Summary
Overview
Work History
Education
Skills
QUALIFICATIONS
Timeline
Generic

Shirley Lindsey

Temple Hills,MD

Summary

I am a results-driven professional with multiple years of solid experience and a proven record of achievement in managerial and non-managerial positions. As an accomplished leader, I specialize in account receivables, supervision/management, fostering internal and external collaboration with an agency’s mission, vision, and operational objectives.

Overview

14
14
years of professional experience

Work History

Patient Financial Service Supervisor

United Medical Center
07.2020 - 01.2021
  • Supervise 5 employees
  • QA a few account weekly to ensure staff stays compliant and for any billing collection challenges that may need to be addressed for resolution
  • Assist Patient Account Representative with difficult patient, insurance calls and account for resolution
  • Assist insurance verification team with finding policy information when to provide by patient upon admission
  • Work with Department of Healthcare Finance to get DC Medicaid recipients valid policy/date of birth to screen the Medicaid portal to eliminate necessary denials
  • Work closely as PFS department with government Medicaid MCO’s, Medicare Advantage Plans, Commercial Accounts
  • Collect and follow-up on three MCO ATB reports
  • Alpha Split A through DI
  • Credit Balances
  • Secondary balances
  • Ensure all Medicare Advantage informational claims are submitted daily to stay in compliance with CMS regulation
  • Review and resolve high/low dollar accounts from oldest to current starting day 365
  • Identify & submit all Professional fee accounts to claims representative for follow-up/collections
  • Appeal denied psych claims due to overlapping patient hospital claims when diagnosis are not related
  • Contract all 365 day old accounts the FA/R due to aging and non-payment from various insurances
  • Utilize online claim status website for resolution of account balances
  • Call insurance company representatives for more detailed information provided by online websites
  • Claims
  • Rebill claims for online
  • Submit 37 adjustment claims with generated claim numbers to avoid duplication denials/rejections
  • Merge attached charge accounts that are not DRG based for additional payment(s) otherwise will attach charges for adjustments
  • Appeal disputed rejected or denied claims not in agreeance with MCO with medicaid documentation
  • Submit account write off due to various reasons to Management for review
  • Work credit balance report identifying over-ruled credit(s)

Patient Access Specialist United Medical Nursing Center

United Medical Nursing Center
12.2018 - 01.2021
  • Check Daily Census, 24 hour report & transfer report new admissions and discharges from the nursing home
  • Work closely with Admission Coordinator to ensure daily census information is correct
  • Attend daily Morning meeting for status of any resident/status issues for the day
  • Apply for DCSNF Medicaid for all future residents
  • Convert all Community DC Medicaid insurance over to long term care Medicaid
  • Submit SNF Medicaid applications with start for care, level of care, resident income, bank statement, leases, marriage license for community spouse allowance
  • Explain the financial obligation that future residents has to the facility per ESA, SSA, OPM, Veterans Administration once converted that the resident is only allowed $70 per month with the exception of a veteran who gets the allotted $100 each month
  • Non-compliant family members/resident apply for prepay for UMN Go obtain water letter to ensure resident gets payment that Medicaid states goes toward resident care cost
  • Inform all government agencies of future resident admission to avoid resident having overpayments on SSA/OPM records once can be updated to current address
  • Upload application DC quick base for case workers to process for approvals
  • Submit yearly Medicaid re-certification to ensure resident have an on plan coverage
  • Discharge resident back to community and submit documentation to ESA, SSA, OPM for record updates
  • Send monthly statement to residents guardian, POA, rep payee’s
  • Retrieve resident data and assist with getting their allotted income to franchise officer’s office
  • Submit all documents to state surveyors as needed
  • Assist Business Office Manager with correcting SNF claims in Medicare DDE/FISS
  • Work with UMN coordinator to correct the RUG/PDPB score pertaining to Medicare billing
  • Correct SNF Medicare claims in DDE, submit online adjustment in DDE as needed due to changes
  • Assist with BOM with Medicare audits as needed

Business Office Manager-Consultant

The Chappell Group
07.2017 - 01.2019
  • Project with Alice Peck Day CAH 118 Swing Bed Floor
  • Work closely with the APD New Hampshire staff and Supervisor
  • Supervise 5 staff including staff members in New Hampshire
  • Create and generate claims from billing from two systems Meditech (hospital & Greenway physicians)
  • Hospital/Physician claims with modifiers/rejections from payers, corrected field in Change Healthcare
  • Transfer complete claims with coding errors to Medicare Review for diagnosis, MUE reviews, modifiers
  • Correct claims on Medical Review given to vendors and submit to payers
  • Key Medicare claims directly into the DDE for faster processing and payments
  • Correct all Medicare claims that hit the RTP file
  • Submit numerous online adjustment claims as needed
  • Send Medicare Redetermination Request Forms 1st, 2nd, 3rd Level of Appeal denied Medicare claim with notes
  • Send problem spreadsheets to supervisor to resolve the Medicare claims issues
  • Call Medicare as needed basis for difficult claims issues
  • Managed daily office operations, ensuring adherence to company policies and pr
  • Managed daily office operations, ensuring adherence to company policies and procedures.

