Raffaela Santaniello-Hamilton
EMR Revenue Cycle Analyst & Trainer
Saint Joseph,MI
Summary
Dedicated Healthcare Professional & Successful Problem Solver Ready to Work for YOU!
Accomplished and dedicated EHR Revenue Cycle Analyst offering over 20+ years of experience in healthcare information technology with a focus on revenue cycle management. Unique well-rounded working experience as a Commercial, Medicare, Medicaid and Workman's Comp biller and coder, Credentialed EPIC EHR Trainer (Cadence, ADT, Prelude, PB Billing & Claims, HB Billing & Claims), and a Certified EPIC EHR Revenue Cycle Analyst (EPIC Build).
Proficient in reducing debt, collecting payments and collaborating with insurance companies to resolve concerns. Talented communicator, practiced multitasker, and effective collaborator known for streamlining processes that maximize administrative productivity. Offering exceptional talents in analyzing financial data, finding solutions to issues and developing revenue cycle reports.
Overview
20
20
years of professional experience
8
8
Certificates
2
2
Languages
2
2
years of post-secondary education
Work History
Co-Owner/Operator
A Wall Apart (Handyman Services)
Benton Harbor, MI
08.2022 - Current
- Enhanced operational efficiency and productivity by managing budgets, accounts, and costs.
- Evaluated suppliers to maintain cost controls and improve operations.
- Consulted with customers to assess needs and propose optimal solutions.
- Managed day-to-day business operations.
- Provided accurate estimates by defining scope, timelines, potential setbacks, and limitations.
- Prepared estimates used by management for purposes such as planning, organizing, and scheduling work.
- Identified areas for cost saving to help increase profitability and lower client costs.
- Tracked project costs and expenses to monitor progress and identify and mitigate deviations from original estimate.
- Gathered cost and material data for accurate and up-to-date information on material and labor costs.
- Reviewed and updated cost databases to maintain access to most current and accurate information on costs and prices.
- Utilized cost-estimating software to streamline estimating processes and produce accurate and reliable estimates.
- Prepared bids and proposals to submit to clients and secure new business.
- Monitored social media questions and comments and appropriately responded.
- Designed and implemented advertising and public relations activities.
- Updated social media platforms with latest news and corporate details.
- Developed and implemented techniques for increasing page visits and likes.
- Crafted and implemented strategies to increase search visibility and website traffic.
- Devised effective link-building campaigns to increase website authority and visibility.
- Captured new customers by optimizing business strategies and launching products to diversify offerings.
- Promoted business via social media to generate leads and maximize brand identity.
- Devised processes to boost long-term business success and increase profit levels.
- Provided elite customer service by resolving escalated problems and calmly responding to shifting priorities.
- Introduced new methods, practices, and systems to reduce turnaround time.
Electronic Medical Record Analyst & Trainer
Pace Of Southwest Michigan
Saint Joseph, MI
09.2019 - 08.2022
- Assisted with the implementation of an 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 users
- Assisted in development of training programs and tools to promote effective training for staff and physicians
- Successfully completed oral presentations in a 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 the planning and achievement of goals and objectives consistent with CMS Meaningful Use standards
- Established and maintain efficient workflow practices utilizing the 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 the 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 a 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 the 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 the 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.
- nThrive Third Party Claims Administration Manager and Trainer for all new Lakeland HealthCare and Community Connect staff.
- Actively work on all aspects of Resolute Professional Billing, Claims & Remittance implementation through the 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 WQ’s, Payers, Plans, RMO’s, and 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 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 as they relate to system design and build decisions that support the department's function and goals.
- Provided education and training for application end user community – keeping them informed of new release feature/functionality, changes/revisions that impact the operation.
- Developed documentation of test plans, technical documentation, release notes, end-user guides, Tip Sheets, training programs and/or other materials as necessary.
Education
Associate of Applied Science - Computer Networking
Davenport University
Holland, MI 1996 - 1998
Skills
Vast knowledge of the EPIC EHR System, CMS guidelines and regulations, quality & compliance, claims processing and the revenue cycle in its entirety including: Pre-registration including 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 & aging accounts
Billing Dispute Resolution
Audit Procedures
Itemized Statement Preparation
Stop Payments
Billing Data Verification
Discrepancy Resolution
EPIC Software Applications Proficiency
Patient Medical Records Maintenance
Information Analysis
Treatment Documentation
Medical History Recording
Doctor Communication
Data Extraction & Information Security
Training & Developement
Microsoft Office
ServiceNow
Critical Thinking
Certified Electronic Health Record Specialist (CEHRS)
Certification
EPIC Resolute Professional Billing (SBO)
Timeline
Co-Owner/Operator
A Wall Apart (Handyman Services)
08.2022 - Current
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
1996 - 1998