EPIC Resolute Hospital Billing
Melisande Mathurin
Chargemaster Coordinator
Bayonne,NJ
Summary
Diligent, detail-oriented and experienced Chargemaster Coordinator offering solid understanding of legal and regulatory issues surrounding charge capture and coding activities. Background reviewing large data sets with speed and accuracy to verify integrity of information. Talent spotting anomalies in data, information and documentation. Adept at resolving outstanding claims, denials or issues to obtain optimal financial results. Detail-oriented with experience completing back-end billing procedures ensuring all information is entered accurately. Ready to deliver expertise in Revenue Cycle and 17 years of experience.
Overview
1
1
Certification
4
4
years of post-secondary education
18
18
years of professional experience
Work History
Chargemaster Coordinator - Revenue Management
NYU Langone Health - CBO
New York, NY
2019 - 2021
- Maintain Charge Description Master (CDM) and pertinent regulations and policies, ensuring all data elements are accurate and comply with payor and regulatory requirements (i.e. NCCI, MUE, CCI, OCE, etc.)
- Handle appropriate CDM additions, modifications, deletions in the hospital billing system.
- Create and maintain charge capture and coding-related billing edits in the hospital billing system for outpatient and inpatient claims.
- Analyze and resolve claims being held by billing edits.
- Work with Patient Financial Services (PFS) to submit adjusted claims and appeal denied or disputed claims that arise from billing deficiencies.
- Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
- Interpreted management directives to define and document administrative staff processes.
- Led comprehensive regulatory training for 10 staff members.
- Established positive working relationships with colleagues, manager and customers through regular communication and effective anticipation of needs.
- Kept projects on schedule by managing deadlines and adjusting workflows as needed.
- Developed revisions to EPIC Resolute Hospital Billing systems and procedures by evaluating operational practices and identifying improvement opportunities.
- Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork.
Senior Analyst - Revenue Management
NYU Langone Health - CBO
New York, NY
2018 - 2019
- Maintain Charge Description Master (CDM) and pertinent regulations and policies, ensuring all data elements are accurate and comply with payor and regulatory requirements (i.e. NCCI, MUE, CCI, OCE, etc.)
- Handle appropriate CDM additions, modifications, deletions in the hospital billing system.
- Create and maintain charge capture and coding-related billing edits in the hospital billing system for outpatient and inpatient claims.
- Analyze and resolve claims being held by billing edits.
- Work with Revenue Cycle Operations to submit adjusted claims and appeal denied or disputed claims that arise from billing deficiencies. Identified and resolved problems through root cause analysis and research.
- Mapped processes to holistically examine business flow and identify improvement opportunities.
- Investigated and addressed EPIC Resolute Hospital Billing system issues to enhance usability and improve functionality.
- Liaised between Revenue Management department and Revenue Cycle department.
- Gathered, organized and input information into digital database.
- Helped improve Revenue Management operations by showing clear connection between current policies and business results.
- Helped solve diverse program problems with in-depth analysis.
- Documented procedures and business processes and shared information with appropriate stakeholders.
- Maximized team knowledge and productivity by effectively training, monitoring and directing employees in application of best practices and regulatory protocols.
- Identified and resolved problems through root cause analysis and research.
Reimbursement Analyst - Finance
Mount Sinai Health System
New York, NY
2012 - 2018
- Maintain Charge Description Master (CDM) and pertinent regulations and policies, ensuring all data elements are accurate and comply with payor and regulatory requirements (i.e. NCCI, MUE, CCI, OCE, etc.)
- Handle appropriate CDM additions, modifications, deletions in the hospital billing system.
- Create and maintain charge capture and coding-related billing edits in the hospital billing system for outpatient and inpatient claims.
- Analyze and resolve claims being held by billing edits.
- Work with Patient Financial Services (PFS) to submit adjusted claims and appeal denied or disputed claims that arise from billing deficiencies.
- Review implant and high-cost drug accounts to ensure charges are accurate and pricing is in accordance with managed care contract obligations.
- Provide education, documentation guides and training to clinical departments, Patient Financial Services, Medical Records and other revenue producing departments as needed to promote appropriate charge capture processes and improve understanding of the documentation requirements for specific charge activity.
