Sylvia M. Wade
Summary
An accomplished healthcare professional with 35 years of experience in health care management and administration, practice management, financial, billing and revenue management in a cardiology specialty group practice. Skilled in strategic planning, staff development, and process improvement, with reliable and results-driven approach. Recognized for effective communication, leadership, and problem-solving abilities.
Overview
27
27
years of professional experience
Work History
Senior Medical Biller
Bon Secours Charity Health System Medical Group/WMC Health /Metropolitan Cardiology Consultants
01.2024 - 04.2025
- Supervision and management of the cardiology practice billing operations including overseeing and monitoring tasks performed by the billing staff.
- Review claim editing reports for consistent errors and follow up with the management for improvement in quality and performance.
- Review and monitor all claims queues for assigned offices, i.e., charge capture, charge review, edit claims, at risk claims and edit failure work queues.
- Examine patients’ chart in the queue, verifying demographic, insurance, and subscriber details for data accuracy.
- Work with front office staff regarding any information missing in patients’ accounts needed for claims submission.
- Charge Capture and Claim Edit: Verify correct CPT and ICD 10 codes utilized to accurately reflect services provided for visits and Cardiology Diagnostic Testing.
- Charge Edit: Review automatically generated charges in the Charge Edit work queue to verify accuracy of date of service, place of service, CPT Code (s), modifiers, ICD 10 diagnosis code(s) with documented progress notes or reports.
- Claims Processing: Review and verify medical claims for accuracy and completeness before processing. Ensure that all necessary documentation is included and compliant with insurance policies.
- Manual charge entry, including patient demographics, of services rendered by providers which did not automatically drop into charge review work queue following completion of service.
- Human Resources, Payroll (Kronos and UK Dimensions), Accounts Payable (Infor and Concur) tasks and responsibilities outlined below in the Senior Patient Representative Position.
- Served as a subject matter expert on billing-related software and systems, providing guidance and support to colleagues navigating these tools.
- Assisted in training junior medical billers, sharing expertise and best practices to improve overall team performance.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Filed and updated patient information and medical records.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Audited and corrected billing and posting documents for accuracy.
- Managed high-volume workloads while maintaining attention to detail, resulting in increased accuracy and reduced errors in submitted claims.
- Enhanced revenue by efficiently processing medical billing claims and ensuring accuracy.
- Collaborated with healthcare providers to obtain necessary documentation for accurate billing.
- Supported the implementation of a new electronic health record system, leading to more efficient billing practices.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Delivered timely and accurate charge submissions.
Senior Patient Service Representative
Bon Secours Charity Health System Medical Group/WMC Health /Metropolitan Cardiology Consultants
11.2021 - 12.2023
- Provide specialty guidance and requirements to Cerner Build team, BSMG Billing Manager and SVP for BSMG Medical Group Cardiovascular specialty requirements for charge capture and applications associated with transition to new EMR billing system.
- Train, coach and mentor billing staff in billing procedures and workflows. Supervision of staff, review of billing workflow for staff members and assignments.
- Human Resources: Provide Business Manager with administrative support regarding HR issues including staff peer counseling, verbal, and written warnings, staffing issues.
- Payroll and maintenance of UK Dimensions practice payroll system including timecards, schedules, and absences.
- Submission, review and approval of practice-related invoices and expenses for payment through the INFOR Cloudsuite Financial System.
- Customer Service: As the first point of contact, provide information about hospital policies, answer questions, and address concerns, ensuring that patients feel welcomed and informed.
- Register patients for services, including collecting and verifying demographic and insurance information. Ensure that all necessary forms are completed accurately and entered the system.
- Insurance Verification: Confirm patients' insurance coverage, understand specific benefits, and notify authorization specialists of impending services, to prevent billing issues.
- Charge Capture for Cardiology Office Diagnostic Testing – Echocardiograms, Stress Echocardiograms, Vascular Studies, Nuclear Cardiology Stress Tests.
- Assisted Medical Group Credentialing Department with credentialing and on-boarding of new providers through CAQH as well as participation in the recredentialing process. Ensure license and board certifications were up to date.
- Maintained strict confidentiality of patient information in compliance with HIPAA regulations.
- Collaborated with clinical staff to ensure seamless coordination of patient care and treatments.
- Boosted efficiency within the clinic''s daily operations by proactively identifying areas for improvement or streamlining.
