Tess Paisley
Loganville,GA
Summary
Meticulous Revenue Cycle Manager with strong background in continuous improvement and revenue performance analysis. Focused and organized with demonstrated success in achieving company goals through increased efficiency initiatives illustrated over 24 years of Revenue Cycle Management success.
Overview
29
29
years of professional experience
Work History
Practice/Revenue Cycle Manager
Georgia Brain & Spine Center, PC
08.2016 - 03.2020
- Manage all aspects of the Practice, Revenue Cycle, including but not limited to Coding, Billing, Collections, Recruitment and staff training
- Ensures monitoring and appraisals of employees productivity and provide merit increases accordingly
- Oversees surgical scheduler to ensure accuracy of prior authorizations and OR scheduling
- Oversees the daily financial operations of the front office
- Ensures that ALL DME products are authorized prior to dispensing
- Coordinates administrative and clinical services
- Liaison between Patients and Insurance carriers regarding claim denials/benefits
- Ensures that the Group as well as all Providers maintains their PAR status with Insurance Carriers
- Provide support to the surgeons and physician's assistant as needed
- Order all practice supplies and ensure that rates are within the practice budget
- Develop and maintain excellent relationships with referring physicians and attorneys
- Lien negotiations, Commercial Insurance Fee Schedule negotiations, Appeals
- Monthly Financial reporting and set goals for the following month
- Maintain membership with N.E.R.V.E.S to stay abreast of changes in Neurosurgery
- Ensure that the practice is compliant with all laws and regulations
- Ensure that the Medical Assistant, Physician and PA captures all necessary information and provide counseling for Medicare 65+ patients for MACRA/MIPS purposes
- Assessed current revenue cycle procedures and implemented improvements to foster efficiency.
- Monitored and guided revenue cycle operations.
- Supported clinical team members with revenue cycle procedures and addressed issues.
- Completed financial reporting and analysis for billing revenue cycle.
- Performed routine closings, maintained clean, accurate and accessible records and kept close eye on transaction updates throughout each quarter.
- Established and enforced internal controls, workflows and policies for tracking, reconciling and reporting on accounting activities.
- Recruited, interviewed, hired and trained [Number] employees and implemented mentoring program to promote positive feedback and engagement.
- Onboarded new employees with training and new hire documentation.
- Cross-trained existing employees to maximize team agility and performance.
- Maximized performance by monitoring daily activities and mentoring team members.
- Approved regular payroll submissions for employees.
- Reviewed performance data to monitor and measure productivity, goal progress and activity levels.
Billing Manager
Urgent Care
06.2014 - 08.2016
- Manage daily operations of the Reception Desk and Billing Department
- Manage all aspects of Billing, Coding and Accounts Receivables
- Oversee a staff of 4 Billers/Collectors, ICD 10 training and provide daily support to front and back office staff
- Coordinate with the sales and marketing team to ensure that monthly goals are met.
Practice Manager
Nostrand Medical Practice, ProHEALTH Care Associates
09.2011 - 06.2014
- Manage daily operations and ensure IT reliability
- Oversee a staff of 15 employees and provide support to 10 physicians
- Manage physicians calendar to ensure that the practice is fully staffed at all times
- Ensure that ALL OB deliveries and surgeries are approved and paid timely
- Ensures that high risk patients are monitored closely and that deliveries are Authorized as such
- Ensures that lab results are reviewed by the MD, provided to patients timely and follow up appointments are made if necessary
- Closely monitors recall visits for patients with abnormal test results and ensures That reminders are mailed, appointments are confirmed and kept by patients otherwise A phone call will be initiated and documented in the patients file
- Ensure that exam rooms are clean, presentable and stocked with necessary supplies
- Manage client reception and client services coordination
- Recruitment, Performance management, recommends merit increases, staff Development and training
- Provide the required leadership, support and direction for office initiatives and conducts special projects
- Maintain compliances in areas such as OSHA, HIPAA, Coding
- Coding, Billing, A/R, collections and payment posting for five physicians
- Resolve billing issues and manage employee relations
- Prepare and analyze weekly, monthly and yearly financial reports
- Oversees inventory and purchases of Medical and Office Supplies
- Test and assisted with the Implementation of the eClinical Works software
- Train clinical, non-clinical staff and Physicians on eClinical Works both in Individual and group setting and manage all clinical data input
- Monitors state and Federal legislative actions regarding medical records, Vital statistics, patient Confidentiality and release of information.