- Identify charging, coding or clinical documentation issues, patterns of rejections, partial denials or denials from third party payers and work with ancillary departments to resolve issues, decrease denials, and notify appropriate leadership.
- Respond to RAC and other third-party payer audit requests in collaboration with Health Information Management and Patient Financial Services.
- Ensure maximum team performance through training, mentoring and coaching of new hires.
- Participate in the development and optimization of the revenue systems and software supporting enhancements throughout the health system.
- Attend seminars, workshops and webinars to stay informed and updated on changes in insurance, coding and billing guidelines.
- Navigate multiple patient accounting and financial systems (i.e.
- Epic, Eagle, Keane, McKesson, QSight, IDX-Rad, Horizon Surgical Manager, etc.) to evaluate data required to successfully complete revenue analysis.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
- Acted as Chargemaster subject matter expert, answering internal and external questions and inquiries.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
Outpatient Billing Manager - Patient Financial
Brookdale Hospital
Brooklyn, NY
2010 - 2012
- Managed, disciplined, trained, evaluated performance and ensure productivity benchmarks are maintained for a department of 30 employees including two supervisors, two file clerks and 26 accounts receivable clerks.
- Attended weekly Revenue Cycle meetings with the Vice President of Clinical Operations and department heads to discuss financial reports, incoming revenue, and plan best use of accounting resources to improve the day to day management of the business, resolve outstanding operations issues, introduce best practice and innovative thinking and build cooperation with the front-line departments.
- Analyzed and improved the front-end billing operations through monitoring of performance criteria including billing operations key indicators like denial trending and co-pay collection.
- Worked closely with Charge Master and HIM departments to identify, review and monitor coding denials.
- Determine operational or coding problems for the development and revision of super bills.
- Worked closely with IT and System Analyst support to ensure system updates and rules are monitored and correct.
- Supported new program development by advising on fee arrangements for special services and assist in the creation and development of third-party contracts.
- Resolved complex billing situations, pre-billed edits, NEIC rejections and collaborate with departments to implement corrective action.
- Met with staff to communicate changes to policies, procedures and processes while effectively managing and developing the staff to ensure that they are motivated and empowered to maximize performance and maintain high morale.
- Reviewed and prepared credit balance reports for submission to Medicare on a quarterly basis.
- Tracked and maintained patient complaints and resolution records.
- Attended seminars, workshops and webinars to stay informed and updated on changes in insurance, coding and billing guidelines.
- Reviewed billing problems, researched issues and resolved concerns.
- Created new standard operating procedures improving billing accuracy and cash flow.
- Trained and mentored staff on procedures, compliance requirements and collections techniques.
- Conducted performance reviews and implemented improvement plans.
- Validated existing accounting management and reporting systems to assess quality and conformance, identify problems and implement corrective actions.
- Directed operations in busy 30-person billing group managing $15 million in monthly funds.
- Oversaw high-volume accounting operations with 30-person team focused on efficient budget administration, AP/AR and other financial management needs.
- Administered financial aspects of contracts, including establishing and checking coding procedures, monitoring reports and updating internal files.
- Worked closely with Outpatient Billing Supervisor to maintain optimum levels of communication to effectively and efficiently complete projects.
Outpatient Billing Supervisor - Patient Financial
Brookdale Hospital
Brooklyn, NY
2007 - 2010
- Distributed and monitored daily workload for 25 employees.
- Solved operational problems with front-line departments and insurance companies.
- Developed and implemented procedures related to Finance department operational issues in collaboration with coders, medical records and administrative staff.
- Created effective departmental processes and train staff to ensure that they are implemented and update staff on new procedures with HIPAA, JCAHO and insurance companies.
- Maintained and updated Patient Financial Policy and Procedure manuals.
- Identified credentialing issues and resolve with the Provider Enrollment department or the physicians.
- Assisted in patient care activities by screening phone calls, handling patient's questions, resolving problems promptly or communicate the issue to the appropriate third-party agency for resolution.
- Assisted Outpatient Billing manager and Director of Patient Financial Services with interviews for potential hires.
