20 Years of Experience as a Healthcare Professional
Raffaela Santaniello-Hamilton
Revenue Cycle Management
Saint Joseph,MI
Overview
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DEDICATED PROFICIENCY IN REVENUE CYCLE MANAGEMENT.
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CERTIFIED EPIC EHR PROF BILLING (SBO), Claims & Remittance
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Credentialed EPIC EHR Trainer: Cadence, ADT, Prelude.
Work History
Electronic Medical Record Analyst & Trainer
Pace Of Southwest Michigan
Saint Joseph, MI
09.2019 - 08.2022
- Assisted with implementation of effective EMR system that is improving efficiency and reducing costs.
- Led, designed and implemented training programs and initiatives which contributed to successful completion of CMS Meaningful Use Stage 1 objectives.
- Provided training, application support and assistance to Electronic Medical Records (EMR) end user.
- Planned, implemented, trained billing and finance department front-end and back-end revenue cycle billing workflow to ensure accuracy in information entered into EMR as well as reporting to CMS, Quality, and Compliance.
- Assisted in development of training programs and tools to promote effective training for staff and physicians.
- Successfully completed oral presentations in group environment, as well as one-on-one training sessions
- Aided with audit processes for security, end-user access, HIPAA and all regulatory compliance requirements
- Provided support during EMR downtimes, software/system updates and interfaces
- Aided with planning and achievement of goals and objectives consistent with CMS Meaningful Use standards
- Established and maintain efficient workflow practices utilizing EMR to meet physician and staff needs
- Consistently complied with applicable laws and regulations to ensure facility adheres to CMS standards
- Educated staff on state and federal statutes, rules and regulations governing CMS Meaningful Use objectives
- Interpreted and communicated new or revised policies to staff
- Strategically planned methods to achieve operational goals and targets
- Encouraged creative thinking, problem solving, and empowerment as part of EMR committee to improve employee morale and teamwork with EMR projects
- Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices to facilitate proactive work environment
- Closely collaborated with management team to make necessary system improvements to satisfy physician and staff needs for improved services
- Created and maintained computerized record management systems to record data and generate reports
- Provided appropriate access to and protect confidentiality and integrity of patient, provider, employee, and business information in compliance with organization policies and standards
- Point person for all authorization issues (no auth provided to external facility/vendor/provider, authorization incomplete or incorrect, etc.).
Medical Billing & Coding Manager
Edgewater Family Health PLC
Saint Joseph, MI
01.2018 - 08.2019
- Oversaw daily Billing Department functions, including medical coding, charge entry, claims, payment posting, and reimbursement management.
- Examined patients encounter forms to verify diagnosis codes, and reconcile codes against services rendered.
- Accurately input procedure and diagnosis codes into billing software to generate invoices.
- Used electronic charge capture practices such as billing and account receivables system and medical billing clearinghouse accounts to submit codes and invoices on time.
- Followed-up on past due invoices and delinquent accounts to reduce number of unpaid and outstanding balances.
- Documented patient data and medical records, and performed routine medical record audits to comply with insurance company requirements.
- Upheld and reinforced compliance with office policies and federal regulations such as HIPAA.
- Provided administrative support to physicians and interpreted medical reports and data to assign ICD-10 codes.
- Entered diagnosis codes and patient information into billing software.
- Updated and managed diagnosis lists, coordinate routine documentation and coding audits, and execute qualitative analysis of discharged charges.
- Maintained currency on coding, sequencing, and procedure best practices.
- Reviewed and validated accuracy of charges, including dates of service, services provided, location, patient identification, and provider signature.
- Collected, posted, and managed patient account payments, and prepared and submitted claims forms to insurance companies and other third-party payers.
- Performed insurance verification, pre-certification, and pre-authorization.
- Entered procedure and diagnosis codes, and requisite patient information into billing software to streamline invoicing and account management; added modifiers, verified diagnosis, and coded narrative diagnosis.
- Responded to staff and client inquiries regarding CPT and diagnosis codes.
- Completed and tracked all Insurance and Patient Refunds.
Epic Revenue Cycle Analyst
Lakeland HealthCare
Saint Joseph, MI
04.2008 - 03.2018
- Epic Credentialed Trainer prior to being promoted to EPIC EHR Revenue Cycle Analyst within 1-year. Trained over 70+ inpatient and outpatient healthcare roles for Cadence, ADT & Prelude Epic Applications.
- Epic Certifications: Resolute Professional Billing, Resolute Professional Claims Admin, Remittances.
