Kathleen E. Mace
State DME Billing & Insurance Supervisor
Georgetown,US
Summary
Highly knowledgeable in Medicare, Medicaid, and private insurance guidelines. Strong focus on maintaining compliance and implementing policy updates. Skilled in streamlining processes to enhance operational efficiency, reduce errors, and optimize reimbursement cycles in revenue cycle management and clinic operations. Demonstrated expertise in managing and supervising Durable Medical Equipment (DME) billing operations, ensuring accuracy and compliance with Medicare, Medicaid, and commercial insurance policies and regulations. Proven ability to lead and train teams, fostering a collaborative and high-performing work environment. Exceptional at resolving complex insurance claims, billing disputes, and clinic workflows and processes through detailed analysis and effective communication with executive directors.
Overview
18
18
years of professional experience
4
4
years of post-secondary education
Work History
State DME Billing & Insurance Supervisor
OrthoVirginia, Inc.
10.2023 - Current
- Supervise and manage statewide Durable Medical Equipment (DME) billing and insurance operations, ensuring compliance with Medicare, Medicaid, and commercial insurance guidelines
- Oversee daily billing activities, ensuring timely and accurate submission of claims
- Lead a team of 4 extraordinary professionals, providing training, mentorship, and performance evaluations to promote a high-performing work environment
- Implement and monitor operational procedures to enhance efficiency, reduce errors, and optimize reimbursement cycles across multiple locations
- Spearhead initiatives to improve communication between teams, streamline workflows, and promote collaboration across departments
- Manage insurance claims, including verification, authorizations, and follow-up
- Generate and analyze billing reports to identify trends and improve workflow processes
- Collaborate with DME leadership, providers, and insurance teams to optimize workflows, maximize revenue, and minimize expenses
- Participate in providing ongoing training to providers and management teams to enhance knowledge of DME equipment, medical terminology, and updates within Medicare, Medicaid, and commercial insurance guidelines and requirements
State Lead DME Insurance & Business Specialist
OrthoVirginia, Inc.
03.2022 - 10.2023
- Oversaw and coordinated statewide Durable Medical Equipment (DME) insurance processes, ensuring compliance with Medicare, Medicaid, and commercial insurance guidelines
- Led cross-functional teams to streamline DME workflows, improving efficiency and reducing denials
- Acted as the primary point of contact for escalated insurance cases, resolving complex billing issues with a focus on accuracy and customer satisfaction
- Analyzed operational data and insurance trends to identify opportunities for process improvements and revenue optimization
- Trained and mentored team members, fostering professional growth and ensuring adherence to best practices in DME insurance and business operations
- Developed and implemented strategies to maintain compliance with evolving regulatory requirements, minimizing risk and maximizing organizational efficiency within the revenue cycle management as well as clinical operations
DME Business & Financial Services Specialist
OrthoVirginia, Inc.
04.2018 - 03.2022
- Oversee DME billing operations to ensure compliance with Medicare, Medicaid, and commercial insurance guidelines
- Analyze financial transactions and billing processes to ensure compliance with Medicare and regulatory requirements
- Optimize reimbursement cycles and improve financial performance through meticulous analysis and process improvements
- Maintain accurate documentation and update account information to ensure seamless operations
- Resolve discrepancies and disputes in insurance claims through effective communication with insurance providers
- Resolve member or client service issues by identifying the cause of the problem and implementing effective solutions
- Generate and verify weekly financial reports to maintain charge accuracy
RCM MD Insurance Billing Specialist
OrthoVirginia, Inc.
01.2017 - 01.2018
- Efficiently manage Service Now tickets for timely issue resolution
- Conduct Charge Review to ensure compliance with insurance regulations
- Streamline DME authorization processes to minimize delays
- Proactively address co-pay discrepancies to enhance revenue flow
- Follow up on Orthotics denials to recover lost revenue opportunities
- Resolve missing insurance payments to ensure accurate account management
- Verify weekly reports for Orthotics and Kodiaks to maintain charge accuracy
Senior Quality Claims Analyst
OrthoVirginia, Inc.