- Assisted in the training of new staff members, ensuring adherence to best practices and clinic protocols.
- Verified patient insurance eligibility and entered patient information into system.
- Provided excellent customer service to patients and medical staff.
Practice Manager
Bon Secours Charity Health System Medical Group/WMC Health /Metropolitan Cardiology Consultants
10.1998 - 11.2021
- Responsible for leading and managing all aspects of the day-to-day operations of a large Cardiology specialty practice.
- Oversee and manage the day-to-day operations of the practice operations by maintaining office systems, applications, workflows, staff supervision, personnel management, billing and financial operations and policies and procedures.
- Manage and Monitor patient financial services, including billing, collections, customer service, cash posting and denial management, Spearheaded all aspects of the billing department for multiple offices including AR, collections, credentialing, practice productivity, implemented new policies and procedures for staff and ensured staff were trained in new computer systems (Athena, EPIC and Cerner)
- Directed, directed and maintained all workflow and policies for AR management. Ensured staffs trained and accountable for all AR tasks within the practice
- Recruitment, training, and monitoring of practice staff (front desk, clinical and technical) encompassing three locations and twenty-eight employees. Regularly evaluated employee performance, provide feedback and assistance, coach and discipline staff as needed.
- Payroll and maintenance of UK Dimensions practice payroll system including timecards, schedules, and absences.
- Served as liaison between Practitioners, office staff, clinical staff, and technicians, to coordinate and ensure successful delivery of care and services.
- Accounts Payable - Submission, review and approval of practice related invoices and expenses for payment through the INFOR Cloud suite Financial System, including but not limited to emailing invoices to Charity Invoices, follow-up with AP inquiry for any invoice payment issues.
- Ensure compliance of regulatory, accreditation (ICANL) and system processes.
- Monitor and approve practice expenditures on corporate credit card through CONCUR and complete monthly reporting of same. Submission of physician/provider/staff reimbursement expenses for corporate approval and reimbursement.
- Assisted and functioned as intermediary with Medical Group Credentialing Department with credentialing and on-boarding of new providers through CAQH as well as participation in the recredentialing process. Ensure license and board certifications were up to date.
- Functioned as liaison with providers and hospital medical staff offices to ensure compliance and completion of medical staff applications and reappointment applications.
- Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
- Evaluated practice workflows regularly to identify areas for improvement and implement necessary changes efficiently.
- Oversaw the hiring process for new employees, selecting candidates who aligned with the practice''s mission and values.
- Addressed and remedied all patient or team member issues.
- Oversaw accounting, budgeting, and financial reporting.
- Supervised team of [Number] office personnel.
- Coordinated with physicians to optimize appointment schedules and maximize daily patient flow.
- Provided supervision and management to team of support personnel.
- Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
- Improved practice revenue through effective financial management and strategic cost reductions.
- Ensured compliance with healthcare regulations, maintaining up-to-date knowledge on industry standards and best practices.
- Enhanced staff productivity by providing comprehensive training programs and regular performance evaluations.
- Created and implemented organizational policies and procedures.
- Increased patient satisfaction by streamlining appointment scheduling and implementing efficient check-in processes.
- Implemented new electronic health record system, leading to increased efficiency in patient data management.
- Consulted with healthcare professionals on business decisions.
- Managed all aspects of billing and coding, reducing errors and improving reimbursement rates.
- Improved operational workflows, which allowed for increase in number of daily patient appointments.
- Developed and enforced office policies to ensure compliance with healthcare regulations, improving practice efficiency.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
Skills
- Experience with Athena, EPIC, and Cerner systems
- Healthcare office management
- Charge capture management
- Knowledge of UK Dimensions payroll systems
- CAQH credentialing experience
- Revenue Cycle Management
- Claims processing expertise
- HIPAA compliance
- Proficient in INFOR accounts payable processes
- Patient data accuracy assurance
Timeline
Senior Medical Biller
Bon Secours Charity Health System Medical Group/WMC Health /Metropolitan Cardiology Consultants
01.2024 - 04.2025
Senior Patient Service Representative
Bon Secours Charity Health System Medical Group/WMC Health /Metropolitan Cardiology Consultants
11.2021 - 12.2023
Practice Manager
Bon Secours Charity Health System Medical Group/WMC Health /Metropolitan Cardiology Consultants
10.1998 - 11.2021
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