- Project Manager/Built for RHC (Rural Health Clinic), FQHC (Federally Qualified Health Center) & IHS (Indian Health Service), Claims build, and Cash Drawer implementation.
- Scheduled and attended RHC, FQHC & IHS call with all Michigan hospitals to review questions, CMS guidelines, build practices and best practices.
- Actively worked on all aspects of Resolute Professional Billing, Claims & Remittance implementation through maintenance stage.
- Developed product content (build all necessary codes, databases, rules and functions.
- Ensured test scripts are created, reviewed and updated to reflect proposed workflow solutions for annual upgrade.
- Collaborated effectively with Epic personnel using Sherlock or other communication tools.
- Worked Professional Billing, Claims, Remittance and Security tickets within service level agreements Liaison between business office and Epic team.
- Sole claims and remittance analyst for all Lakeland Healthcare hospitals, providers and clinics as well as 60+ Community Connect offices.
- Continually built Claim Edits, Claim Edit Work-queue, Payers, Plans, Remittance Option Master-file, and Extensions (LPP's).
- Created and maintained Claim and Remittance Batches for Lakeland HealthCare and Community Connect.
- Built and maintained all claims printers for Lakeland HealthCare and Community Connect practices.
- Met with managers, directors and billing office staff to review what was necessary to start build & implementation of Epic.
- Security Analyst for Lakeland Healthcare new and current employees as well as all Community Connect employees.
- Built and maintained all Lakeland HealthCare and Community Connect Fee Schedules.
- Worked collaboratively with Systems Analyst to develop designs, mockups and prototypes.
- Researched to develop, configure and modify moderate to high complexity "break fix" solutions in Epic.
- Consulted with customers to understand workflows, processes, data collection, report details and other technical issues associated with application software related to system design and build decisions that support department's function and goals.
- Provided education and training for application end user community – keeping users informed of new release feature/functionality, changes/revisions that impact operation.
- Developed documentation of test plans, technical documentation, release notes, end-user guides, Tip Sheets, training programs and/or other materials as necessary.
- Extracted and defined record and file data and compared it to business operations information to better understand revenue cycles.
- Boosted job efficiency by working closely with other analysts so that tasks and processes could be streamlined and duplication was avoided.
- Maintained composure and patience in face of difficult customer situations, applying de-escalation techniques and positive customer support.
- Maintained positive working relationship with fellow staff and management.
- Answered user inquiries to resolve computer software or hardware operation problems.
- Conducted workflow analysis, space design or cost comparison analysis.
Education
Associate of Applied Science - Computer Networking
Davenport University
Holland, MI05-1998
Skills
- Vast knowledge of EPIC EHR System, CMS guidelines and regulations, quality & compliance, claims processing and revenue cycle in its entirety including Pre-registration along with RTE (Real Time Eligibility), referrals & authorizations, HB & PB billing & coding requirements (ICD-10, CPT, HCPS, Dx, and DRG), clearinghouse and front-end rejections
- Registration errors, claim edits, insurance underpayments, contractual adjustments, claim denials, follow-up, appeals, billing dispute resolution & aging accounts
- CER/CEV Epic Rule Build and Usage
- Stop Payments, Write-offs (adjustments), Flags
- EPIC Software Applications Proficiency
- Patient Medical Records Maintenance
- Treatment Documentation, Workflow Documentation (Desktop Procedures, Tips & Tricks, User Guides)
- Medical History Recording
- Quality & Compliance, CMS Guidelines & Requirements, Managed Care Regulations
- Data Extraction & Information Security
- Training & Development, Treatment Documentation, Critical Thinking, Physician Efficiency Training
- Microsoft Office, ServiceNow, Google, JIRA Ticketing System, Fresh Desk
- Critical Thinking, Data Analysis & Reporting
- Electronic health record system management
Languages
English
Italian
Certification
EPIC Resolute Professional Billing (SBO)
EPIC Resolute Professional Claims Admin (SBO) & Remittances
Nationally Certified Insurance and Coding Specialist (NCICS)
Certified Electronic Health Record Specialist (CEHRS)
CCS - Certified Coding Specialist (C21867)
CPC - Certified Professional Coder
RHIT - Registered Health Information Technician
RHIA - Registered Health Information Administrator
Languages
English
Professional
Italian
Professional
Timeline
Electronic Medical Record Analyst & Trainer
Pace Of Southwest Michigan
09.2019 - 08.2022
Medical Billing & Coding Manager
Edgewater Family Health PLC
01.2018 - 08.2019
Epic Revenue Cycle Analyst
Lakeland HealthCare
04.2008 - 03.2018
Associate of Applied Science - Computer Networking
Davenport University
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