Lydia Battle
New York,NY
Summary
Experienced compliance professional with strong analytical skills and expertise in regulatory standards. Consistently ensures adherence to policies while fostering team collaboration and adapting to changing needs. Skilled in risk assessment, audit planning, and process improvement. Reliable and focused on achieving measurable results.
Overview
17
17
years of professional experience
1
1
Certificate
Work History
Compliance Auditor - Coding
SOL Mental Health
09.2022 - Current
- Revenue cycle management of AI e-billing and Coding Compliance oversight estimating 200 providers, 20 Care Team leaders/members, offshore external billing team and about 2,000 patients for the New York region [13 locations].
- Collaborate with cross-functional teams to ensure timely implementation of corrective actions, mitigating potential compliance issues.
- Develop, implement, and refine audit procedures to ensure compliance with regulatory standards, including healthcare-specific audits
- Analyze audit results and resolve compliance issues.
- QCC Tickets for EHR claim configuration issues.
- Oversee and conduct internal audits related to billing, coding, and documentation, with a focus on identifying discrepancies and areas for improvement
- Maintain up-to-date knowledge of regulatory changes affecting the business landscape, proactively adapting audit strategies as needed.
- Analyze audit findings, compile reports, and present recommendations for corrective actions to senior leadership & clinical team members
- Serve as a subject matter expert on healthcare auditing, coding compliance, and regulatory standards
- Promote ethical decision-making within the organization by serving as a trusted resource for addressing complex compliance questions or concerns.
- Ensure accurate documentation of audit findings, corrective action plans, and ongoing monitoring efforts
- Leverage data analytics tools to enhance audit efficiency and accuracy, generating valuable insights to drive continuous improvement efforts.
- Deliver comprehensive training programs for employees & clinical team members on key compliance topics, fostering a sound understanding of relevant regulations and best practices.
- Evaluate the effectiveness of existing enterprise-wide risk management strategies in safeguarding organizational assets from potential threats or liabilities.
- Adhere to strict HIPAA guidelines to protect patient confidentiality and privacy
- Assess third-party vendor relationships for compliance concerns, minimizing potential risks associated with external partnerships.
- Demonstrate strong remote work skills, efficiently managing tasks and communication with team members
- Streamline internal processes by identifying inefficiencies in the existing control systems and recommending improvements.
- Reduce financial risks through meticulous analysis of financial statements, internal controls, and operational procedures.
Sr. Lead Remote RCM Billing Associate
Neighborhood Psychiatry-Mental Health Private Practice
10.2020 - 09.2022
- e-billing Claim submissions
- Review claims denied for coding errors, bundling, medical necessity, and/or other related reasons
- Correct coding errors, drafts appeal letters based on physician documentation and coding guidelines, submit supplemental claim information to insurance companies and follow-up on appeals as necessary
- Compare coding to notes/documentation and communicate with providers to suggest improvements, clarify errors, correct coding, prepare appeals/reconsideration requests and escalate concerns as needed to executive team
- Appeal complex denials through review of payer policies, coding, contracts, and medical records
- Review Aging report for unbilled charges and follow up with physicians and/or practice management for unbilled services
- A/R follow up using aging reports-Identifying and review denials, corrected claims, process appeals, review overpayments/underpayments on accounts, and refund requests from carriers in addition to disputing patient chargebacks or insurance recoupment.
