Melda Okwara
Charlotte,North Carolina
Summary
Dynamic Billing Supervisor with extensive experience at NOVANT HEALTH, recognized for optimizing productivity and enhancing patient experience. Proven track record in medical billing and claims management, successfully recovering over $75,000 in retro payments. Adept at training teams and implementing quality assurance measures to ensure accuracy and compliance in billing processes.
Overview
24
24
years of professional experience
Work History
Billing Supervisor
NOVANT HEALTH
Charlotte, North Carolina
01.2016 - Current
- Mentored employees, conducted performance evaluations, counseled and provided disciplinary actions when needed
- Prepared ad hoc analysis to determine billing performance and to direct the team focus to maintain expected claims volume and cash flow
- Created and implemented a billing & instructional manual for new employees
- Successfully recovered over $75,000 from Medicaid in retro payments
- Submitted electronic claims to Medicare and CSC (Medicaid). Posted insurance payments to patient accounts
- Charged with patient collections and re-billing various insurance companies; formulated Appeal letters
- Instrumental in setting up two new billing locations, trained new staff, writing office policies, software update, phone system, and work station installations
- Responsible for monitoring all claims submitted to Medicaid as well as private carriers and reviewed all information for accuracy to ensure immediate payment.
- Assist sister offices with daily billing questions and escalated any problem that needed immediate attention.
- Attend and facilitate meetings on the ongoing process of the insurance department.
- Trained, delegated and assist staff in data entry, editing and maintained records of all incoming and outgoing work.
- Assist in maintaining staff relations, resolved problems and ensure efficiency of operation.
- Manages outflow and issuance of $3 to $4 million in monthly invoicing for multiple contracts
Business Office Team Lead
NOVANT HEALTH
Charlotte, North Carolina
01.2013 - 01.2016
- Coordinate billing and claims processes for a healthcare leader comprised of hospitals, nursing homes, physician practices, outpatient surgery centers, rehabilitation and community health outreach programs, serving patients through North Carolina, South Carolina, Virginia, and Georgia.
- Serve as the liaison between the business department, medical offices, and third party payers to resolve billing discrepancies and ensure reimbursement accuracy.
- Manage 50 clinic accounts, create weekly reports for the business office manager, and evaluate insurance claim refusals in order to ascertain the reason for the denial.
- Honored with a prestigious internal award presented in recognition of outstanding leadership, dedication, and team support in 2014.
- Personally trained the office’s weakest employee, significantly boosting the employee’s productivity and contribution, and increasing the office’s overall culture of quality and customer service.
- Led a team of Patient Account Representatives, overseeing all aspects of the team’s performance, from scheduling hours, to addressing employee disputes, to hiring and training new employees.
- Built in-depth knowledge of insurance requirements, diagnosis codes, managed care contracts, HMOs, Medicare, and Medicaid, becoming the office’s go-to expert for all billing challenges.
Patient Account Representative III
NOVANT HEALTH MEDICAL GROUP
Charlotte, North Carolina
01.2009 - 01.2013
- Oversaw patient billing processes for a physician-led organization comprised of physician partners who are supported by highly-skilled professionals to provide assistance and support at every level.
- Examined patient charts to obtain diagnosis codes, ensuring completeness, specificity, and treatment appropriateness, and coordinated results with billing processes in order to establish proper coding, sequencing of diagnoses, and procedures.
- Submitted refund requests for claims paid in error, managed appeal processes, and presented claims.
- Minimized the number of unpaid claims by thoroughly investigating past due invoices and insurance conflicts, while strictly following all federal and state guidelines relating to patient privacy.
- Ensured timely and accurate charge submissions through the electronic capture system, including billing and account receivables via the Epic system and other clearing house functions via Emdeon.
Account Specialist
SOUTHEAST RENAL ASSOCIATES
Monroe, North Carolina
01.2007 - 01.2009
- Managed full-cycle medical billing processes for the billing department of a leading medical group specializing in renal care and dialysis.
- Performed insurance verifications, confirmed pre-certifications and pre-authorizations for each patient prior to the start of treatment, and conducted quality control assessments designed to verify that claims and payments were processed in the most accurate and efficient manner.
