Stacey Gay

Review Medical Record documentation and used various software tools such as Epic, 3M and VitalWare software to validate missing charges, resolve pre-bill edits and DNB and Stop Bill billing edits

Reviewed assigned Charge Audit and Claim Edit work queues daily for accurate charge capture and improved overall financial health of the organization.

Communicated between administrative and clinical operations staff to ensure medial documentation is accurate and complete for charge posting and coding review

Follow regulatory IPPS/OPPS guidelines and coding rules, provide recommendations to eliminate late & lost charges, monitor denial trends to alleviate friction issues and increase charging opportunities

Supervised team of 24 full-time employees regarding the day-to-day functions of the Account Resolution department regarding claim follow up, denials and appeals. Provided weekly and monthly reporting for forecast analysis and ad-hoc reporting in support of decision-making.

Led project teams to identify and resolve billing errors and payment discrepancies due to contractual issues and provided recommendations for resolution review and decision making

Reviewed and analyzed payer Explanation of Benefits, EDI 83X and 27X Code Sets, and other payer correspondence to resolve denials, payment variances and verify expected reimbursement was received

Created and delivered a new hire training curriculum for promptly identify trends in new denials received and create action plans for Departments to reduce/eliminate denials

Drafted and implemented training curriculums, reference tools, SOP’s, Job Aids and other support materials;

Performed QA evaluations of staff documentation to provide feedback and corrective training if needed

Provided guidance to team of 12 people regarding credit balances to recommend refunds and or adjustments due to insurance carrier or self-pay overpayments

Implemented productivity matrix for Refund Department and developed workflow tools to increase productivity

Led team meetings to review employee accomplishments, performance goals and expectations, changes workflow processes, and to review ad-hoc project assignments for the department.

Maintained rapport with Managed Care and Accounts Receivable Department to resolve negative payer trends and to stay u regarding Payer Contracts, CDM and Government Fee Schedule (CMS, OPPS, APC, etc.) rates.