- Responsible Party (patient) follow up using aging reports- Handle collection of patient portions of bills (copays, deductibles, self-pay, etc)
- Send patient statements and coordinate with patients regarding outstanding balances (self-pay, copay, deductible and coinsurance balances)
- Act as a financial counselor to patients who require assistance understanding their benefits and financial options
- Post payments - QuicRemit, Zelis, missing EFT payments, Lyra, Credit card/cash payments
- Mail as it comes in
- Work with front-end staff to ensure patient insurance information and benefits are verified accurately and timely
- Act as a resource to front end practice staff to identify gaps in financial clearance processes
- Analyze and investigate denial trends, payer specific carrier submission requirements & system optimization
- Ensures denial reviews are conducted in a timely manner
- Fulfills Continuing Education Units necessary to maintain certification status
- Assists in training current and new providers on the use of EHR systems and departmental policies and CPT/ICD coding
Credentialing/Authorization Specialist
Henry Street Settlement-Mental Health Facility
05.2015 - 06.2020
- Achievements: Increase revenue in non-profit facilities by enrolling facilities in many health plans, follow up on denials and contract negotiations
- Onboarding of new medical personnel
- Maintenance of credentialing tracker for provider details and payor enrollment status
- Maintain CAQH database with up-to-date licensure and other credentialing forms
- Primary source verification for resolving issues concerning provider’s enrollment with insurance companies
- Ensures timely completion of credentialing and re-credentialing of providers for all insurance carriers
- Obtains appropriate credentials as well as updated copies prior to the expiration date of any license, certification, or other required documentation
- Acts as liaison with Practitioners, billing management, insurance carriers and Executives
- Process new applications for physician privileges to the facility
- Assist patients in enrolling in health plans in-network with facility
- Manage primary clinic ensuring medical staff notes are complete and locked (monitoring eClinicalWorks) so claims for billing department can be submitted
- Denials (follow up and appeals -APG rate disputes)/Management of Prior Authorization request
- Work with Vice president to Review and negotiate insurance contracts and amendments during credentialing and recredentialing
- Authorization submission request for PROS behavioral health services
- Demographic patient tracking for Senior Pearls clinic in NYCMED
Billing Manager/Entitlement Specialist
Outreach Development Corporation
08.2008 - 04.2015
- Company Overview: Juvenile Delinquency Inpatient Rehabilitation Treatment Facility Center
- Achievements: Increased revenue in non-profit facility about $360,000/annual (HRA only)
- Maintained all systems within billing at this site
- Liaison for HRA, Medicaid and SSI
- Revenue Reports and AP/AR (HRA and SSI funds)
- Create Financial Contracts for residents and follow up on compliance
- Send statements and collect fees
- Scheduled financial appointments for all clients and processed applications (HRA, Medicaid and SSI application processing)
- Contact external and internal financial departments to resolve problems with individual accounts regarding shelter, insurance, food stamps, cash or SSI payments
- Supervisory: Supervised and troubleshot any situations that arose in the billing process
- Managed day-to-day accounting activities, supervised staff and responsible for managing billing team
- Assisted the Finance Director with monthly closing of books, accruals, setting up of newly acquired residents, and other accounting related duties as needed
- Created and maintained billing procedures and checklists
- Managed vendor and customer questions and coordinated between departments
- Won Employee of the Year award in 2013 for streamlining billing process
- Prepared reports for management and presented information in meetings
- Outlined billing process and necessary improvements
- Trained new billing clerks in billing procedures
- Juvenile Delinquency Inpatient Rehabilitation Treatment Facility Center
Education
Bachelor’s degree - Criminal Justice
John Jay College
New York, NYSkills
- E-billing expertise
- Appeals / denial management
- Proficient in E/M coding
- Medical Compliance Auditing and coding ( CPT & dx )
- Provider credentialing
- Training in billing processes for global teams [in-house & offshore ]
- Facilitating regulatory inspections
- Risk assessment
- HIPAA compliance
- Accounts receivable management
- Revenue cycle management
- Provider auditing & Training
Certification
Billing
Coding
Auditing
Compliance
Credentialing
Behavioral Health Coding
Timeline
Compliance Auditor - Coding
SOL Mental Health
09.2022 - Current
Sr. Lead Remote RCM Billing Associate
Neighborhood Psychiatry-Mental Health Private Practice
10.2020 - 09.2022
Credentialing/Authorization Specialist
Henry Street Settlement-Mental Health Facility
05.2015 - 06.2020
Billing Manager/Entitlement Specialist
Outreach Development Corporation
08.2008 - 04.2015
Bachelor’s degree - Criminal Justice
John Jay College
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