SAM NINALGA
Layton,UT
Summary
Versatile professional with over 30 years in customer service, public relations, and healthcare finance. Expertise in billing, account management, and coding (ICD-9/10, CPT, HCPCS). Proficient in various software applications including IDX, Excel, and MedHost. Collaborative team member with strong interpersonal skills and a Master of Business Administration degree.
Overview
19
19
years of professional experience
Work History
Director of Business Office Operations
Highland Ridge Hospital/Acadia Healthcare
11.2022 - 05.2026
- Lead and provide operational directives for all Business office activities related to the claims management and collections of the facility receivables and ensure timely, efficient cash collections to support the overall financial goals of the facility.
- Monitor and report on key metrics such as cash collections, days outstanding, unbilled, denials, daily census, etc. in conjunction with the CFO.
- Facilitated communication with third party insurance carriers to resolve cash flow issues and enhance patient/member satisfaction.
- Provide staff management to include hiring, development, training, performance management and communication to ensure effective and efficient department operations.
- Monitored outside collection vendors for facility receivables, balancing agency reports with system reports and approving agency invoices.
- Lead and provide operational directives for all Business office activities related to the claims management and collections of the facility receivables and ensure timely, efficient cash collections to support the overall financial goals of the facility.
- Work closely with Utilization Review and Admissions staff to ensure proper authorization of patient insurance coverage and correction of denials generated by those departments.
- Provide staff management to include hiring, development, training, performance management and communication to ensure effective and efficient department operation.
- Star Waddell, CFO/Debbie Kraemer Verification: 615-242-8246 Co. Code: ACA333
Business Office Coordinator
Highland Ridge Hospital/Acadia Healthcare
09.2014 - 10.2022
- Medicare Part A and Part B, Medicaid, commercial insurance billing and collections.
- Insurance verifications and upfront cash collections.
- Evaluated and analyzed financial transactions to identify discrepancies and variance issues.
- Performed insurance verifications and managed upfront cash collections to ensure accurate billing.
- Analyzed AR reports for collections, denials, and unbilled claims to identify trends and improve collections DSO and cash flow.
- Conducted account research and reconciled discrepancies to ensure accurate financial records. Looking for unusual conditions that need further investigation and offering solutions to current systemic protocol that will enhance operations.
- Psychiatric account manager that performs in-depth analysis on patient accounts.
- Kelley Draper, Director Verification: 615-242-8246 Co. Code: ACA333
Billing Specialist/Insurance Collections
Orbit Medical, Inc.
12.2006 - 02.2014
- Respiratory/DME insurance billing specialist.
- Processed insurance payments to patient accounts, ensuring accurate allocation to reduce discrepancies.
- Aggressively followed up with insurance companies (government and private payers) regarding denials and payments.
- Rebilled insurance companies and third parties to expedite payment recovery for patients.
- Researched, reconciled, created and mailed insurance claims.
- Processed insurance payments to patient accounts
- Followed up with insurance companies (government and private payers) on denials and payments to enhance collection rates.
- Kelley Draper, Manager 385-695-6536
Education
MBA - Business Administration
University of Phoenix
Salt Lake CitySkills
- Financial management
- Operations management
- Financial reporting
- Regulatory compliance
- Analytical thinking
- Decision-making
- Training development
- Issues resolution
- People management
- Healthcare regulations
- Communication skills
- Issue resolution
Timeline
Director of Business Office Operations
Highland Ridge Hospital/Acadia Healthcare
11.2022 - 05.2026
Business Office Coordinator
Highland Ridge Hospital/Acadia Healthcare
09.2014 - 10.2022
Billing Specialist/Insurance Collections
Orbit Medical, Inc.
12.2006 - 02.2014
MBA - Business Administration
University of Phoenix