Open To Work
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
19
19
years of professional experience
Work History
Business Office Manager (consultant)
Thomas Circle
10.2015 - 01.2016
- Attended daily morning and attended weekly PPS meetings reporting Medicare days and for resident status
- Converted Community Medicaid to LTC Medicaid for pending residents and explained financial obligations per regulations of government agencies
- Re-certified SNF Medicaid residents to avoid lapse in coverage and payment delays
- Checked Medicare & Medicaid recipients benefits before billing
- Create & bill monthly Medicare A & B claims once charges, diagnosis, revenue codes and MDS RUG scores are gathered and keyed directly into Medicare DDE for quicker payment
- Create & bill monthly Medicaid claims and keyed directly into either the web portal or the billing software Winsap
- Submit SNF 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 in PC as 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 Point Click Care
- Add POA, Guardian, Rep Payee, Physician NPI numbers into the roster and to each resident accounts
- Submit the Medicare required No-Pay claims for discharged residents, exhausted benefits for CMS to score - calculate the resident Medicare benefits from the 60-day spell of illness
- Submit numerous online Medicare adjustments
- Note PCC for all actions taken
Business Office Manager (consultant)
The Chappell Group
09.2013 - 01.2016
- Supervise 35 employees and trained them on the billing/account receivables process
- Main Care Medicaid Bill Submission/Denials/Collections 80,000 closed/open claims project
- Evenly split accounts from years 2010-2013 accounts for 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 on all billed/resubmit claims for payment status's, denials, and for possible account adjustments
- 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 and timeframe for resolution
- Forward all spend own/credentialing/bundled/unbundled issues to the Maine staff for follow-up and resolution
- 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 10 employees
- Working from created spreadsheets split by employee name of 1900 credit balance each for resolution
- Review account & analyst data to conclude what is needed to get account balance to zero
- Reverse and re-bill denied claims that were overpaid due to the MCR/Commercial EOB cross over being invalid
- Requested ME Medicaid retract duplicate paid claims were the primary & secondary insurances paid due to the EOB crossover which caused overpayments to facility
- Issue a paper refund ME Medicaid on claims paid under codes CO-143CO-192CO-9 and Co-45 due to not being able to reverse claims in Health pass & forward to Main Staff for mailing
Patient Financial Service Supervisor
United Medical Center
07.2020 - 07.2025
- 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 information uploaded in the Medicaid portal to eliminate necessary denials
- Collections on government Medicaid MCO, Medicare Advantage Plans, Commercial Accounts through alpha split A through DI
- Review and resolve high/low dollar accounts from highest/lowest using all websites and phone calls
- Submit Medicare Advantage informational claims daily to stay in compliance with CMS regulation
- Appeal denied psych claims overlapping with inpatient claims when diagnosis are not related
- Contract all 365 day old accounts due to aging and non-payment from various insurances
- Re-bill claims and submit 137 adjustment claims with generated claim numbers to avoid duplication denials/rejections
- Denied accounts that are not DRG related merge charges and re-bill as a new claim to get additional payments
- Duplicate accounts with same diagnosis, adjust off A/R
- Appeal rejected or denied MCO claims MCO with medical documentation
- Submit adjustments due to various reasons to Management for review
- Work credit balance report identifying true versus non-credits for refunds and adjustments
- Work Medicare RTP file and key claims directly for quick payment
- Note daily actions taken on accounts
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/staff 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
- Non-compliant residents/family members apply for rep payee to ensure UMNC gets payment for care cost per Medicaid 1445 form
- 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 UMNC coordinator to correct the RUG/PDPM score pertaining to Medicare billing
- Correct SNF Medicare claims in RTP, 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 Director
Dean-wood Rehabilitation & Wellness Center
10.2011 - 01.2013
- Assist admissions to ensure resident demographics are listed under the right financial class
- Apply for long term care Medicaid for all potential residents
- Supervise and back-up the AP Coordinator issuing residents monthly and daily cash per request and keep receipts of transactions
- Input resident money into RFMS to replenish resident funds, petty cash, & send to NJ staff for review, processing and cutting checks
- Setup direct deposit with SSA/OPM/Railroad Retirement/Veterans Administration for LTC resident checks to be deposited into RFMS to make care cost to facility easy and hassle free for the residents
- Setup payment plans for discharged residents on any charges not covered by insurance
- Liaison between New Jersey corporate office and Dean-wood RCW, SSA, Department of Human Services offices
- Assist corporate tracker & submit all requested information to Medicaid and other government agencies
- Meet with residents & family members to obtain information for the application process and explain the financial obligations per DC Medicaid policy to residents, family guardian, POA, rep payee
- Attend care conference meeting per Social Worker request explaining any questions resident may have pertaining to transitioning to LTC and financial obligations pertaining to care cost, coinsurance, allotted money
- Assist social worker with SSA applications, apply for rep payee, government cell phone, obtain resident income, per request & attend weekly PPS meeting for Medicare resident pending status
- Set up phone appointments in office with Social Security Administration for residents
- Work with admissions department and contact Delmarva to obtain level of care 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 in RTP file
- Call Medicare CSR on complicated claims in the RTP for help in getting resolved and paid
- Appeal Medicare claims with all requested documentation per the ADR from Medicare Medical Review Department
- Assist corporate compliance with Medicare/Medicaid audit requests
- Registered and set up Visio for shared billing system for SHW-Hadley staff to bill Medicare claims/DDE follow-up
- Set up online websites for claims billing, obtain authorizations and eligibility searches
- Complete weekly Ambassador, Angel & Abaquis rounds inputting into Mediquis
- Administrator on duty of entire building on assigned weekends
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 CPSI for finalization of diagnosis, surgery codes in order to submit Medicare claims
- Billed LTAC Medicare & assisted with billing Medicaid claims
- Posted LTAC Medicare remit and Medicaid remit as needed
- Residual billing for all third party and secondary claims to Medicaid with Medicare EOMB attached for claims that did not crossover
- Follow-up on all Medicare TAC SNF, Secondary claims
- Worked the Medicare & Medicaid denials and resubmitted claims
- Submitted numerous online adjustments in Medicare DDE
- 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 HIQA
- Assisted admissions to ensure patient demographics entered were listed under 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, VA06-1981
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
Work Preference
Work Type
Full TimeContract WorkPart TimeLocation Preference
RemoteTimeline
Patient Financial Service Supervisor
United Medical Center
07.2020 - 07.2025
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)
Thomas Circle
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