USA
06.2022 - Current
- Implemented and Managed the conversion of an analog Phlebotomist- Medical System Phlebio to Advanced MD Practice Management and EHR System for Billing and collections in-house in one System
- Set up Credit card on file integration for payments online and through the patient portal
- Worked closely with the Billing Service to ensure correct billing processes
- Trained the front end staff on Insurances, patient demographics and System Operations
- Conducts Insurance Eligibility benefits verification via-web based and through the Practice Management System Advanced MD
- Call Insurance Carriers to overturn Insurance denials and/or underpayments
- Research historical reimbursement trends on Cpt/HCPC reimbursement on carriers, plans and accounts
- Examine and review Insurance denials and overturn letters to provide next steps for other departments
- Handled inbound patient and facilities inquiries on patient balances and insurance requests
- Manage the credentialing and contracting of Insurance Plans for the Facility
- Implemented Financial and Hipaa compliance forms for all the patients through our Pm System
- Comply with HIPAA, PHI and its implications, ABN, MSP, Emtala and other regulations which affect the registration process
- Provided accurate diagnosis codes Lab Services, procedure codes and reviewed medical orders from facilities and providers for accurate billing of insurance claims
- Corrected and refiled claims that were not properly handled by our Billing service
- Scan Documents into patient charts
Lead Billing Specialist
Spectrum Dermatology PLLC
Scottsdale, USA
07.2017 - 06.2022
- Approved claims submission (electronically) for 16 providers 4 locations
- Review and correct 'unbilled' exclusions and claims rejections
- Follow Up with Insurance account receivables (Research, Submission and Appeals)
- Handled inbound patients inquiries questions and rejections of claims
- Processed patients payments and refunds
- Communication training for all front desk personnel
- Handled Billing Office mail and Updox documents for our Billing Service
- Interface with various Billing service groups as needed to follow up on claims issues and concerns
- Operate within the team environment to include, joint decision making problem solving and accountabilities for our Billing staff
- Utilize Excel, Updox to run and update reports
- Balanced the credit card report against our Advanced MD Practice management system for accurate payment allocation
Billing Manager
Valley of the Sun Dermatology Inc.
Scottsdale, USA
04.2002 - 06.2017
- Analyzed organized and performed billing office operating procedures and procedures, such as charge entry, payment posting, claim filing
- Management and Training of all Front Desk and Billing Personnel
- Implemented a New Billing System from Allscripts to Advanced MD and help Set up Ema EHR System (Modernizing Medicine for Dermatology Practice)
- Provide expertise and resources to coordinate documents management as assigned
- Effectively manage projects, resulting in timely and cost-effective delivery of projects outcomes
- Handled all Insurance contracts for the Physicians and the Physician's assistant
- Hire and trained all Front Desk and billing Staff
- Research and resolve incorrect payments, Eob rejections, and other issues with outstanding accounts
- Follow Up on insurance and patient aging reports
- Resubmitted and corrected claims as necessary
- Created new ways to simplify operations for the practice
Education
Certificate - Anatomy, Claims Denial resolution, Evaluation and Management, PCI-DSS compliant-Information Security Awareness in the workplace
AAPC
Phoenix, AZHigh School -
Institute of Commerce High School
Panama City, PanamaSome College (No Degree) - Communications, Marketing, Human Resources, Accounting, Business Management, Business Law
Maricopa Community Colleges, Glendale Community College
Scottsdale, AZSkills
- Lytec
- Med Manager
- PCN Computer Software
- Medic
- Misys Tiger
- Allscripts
- Advanced MD (PM)
- AdvancedMD (EHR)
- Ema EHR
- Excel
- Google Documents
- Word
- QuickBooks Pro
- POS Sales
- ADP
- ICD 10
- Medical Terminology
- Medical Insurance
- Excellent Interpersonal skills
- Excellent phone skills
- Fluent in Spanish
- Claims processing
- Medical coding
- Regulatory compliance
- Insurance verification
- Patient billing
- Data analysis
- Customer service
- Team collaboration
- Project management
- Medical billing software mastery
- Patient confidentiality practices
- Team leadership qualities
- Medical coding expertise
- Continuous improvement mindset
- ICD-10
- Electronic health records experience
- Payment posting
- Revenue cycle management
- Effective communication
- Claims processing proficiency
- Healthcare reimbursement principles
- Accounts receivable management
- Time management techniques
- CPT coding
- Medicare and medicaid regulations
- Denial management strategies
- Financial reporting
- Collections process handling
- HIPAA compliance
- Conflict resolution strategies
- Staff training and development
- Analytical thinking capacity
- Procedure optimization
- Denial management
- Project leadership
- HIPAA
- Cash flow forecasting
- Staff training
- Training and mentoring
- Team building
- Collections management
- Operations monitoring
- Audit support
- Program improvements
- Workflow planning
- Process improvements
- Team direction
- Collections experience
- Interest calculations
- Collections
- Personnel oversight
- Billing review
- Report preparation
- Medical billing expertise
- Invoice processing
- Human resources knowledge
- Teamwork
- Professional demeanor
- Build customer relationships
- Proactive and focused
- Professionalism
- Willing to learn
Affiliations
- Zumba classes
- Animal shelter volunteer
- Gardening
Timeline
Billing Manager
Unique Lab Services LLC
06.2022 - Current
Lead Billing Specialist
Spectrum Dermatology PLLC
07.2017 - 06.2022
Billing Manager
Valley of the Sun Dermatology Inc.
04.2002 - 06.2017
Certificate - Anatomy, Claims Denial resolution, Evaluation and Management, PCI-DSS compliant-Information Security Awareness in the workplace
AAPC
High School -
Institute of Commerce High School
Some College (No Degree) - Communications, Marketing, Human Resources, Accounting, Business Management, Business Law
Maricopa Community Colleges, Glendale Community College
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