Competent Reimbursement Accounts Manager bringing several years of experience managing a team of six, handling, claims, accounts receivable, denials, and leading in system implementations. Exemplary skill in resolving billing disputes, providing excellent customer service, payments, management reports and administrative duties. Recognized for effective leadership with consistent achievement of objectives. A highly analytical individual known for effectively working with all personalities. Ready for a new position that involves successfully handling various tasks in fast-paced settings.
Hi, I’m
Peggy Capozzoli
Oviedo,FL
Summary
Overview
14
years of professional experience
Work History
Family Medical Center - Career PromotionOrlando, FL
Patient Account Manager /Patient Account Representative
09.2014 - 07.2023
Job overview
- Liaised between physicians, staff members, patients, and insurance carrier to verify that each party has accurate and pertinent information for best practice results.
- Provide regular feedback to 9 providers and 51 back-office staff regarding prior authorization payer requirement, LCD medical necessity, ICD10 coding, required documentation, cpt code supporting documentation for for improved clean claims.
- Review, collect pertinent documentation, and write strong effective appeals on denied claims for reprocessing or redetermination.
- Confirm COB responsibility - primary, secondary payer, workman's comp, liability or automobile claim liability through CMS or commercial website and confirm patient actions.
- Answered clients' questions regarding EOB determination, insurance adjudication and patient liability in easy-to-understand terms.
- Researched billing errors and discrepancies to initiate corrective action for Quality check and self-audits.
- Post Medicare and commercial insurance payment averaging $30,000 to $40 per EFT, physical checks or Credit cards payments according to electronic EOB provided or various payer portal website such as Vpay, Zelis, Echo as well as patient payments.
- Ensure Company goals and Billing benchmarks are met with a 4 day claim turnaround time for an average of 280 encounters per day. Reviewed with administrator to collaborate improvements as needed.
- Implement guidelines and assist all departments - lab, xray, EKG, ultrasound, sleep study, in billing, payment and service restrictions per specific payer contract.
- Developed strategic plans for day-to-day financial operations.
- Prepared cash flow reports, cost analysis and monthly, quarterly and annual reports in excel and other forms of reports such as each type of service revenue, provider productivity, and denial ratio.
- Collaborate with staff to ensure correct collection of payments and assist in balance disputes.
- Reconcile petty cash daily for three locations.
- Provide Administrative assistance to Administrator and providers regarding any professional liability documentation and provider record keeping for payers such as CAQH and individual payer websites.
- Review insurance payments to ensure correct contracted payments and repricing payments according to each insurance contract.
- Attend weekly manager meetings and monthly staff meetings.
Family Medical CenterOrlando, FL
Billing Manager
06.2009 - 08.2014
Job overview
- Trained and mentored billing staff of 8 on procedures, compliance requirements, and collections techniques.
- Managed monthly billing process to meet company revenue goals.
- Reviewed billing problems, researched issues, and resolved concerns.
- Worked with customers to develop payment plans and bring accounts current.
- Established and checked coding procedures, monitored reports and updated internal files.
- Developed and implemented office policies and procedures while adhering to HIPAA and OSHA regulations.
- Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
- Liaised with customers, addressed inquiries, handled meeting requests, and answer billing questions to provide outstanding customer care.
Education
NPCC National Provider Compliance CorporationOrlando, FL
from NACRA, Billing, Coding & Compliance
11.2019
University Overview
NPCC - National Provider Compliance CorporationOrlando, FL
from Local Medicare Changes Seminar
11.2019
University Overview
Skills
- Self-Motivated
- Active Listening
- Excellent Communication
- Analytical and Critical Thinking
- Solution development
- Leadership
- Teamwork and Collaboration
- Benchmark and Goal measure
- Payment Processing - Posting
- Appeals and Denial resolution
- Claim Resolutions
- Report Generation
- ICD10 and CPT code proficiency
- Strong Administrative background
Timeline
Patient Account Manager /Patient Account Representative
Family Medical Center - Career Promotion
09.2014 - 07.2023
Billing Manager
Family Medical Center
06.2009 - 08.2014
NPCC National Provider Compliance Corporation
from NACRA, Billing, Coding & Compliance
NPCC - National Provider Compliance Corporation
from Local Medicare Changes Seminar
Additional Information
Additional Information
Microsoft - proficient - Word, outlook, Excel, One Note.
EHR system- Eclinical, Greenway, Phreesia
Financial systems - Clearinghouse (Waystar/Navicure), Credit Card payment websites (Open Edge/Global merchant), Collection websites (TSI/TSICO)
Insurance Payment Portals - ECHO remit payment, VPAY, change HealthCare websites.
Insurance - All commercial website log ins, Medicare and Medicare Spot log in
Competent computer trouble shooting for remote work situations
Ethernet and Wi-Fi connection
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