Business Office Manager (consultant)

Ircle-2 Bed SNF
10.2015 - 01.2016
  • Create and monthly annual Medicare A & B claims on charges, diagnosis, revenue codes and MDS RUG scores are gathered and keyed directly into Medicare DDE for quicker payment
  • Create and annual DC Medicaid claims and keyed directly into either the web portal or the billing software Winsap
  • Submit DC Medicaid claims with room & board amounts based on the case mix rate and not facility rate
  • Post therapy and pharmacy charges to each resident account
  • Generate all SNF claims on PC Pasco for 02/01/2016 and clean up the edits before keying into DDE and Winsap
  • Input each resident demographic diagnosis, rug scores in new implemented Robin Click Care
  • Add each POA, guardian & representatives to each resident accounts
  • Add each physician NPI numbers into the roster
  • Submit the Medicare required No-Pay claims for discharged residents, exhausted benefits for CM to score - calculate the resident Medicare benefits from the 60-day spell of illness
  • Submit numerous online Medicare adjustment requests

Business Office Manager (consultant)

The Chappell Group
09.2013 - 01.2016
  • Main Care Medicaid Bill Submission/Denials/Follow-up 60,000 closed/open claims project
  • Supervise 35 employees and trained them on the billing/account receivables process
  • Working from created spreadsheets year 2010-2013 accounts given to my team highest staff to work until resolved
  • Review the Medicaid account on Siemens Solo before working on Medicaid system health pass
  • Bill claims for the first time that were not submitted for payment
  • Reverse and resubmit claims to ME Medicaid for payment as needed
  • Denied claims - Re-keyed as new claims to stop ME Medicaid denying as a duplicate per their instructions
  • Follow-up weekly/resubmit claims with a vendor for some other reasons to get paid or account adjustment
  • Establish good working relationship with ME Medicaid staff for claims help and resolutions
  • Contact ME Medicaid Representatives for reference billing question and unresolved internal issues that affect payment from ME main staff for issue resolution
  • Forward all spend down/credentialing/bundled/unbundled issues to the Maine staff for follow-up and resolution
  • Utilize the Maine staff for various issues
  • Contact all Maine staff for system failures issues
  • 08/01/2014 Main Care Medicaid (8,000), Mercy Hospital (12,000) Credit Balance Resolution Project
  • Supervised 5 employees
  • Working from created spreadsheets split by employee name of 90 credit balance each for resolution
  • Review account annually as data to conclude what is needed to get account balance to zero
  • Reverse and re-bill denied claims whatever overpaid out to the MCR/Commercial EOB’s cross over being invalidated
  • Retrace ME Medicaid duplicate paid claims and claims were primary & secondary insurances paid due to the EOB’s cross given ME Medicaid reimbursement the facilities
  • Medicaid claims paid in code CO-143CO-192CO-9 and Co-45 not able to reverse claims in Health pass would issue a refund on Main Care Medicaid mail to Maine staff

Business Office Director

Dean-wood Rehabilitation & Wellness Center
10.2011 - 01.2013
  • Supervise and back-up the AP Coordinator with resident and allot the money disbursement as needed
  • Input resident money into RFM to replenish resident funds, cut check and cash
  • Liaison between New Jersey corporate office and Deanwood RCW, SSA, Department of Human Services offices
  • Work with corporate to resolve and submit all request information to proper departments and agencies
  • Apply for DC Medicaid for long and short term residents coming into admission facility
  • Convert all Community DC Medicaid to Skilled Nursing Medicaid upon admission
  • Meet with residents & family members to obtain information for the application process
  • Explain DC Medicaid policy for SNF residents versus community residents to resident, family guardian’s, POA’s
  • Set up direct deposit with SSA/OPM/Railroad Retirement for long term care resident checks to be deposited directly in RFM to make pay ability to facility easier and hassle free
  • Set up payment plans with discharged residents to meet facility financial obligations explanation
  • Attendance conference meeting per Social Worker request with resident for financial obligations explanation understanding facility fit transitioning to long term care, co-insurance due on 21st day after Medicare pays payment due to facility fit straight DC Medicaid
  • Assist social worker with SSA application apply for prepay, cell phone application obtain resident income, per the request & attend weekly PPS meeting for Medicare resident pending status if exhausted days
  • Set up phone appointments in office with Social Security Administration for residents
  • Work with admissions department and contact Delmarva to obtain reviews on an as needed basis
  • Meet with Department of Human Services on weekly basis for status on Medicaid pending cases
  • Correct Medicare claims/adjustments to DDE system
  • Complete weekly Ambassador check, funds monthly, ABA guidance on inputting in Mediquis
  • Administration duty of entire building on assigned weekends
  • Appeal Medicare claims with all requested documentation per the ADR from Medicare Medical Review Department
  • Assist corporate compliance with Medicare/Medicaid audit requests
  • Trained admissions department co-workers on Medicare HICAA
  • Worked with the admissions to ensure patient demographics entered in the correct financial class
  • Disbursed allotted money to resident with receipts and document all transactions
  • Created Medicare billing/follow-up manuals for Patient Financial Services
  • Registered and set up Visio for shared billing system for SHW-Hadley staff to bill Medicare claims/DDE follow-up
  • Set up online claims billing with third party insurance companies and follow-up status websites, obtain authorizations and eligibility searches

