Consultant
Maria R Buss
Via Compass
Neenah,WI
Work Preference
Minimum Desired Compensation
$114/hr
14
years of professional experience
Healthcare professional with a decade of experience in managing patient journeys from scheduling to payments. Expertise in root cause analysis and claims management, driving operational efficiency and compliance while enhancing patient and provider satisfaction through strategic collaboration.
Work History
Consulting ( Flex/1099)
1 Year 7 Months- Provided advisory services on revenue cycle management and practice management to enhance operational effectiveness.
- Conducted root cause analysis and managed claim denials to identify and resolve underlying issues.
- Sought full-time remote employment for career advancement.
Claims Analyst III
3 Years 6 Months- Worked remotely for four years ( nearly 4 years). Reason for leaving: mandated hybrid work within 50 miles
- Analyzed claims data to identify trends and discrepancies.
- Reviewed and processed insurance claims for accuracy and compliance.
- Collaborated with cross-functional teams to resolve claim inquiries.
Consultant
6 Months- Developed strategic plans that enabled medical practitioners to navigate challenges during covid-19 recovery.
- Collaborated with community physicians to analyze performance metrics, driving informed process improvements.
- Facilitated workshops to identify client needs and customize solutions.
Practice Administrator
8 Years 9 Months- Coordinated people processes and technology execution to enhance operational support.
- Collaborated with stakeholders to pinpoint improvement opportunities.
- Managed daily operations of multiple clinic locations efficiently.
- Coordinated staff schedules to optimize patient care and clinic coverage.
- Implemented patient management systems to enhance workflow effectiveness.
Education
Bachelor of Science - Education, Economics minor
Skills
EHR software expertise
Root cause identification
Claims processing
Virtual collaboration
Practice administration
Regulatory compliance
Performance analysis
Team collaboration
Clear communication
Customer service
Staff training
Revenue cycle management
Personal Information
Title: SME Practice Administration, Professional Claims Management
Accomplishments
- Clean claims rate of 98.5% and denial rate under 3% year ensuring a predictable consistent revenue stream year over year
- Successful EHR integration of two specialty practices to the hospital Epic system (practice manager role)
- Successful consolidation of six independent practices into one medical group (operations manager role)
- Successfully reported and qualified for CMS Meaningful Use Incentive Program 2012-2019
Qualifications
- More than ten years managing professional billing functions in primary and specialty practice including medical billing company, outpatient/ambulatory surgery/ED and managed care payer claim processing of Medicare and Medicaid claims.
- Expert knowledge of healthcare RCM end-to-end
- Working knowledge of payer reimbursement rules, SLAs, CMS billing policies
- Working knowledge of ICD-10, CPT-10, HCPCS coding and proper use of modifiers, prior authorization and medical necessity standards
- Demonstrated experience as a liaison between independent practice groups and the hospital
- Demonstrated ability to monitor KPIs and data metrics, identify areas for improvement to inform process improvement decisions
- Demonstrated ability to manage people, processes and technology
Timeline
Consulting ( Flex/1099)
Via Compass
03.2025 - CurrentRead More
Claims Analyst III
Elevance Health
09.2021 - 03.2025Read More
Consultant
Via Compass
03.2021 - 09.2021Read More
Practice Administrator
Turlapati Clinics
06.2012 - 03.2021Read More
St Marys College
Bachelor of Science from Education, Economics minor
Read More