Summary
Overview
Work History
Education
Skills
Timeline
Generic

MaDonna Reynolds

Denver,CO

Summary

With 20 years of experience in medical billing, I have consistently taken on progressive responsibilities, including supervisory roles. My expertise lies in Revenue Cycle Supervision, Contract Monitoring, staff selection, performance reviews, and disciplinary procedures. I possess strong knowledge of medical billing for surgical centers and hospital billing, as well as a proven ability to interpret and evaluate medical contract agreements related to claims processing and payer rules. I excel in working with various levels within a company. Additionally, I have extensive experience in accounts receivable, including direct communication with payers to ensure accurate payment application. I also have experience in accounts payable, including direct communication with payers to generate refunds. I have strong customer service experience and I am proficient in Meditech, Epic, DMS, Excel, and Microsoft Office.

Overview

20
20
years of professional experience

Work History

Supervisor Contract Compliance/Commercial Credit Balance/Medicaid Credit Balance/ Commercial Follow up

Common Spirit Formally Centura Health
04.2007 - Current
  • Monitor Contract Compliance associates, Monitor Credit Balance associates (Medicaid and Commercial payers), Monitor Commercial Follow up associates, Weekly productivity – 19 direct reports, Monthly quality assessments – 19 direct reports, Monthly staff meetings, Bi-Weekly and Weekly calls with reconciliation vendor and contracting staff regarding current problems and resolutions, Review and approve all Commercial and Medicaid refunds over 5k, Review and Approve all time off request in Kronos, Provide disciplinary action when needed.

Patient Account Lead – Contract Compliance & Credit Balance

Centura Health
01.2016 - Current
  • Create and Implement policies and procedures for Contract Compliance & Credit Balance staff, Bi-Weekly and Weekly calls with reconciliation vendor and contracting staff regarding current problems and resolutions, Communicate resolutions and current needs for clarification/ improvement in reconciliation process to all Compliance & Credit Balance staff and senior leadership, Monitor payments from payers to ensure they were following contracted rates, Train associates on how to work with payers directly to resolve contractual disputes, Train Staff on how to clarify and interpret contract verbiage to ensure accurate processing/payment of claims.

Patient Account Compliance Specialist

Centura Health
01.2012 - Current
  • Monitor payments from payers to ensure compliance with contracted rates, Work with payers directly to resolve contractual disputes, Clarify and interpret contract verbiage to ensure accurate processing/payment of claims.

Patient Follow Up Representative II

Centura Health
01.2007 - Current
  • Follow Up with payers on claim status and outstanding balances, Communicate with patients to obtain correct billing information, Facility client invoices and reconciliation, Assist in Contract Compliance, Communicate with billing vendor regarding problem accounts, Create Manual Invoices for problem clients, Verify correct pricing, fee schedules, special pricing on client invoices, Review cash posting and client adjustments, Monitor and resolve all contract loading and reimbursement issues with outside billing/reconciliation vendor, Served as contact person for all client questions and problems, Insurance denials for multiple payers including: Aetna, Anthem, Medicare, Colorado Medicaid, Reconciling insurance and patient payments.

Admissions Lead & Insurance Verification Specialist

Medical Centura Of Aurora
01.2004 - 01.2007
  • Managed diverse set of routine functions in a fast-paced medical environment, Determined employee’s best-fit roles to increase efficiency, Checked in patients, verified demographics and billing information, General office tasks such as copying, filing, and sorting incoming mail, Possessed a strong work ethic and unwavering commitment to customer service, Established validation, authorizations, and referrals for correct billing.

Education

Bachelor of Science - Business Administration And Marketing

Western Governors University
Salt Lake City, UT
07.2027

Diploma of General Studies -

Montbello High School
01.2003

Skills

  • Training and mentoring
  • Goal-Oriented
  • Staff Management
  • Employee Motivation
  • Complex Problem-Solving
  • Staff Discipline
  • Processes and procedures
  • Operations Management
  • Process Improvement
  • Process Monitoring and Improvement
  • Contract Management
  • Analytical Thinking

Timeline

Patient Account Lead – Contract Compliance & Credit Balance

Centura Health
01.2016 - Current

Patient Account Compliance Specialist

Centura Health
01.2012 - Current

Supervisor Contract Compliance/Commercial Credit Balance/Medicaid Credit Balance/ Commercial Follow up

Common Spirit Formally Centura Health
04.2007 - Current

Patient Follow Up Representative II

Centura Health
01.2007 - Current

Admissions Lead & Insurance Verification Specialist

Medical Centura Of Aurora
01.2004 - 01.2007

Bachelor of Science - Business Administration And Marketing

Western Governors University

Diploma of General Studies -

Montbello High School
MaDonna Reynolds