- Submitted monthly invoice statements to special program payers for payment.
- Was responsible for the preparation and submission of Out of State Medicaid Provider Enrollment applications.
- Maintained staff records, work schedules and time accruals.
- Developed and implemented improvements to billing system to maximize efficiency, reduce delinquency and increase accuracy.
- Coordinated with other internal departments and customers to keep operations running smoothly and solve both routine and complex problems.
- Prepared weekly financial reports to assist business leaders with key decision making and strategic operational planning.
- Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of personnel and activities.
- Enhanced collaboration between team members by preparing meeting materials and taking clear notes to distribute to stakeholders.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Supervised and guided new employees on billing and payer-related issues and responded quickly to questions, which improved understanding of job responsibilities.
- Interacted with customers professionally by phone, email or in-person to provide information and directed to desired staff members.
- Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
Radiation Oncology Coordinator - Patient Financial
Brookdale Hospital
Brooklyn, NY
2005 - 2007
- Resolved day to day issues with Radiation Oncology department; including registration, payer denials, patient discrepancies and open receivables.
- Developed and executed registration and insurance verification procedures with staff.
- Prepared and submitted documents for billing and collection; verify accuracy of data submitted to cash posting, billers and follow-up staff.
- Processed and filed third party correspondence.
- Posted denials and perform account adjustments after payment is received.
- Reviewed claims and eligibility through various payer websites.
- Monitor payment trends received from insurance companies and worked with managed care department and insurance on correct reimbursement.
- Prepared monthly A/R reports for the Assistant Director and Director of Patient Financial Services.
- Handled day-to-day financial operations of Radiation Oncology, ensuring high levels of productivity and progression.
- Exceeded goals through effective task prioritization and great work ethic.
- Resolved problems, improved operations and provided exceptional service.
- Worked closely with Radiation Oncology Director to maintain optimum levels of communication to effectively and efficiently complete projects.
Accounts Receivable Clerk - Patient Financial
Brookdale Hospital
Brooklyn, NY
2003 - 2005
- Process denials and submit adjustments, voids and rebills where applicable to Medicaid.
- Performed electronic billing of UB-92 and HCFA-1500 forms to Medicare, Medicaid and Commercial payers.
- Reviewed weekly Medicaid Remittance Report.
- Processed EOB correspondence from third party insurance companies.
- Obtained authorization and utilization for services.
- Reviewed weekly claims correction and edit report through the Fiscal Intermediary.
- Initiated demographic updates of patient information to Medicaid and insurance companies to alleviate billing problems.
- Investigated and reviewed denied claims while troubleshooting and informing management of the trends.
- Handled and resolved patient phone calls regarding bills.
- Opened, sorted and distributed mail within hospital and through the financial departments.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Prepared and mailed invoices to customers, processed payments and documented account updates.
- Stayed on top of applicable federal and state requirements to minimize legal and financial risks.
Education
Bachelor of Science - Business Management
University Of Phoenix
2008 - 2010
Associates of Arts - Business
Western International University
2005 - 2007
Skills
Accounts reconciliation
Software
Craneware
NThrive
Optum EncoderPro
Premier
Nuvia
GHX
EPremis
EMedny
Omnipro
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Certification
CPC - Certified Professional Coder
Timeline
CPC - Certified Professional Coder
07-2021
Chargemaster Coordinator - Revenue Management
NYU Langone Health - CBO
2019 - 2021
Senior Analyst - Revenue Management
NYU Langone Health - CBO
2018 - 2019
Reimbursement Analyst - Finance
Mount Sinai Health System
2012 - 2018
Outpatient Billing Manager - Patient Financial
Brookdale Hospital
2010 - 2012
Bachelor of Science - Business Management
University Of Phoenix
2008 - 2010
Outpatient Billing Supervisor - Patient Financial
Brookdale Hospital
2007 - 2010
Radiation Oncology Coordinator - Patient Financial
Brookdale Hospital
2005 - 2007
Associates of Arts - Business
Western International University
2005 - 2007
Accounts Receivable Clerk - Patient Financial
Brookdale Hospital
2003 - 2005
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