Patient Account Coordinator

The Specialty Hospital of Washington
09.2006 - 05.2011
  • Create, print and bill Medicare long term acute care claims daily for SHW UMCSHW-Hadley
  • Create review print and clean up the Medicare A & B SNF claims billed on a monthly basis
  • Check CPS for finalization of diagnosis, surgery codes in Medicare codes for submitting claims
  • Billed TAC Medicaid claims and posted the TAC Medicaid and SNF remittance as needed
  • Residual billing for all third party and secondary claims to DC Medicaid with Medicare EOMB’s attached
  • Follow-up on all Medicare TAC SNF, Secondary claims
  • Worked the Medicare & Medicaid denials and resubmitted claims
  • Submitted numerous online adjustments DDE to Medicare
  • Submitted Medicare MSP claims through PCACE
  • Speak with CMS daily representatives that help resolve very difficult account and very old outstanding aging accounts
  • Appeal Medicare claims with all requested documentation per the ADR from Medicare Medical Review Department
  • Assist corporate compliance with Medicare/Medicaid audit requests
  • Trained admissions department co-workers on Medicare HICAA
  • Worked with the admissions to ensure patient demographics entered in the correct financial class
  • Disbursed allotted money to resident with receipts and document all transactions
  • Created Medicare billing/follow-up manuals for Patient Financial Services
  • Registered and set up Visio for shared billing system for SHW-Hadley staff to bill Medicare claims/DDE follow-up
  • Set up online claims billing with third party insurance companies and follow-up status websites, obtain authorizations and eligibility searches
  • Speak with family member on a daily basis

Education

High School Diploma -

Radford High
Radford, VA
06-1981

Skills

  • Multi-tasked,Team Player, Detailed Oriented, Independent Worker, Accounts Payable, Multi-task, Customer Service, Quality Assurance, Cash Posting, Data/Charge Entry, Conflict Resolution, Analyzing Reports, Writing & Oral Communication, Creation of Manuals, Credentialing, Microsoft Office, Internet, Typing (45 wpm), Filing/Retrieving, Xerox, Fax Machine, 10 Key Calculator, Spreadsheets, CPSI, Meditech, SMS, Siemens Gold, Claims Administrator, PCACE, Vision share, Premis, Point Click Care ,Greenway, HealthPas Portal, Track,VisionShare, Zirmed, Myabilitynetwork,Greenway,NGS Connex, Change Healthcare, Knowledge of EPIC and Athena, Knowledge of Medical Terminology, ICD-10 & HCPC codes, NDC

QUALIFICATIONS

  • Demonstrated ability to lead and manage others coupled with solid experience and training in Account Receivables, Billing, Claim Denial & Resolution, Cash posting and Collection, Medicare DDE/HIQA/Appeals, Medicare 838 Quarterly Credit Balance Report, Medicare RAC Audits, Medicaid Audits, Community Medicaid, SNF Medicaid, Acute Care, Critical Access Hospital, Long Term Acute Care, Skilled Nursing Home, Mental Health, Customer Service, Geriatric Community
  • Excellent Customer Service skills and establishing contact for business purposes
  • Strong written and verbal communication skills
  • US Citizen

Timeline

Patient Financial Service Supervisor

United Medical Center
07.2020 - 01.2021

Patient Access Specialist United Medical Nursing Center

United Medical Nursing Center
12.2018 - 01.2021

Business Office Manager-Consultant

The Chappell Group
07.2017 - 01.2019

Business Office Manager (consultant)

Ircle-2 Bed SNF
10.2015 - 01.2016

Business Office Manager (consultant)

The Chappell Group
09.2013 - 01.2016

Business Office Director

Dean-wood Rehabilitation & Wellness Center
10.2011 - 01.2013

Patient Account Coordinator

The Specialty Hospital of Washington
09.2006 - 05.2011

High School Diploma -

Radford High

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