Health Information Management Support Instructor
CUNY Bronx Community College
09.2008 - 06.2014
- Develops and maintains training curriculum and materials to support the HIM education process
- Train students on Medical Terminology, Medical Coding & Billing, reimbursement policies and procedures
- Electronic Health Records and the Importance of Confidentiality that must be maintained in accordance with the HIPAA Laws and Guidelines
- Effectively educate and motivate students to ensure the effectiveness of the HIM training
Medical Billing/Collections Manager
Medical Practice Solutions
10.2008 - 09.2011
- Hiring, training, and managing all aspects of medical billing and Collections
- Manage a staff of 15 employees and Conduct performance appraisals
- Analyze weekly, monthly and yearly financial reports
- Develop new ways to increase reimbursement and Assist in key functions of credentialing
- Resolved billing issues and managed employee relations
- Liaison between Patients, Insurance carriers and lawyers on No-Fault or Workers Compensation Lien cases
Medical Billing & Coding Instructor
The Chubb Institute
03.2007 - 10.2008
- Train students on medical billing & coding policies and procedures, the process of extracting procedures and diagnoses from medical records and accurately assigning the corresponding CPT-4 codes, CPT-4 modifiers and ICD-9 codes, how to calculate anesthesia time, selecting appropriate physical status modifiers and qualifying circumstances codes, medical law and ethics, computerized billing and reimbursement techniques
- Microsoft Office
Medical Billing & Collections Manager
Universal Open MRI of
07.2002 - 03.2007
- Managed and trained a staff of five employees, performed overall managerial duties in the absence of the office manager, Interview prospective employees,
- Prepared work schedules for all billing and collection staff, Assigned coverage for vacation and sick time, Payroll, Credentialing, Lien Negotiation, appeals,
- Answered patients inquiries regarding accounts being in collections, act as a
- Liaison between patients and law firms on lien cases, developed & maintained positive business relationships with provider relation managers, case managers, medical directors and lawyers, Collections, corrected claim errors prior to claims submission, ran financial reports, worked on ways to increase A/R
- Increased A/R by 80% within a 1 year period
Medical Billing & Collections Specialist
Professional Billing Solutions
01.1997 - 07.2002
- Performed multi-specialty medical billing and collections, including but not limited to OB/GYN, Pediatric, Internal Medicine, Ophthalmology and Anesthesia
- Assigned to an OB/GYN physician, where I verified coverage, pre-certified
- And scheduled surgeries and deliveries at either hospital or ambulatory surgical centers
- Electronic Claims Submissions
Education
HITECH HIT Coordinator-IT Support Certificate -
Bronx Community College
Diploma - Medical Office Administration
Blake Business School
1996
Computer Information Systems
S.U.N.Y Farmingdale
1995
Skills
- Result-oriented with strong personnel management experience
- Superior interpersonal, communication and leadership skills
- Microsoft Office, eClinical Works, Athena, Insurance Verification & Pre-Authorization,
- PI Claims, Lien negotiations, Collections, Credentialing (CAQH)
- Revenue Operations
- Staff Recruitment and Hiring
- Revenue Cycle Management
- Conflict Resolution Tactics
- Accounts Payable and Accounts Receivable
- Proactive and Focused
- Operational Reporting
- Business Relationship Management
- Insurance Negotiation
- Employee Performance Reviews
- Past Due Account Management
Timeline
Practice/Revenue Cycle Manager
Georgia Brain & Spine Center, PC
08.2016 - 03.2020
Billing Manager
Urgent Care
06.2014 - 08.2016
Practice Manager
Nostrand Medical Practice, ProHEALTH Care Associates
09.2011 - 06.2014
Medical Billing/Collections Manager
Medical Practice Solutions
10.2008 - 09.2011
Health Information Management Support Instructor
CUNY Bronx Community College
09.2008 - 06.2014
Medical Billing & Coding Instructor
The Chubb Institute
03.2007 - 10.2008
Medical Billing & Collections Manager
Universal Open MRI of
07.2002 - 03.2007
Medical Billing & Collections Specialist
Professional Billing Solutions
01.1997 - 07.2002
HITECH HIT Coordinator-IT Support Certificate -
Bronx Community College
Diploma - Medical Office Administration
Blake Business School
Computer Information Systems
S.U.N.Y Farmingdale
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