- Ensured the existence of all necessary documentation and paperwork necessary for treatment, including referrals, treatment plans, and correspondence, significantly reducing the number of insurance denials.
- Developed in-depth knowledge of Medicare billing processes facilitating the office’s ability to comply with governmental regulations and guidelines.
Lead Claim Specialist
PMAB, LLC
Charlotte, North Carolina
01.2005 - 01.2006
- Administered payment and billing processes for a company specializing in recovering unpaid bills for medical offices and hospitals.
- Applied effective collection policies and procedures in order to maximize the amount of bad debt collected, researched payment and recoupment discrepancies, and built a strong working knowledge of IDX, Medix / Mysis, and Nextgen operating systems.
- Analyzed workers compensation claims and worked with adjusters to ensure each claimant received the most appropriate medical care while keeping processing times at a minimum.
- Accurately processed and billed patient and third party providers, consistently completing difficult and challenging projects within a short time frame.
Manager – Front Desk
FIRST CARE MEDICAL CLINIC
Monroe, North Carolina
01.2002 - 01.2005
- Produced excellent customer service scores and well trained staff by focusing on management from the lobby
- Collaborated with staff in development of various initiatives designed to assist in meeting customer service goals
- Consistently achieved budgeted financial goals while maintaining consistent service standards
- Prepared the weekly schedule, handled all customer concerns in a pleasant and professional manner.
- Supervised a staff of 15 front office team members for 6 locations.
- Ensured all employees were properly trained, knowledgeable and provided excellent guest service.
- Responsible for staff understanding and compliance with medical protocols, risk management and safety procedures, regulations regarding patient rights, HIPAA requirements, infection control protocols and applicable OSHA standards
- Assigned duties and shifts to workers
- Coached and counselled employees to ensure adherences to practice policies, standards and procedures.
- Recruited, managed, trained and developed the front office/desk team.
- Analyzed, investigated and resolved patient complaints
- Coordinates monthly staff meetings that address any outstanding issues and record the minutes as well as record the agenda.
- Reconcile the daily cash log and bank deposit from copays and estimate self-pay out of pocket audit report
- Obtained pre-certifications, prior authorizations and referrals for labs, diagnostic tests, office visits, radiological tests and durable medical equipment.
- Posted all co-pays, balances and deductibles as well as handled petty cash budget and deposited daily bank slips.
- Maintained calendars, coordinated breakfast and lunch-ins with sales reps as well as handled a high volume 10-line phone system while checking in/out patients
Education
Bachelor of Science - Psychology and Minor In Interdisciplinary Studies
Belmont Abbey College
Belmont, North CarolinaMedical Coding Specialist Certificate -
University of North Carolina
Charlotte, North CarolinaAssociate of Arts - Psychology
Central Piedmont Community College
Charlotte, North CarolinaSkills
- Patient Experience Management
- Quality Assurance
- Productivity Optimization
- Office Management
- Administrative / Financial Support
- Insurance Claims
- Customer Relationship Management
- Scheduling
- Record Management
- Human Resources Management
- Clinical Policy Development
- Medical Billing
- Data Entry & Analysis
- Account Management
- CPT / HCPCS / ICD-10 Coding
- Managed Care Contracts
- HMOs, Medicare, & Medicaid
- Training
- Accounts Recoupment & Collections
- Front Desk Management
Computer Skills
- Microsoft Windows
- Microsoft Office Suite
- IDX
- Epic
- Athena One
- Experian
- Cerner
Affiliations
North Carolina Psychology Association
Timeline
Billing Supervisor
NOVANT HEALTH
01.2016 - Current
Business Office Team Lead
NOVANT HEALTH
01.2013 - 01.2016
Patient Account Representative III
NOVANT HEALTH MEDICAL GROUP
01.2009 - 01.2013
Account Specialist
SOUTHEAST RENAL ASSOCIATES
01.2007 - 01.2009
Lead Claim Specialist
PMAB, LLC
01.2005 - 01.2006
Manager – Front Desk
FIRST CARE MEDICAL CLINIC
01.2002 - 01.2005
Bachelor of Science - Psychology and Minor In Interdisciplinary Studies
Belmont Abbey College
Medical Coding Specialist Certificate -
University of North Carolina
Associate of Arts - Psychology
Central Piedmont Community College