01.2016 - 01.2017
- Efficiently manage Service Now tickets for timely issue resolution
- Conduct Charge Review to ensure compliance with insurance regulations
- Streamline DME authorization processes to minimize delays
- Proactively address co-pay discrepancies to enhance revenue flow
- Follow up on Orthotics denials to recover lost revenue opportunities
- Resolve missing insurance payments to ensure accurate account management
- Verify weekly reports for Orthotics and Kodiaks to maintain charge accuracy
Quality Claims Analyst
OrthoVirginia, Inc.
01.2014 - 01.2017
- Ensured accurate verification of electronic patient encounters, enhancing compliance with insurance requirements
- Scrubbed charges meticulously, achieving 100% adherence to electronic encounter rules
- Proactively communicated new insurance rule updates, fostering team awareness and compliance
- Collaborated with management to optimize coverage and coordinate group schedules efficiently
- Streamlined orthotics and Kodiak posting, improving billing accuracy and operational efficiency
Charge Poster & Surgical Scheduler Administrative Assistant
Commonwealth Orthopedics
01.2011 - 01.2014
- Company Overview: OrthoVirginia Merge 2014
- Accurately post charges and payments to patient accounts, ensuring compliance with billing guidelines
- Review and reconcile daily charge batches to maintain accurate financial records
- Maintain up-to-date knowledge of insurance policies and billing procedures to optimize charge posting accuracy
- Streamline MRI authorizations, enhancing efficiency for the Herndon office
- Coordinated surgical scheduling for Dr
- Aguiar, optimizing patient flow
- Improved patient communication through effective call assistance
- Served as backup for front desk operations, ensuring seamless check-in and check-out
- Facilitated timely follow-up appointments, boosting patient satisfaction
- Accurately collected co-payments, contributing to improved revenue management
- OrthoVirginia Merge 2014
Front Desk & Check Out Receptionist & Administrative Assistant
Commonwealth Orthopedics
01.2007 - 01.2011
- Company Overview: OrthoVirginia Merge 2014
- Efficiently check in patients, enhance check in process and reduce wait times
- Accurately enter demographics and insurance details, ensuring seamless patient records
- Streamline patient check-out processes, improving overall satisfaction and efficiency
- Schedule appointments effectively, optimizing clinic workflow and patient convenience
- Scan and organize patient information digitally, enhancing data accessibility and security
- Collect co-pays and balances with precision, contributing to improved revenue flow
- Manage MRI authorizations efficiently for Reston office, expediting patient care processes
- OrthoVirginia Merge 2014
Education
GED - General Coursework
South Lakes High School
Reston, VA 09.2000 - 06.2004
Counselor in Training
YMCA
Reston, VA 06.2000 - 08.2000
Skills
Claims oversight
Computer Programs
- Epic
- Service Now
- Breg Vision
- Outlook
- Imprivata Citrix
- Ring Central
- OnBase Unity Client
- ADP
- Acrobat Reader DC
- Biscom Fax
- Zoom
- SRS EHR
- CIH
- AccelaSmart/AccelaCapture
- Microsoft 360
- White Plume
- Emedsys
- Allscripts Pro PM
- Cash register
Timeline
State DME Billing & Insurance Supervisor
OrthoVirginia, Inc.
10.2023 - Current
State Lead DME Insurance & Business Specialist
OrthoVirginia, Inc.
03.2022 - 10.2023
DME Business & Financial Services Specialist
OrthoVirginia, Inc.
04.2018 - 03.2022
RCM MD Insurance Billing Specialist
OrthoVirginia, Inc.
01.2017 - 01.2018
Senior Quality Claims Analyst
OrthoVirginia, Inc.
01.2016 - 01.2017
Quality Claims Analyst
OrthoVirginia, Inc.
01.2014 - 01.2017
Charge Poster & Surgical Scheduler Administrative Assistant
Commonwealth Orthopedics
01.2011 - 01.2014
Front Desk & Check Out Receptionist & Administrative Assistant
Commonwealth Orthopedics
01.2007 - 01.2011
GED - General Coursework
South Lakes High School
09.2000 - 06.2004
Counselor in Training
YMCA
06.2000 - 08.2000
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