Summary
Overview
Work History
Education
Skills
Strengthsandabilities
Certification
Timeline

Tessa Wade

Hawkinsville,GA

Summary

Methodical Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring 30 years of related experience to a dynamic position with room for career growth.

Overview

30
30
years of professional experience
2
2
Certification

Work History

Medical Billing Analyst

Atrium Healthcare System
06.2021 - Current
  • Verify claim accuracy according to the admitting order and CMS guidelines
  • Utilized Medicare/ CMS guidelines to verify compliant claims for Code 44 and missed code 44.
  • Change claim format from inpatient to outpatient as needed according to the determination of a missed code 44 or a code 44
  • Work with Clinical Case Management to verify orders are correct according to the type of claim
  • Maintained compliance with industry regulations by staying up-to-date on changes in policies and procedures, ensuring accurate billing.
  • Mentored junior team members by providing guidance on navigating complex claim scenarios efficiently.
  • Reduced errors in medical billings, effectively addressing discrepancies and rectifying issues promptly.
  • Enhanced revenue collection by efficiently managing medical billing processes and resolving discrepancies.

Quality Analyst

Atrium- Navicent Health
08.2017 - 06.2021
  • Responsible for accurately auditing and presenting monthly metrics for the completed work of 150 Team Members
  • Developed tracking cumulative for employee cumulative quality results.
  • Perform reviews of Claim Specialists, Follow-up Staff, Appeal/ Denial Co-coordinators, Team Leads, and Refund Specialists
  • Completed audits utilizing defined criteria, insurance contracts, Medicare and Medicaid processing guidelines, and internal follow-up expectations
  • Established new reporting metrics to provide Management with accurate, useful, and relevant information
  • Review trends and issues with the Director to support process improvements and coaching opportunities
  • Contributed to the establishing defined follow-up expectations
  • Participated in weekly Team meetings to support industry changes and ensure quality consistency
  • Created and revised procedures, checklists and job aids to reduce errors.
  • Analyzed quality and performance data to support operational decision-making.
  • Provided regular updates to leadership on quality metrics by communicating consistency problems or deficiencies.
  • Administered 1500 internal quality audits and assessed results to inform corrective action measures.
  • Identified process inefficiencies through meticulous data analysis, leading to streamlined and increased productivity.
  • Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training.
  • Used Microsoft to create presentations, flowcharts and graphs detailing data analysis results

Billing/ Collections Supervisor

MRI Management
03.2017 - 07.2017
  • Review the billing accuracy for 10 MRI centers in five states
  • Direct Collection Staff regarding fulfillment of job duties and expectations
  • Assist in the appealing of underpayments and denials
  • Initiate and implement a comprehensive training manual
  • Trending the win/loss of the Appeals
  • Identify billing issues and denial trends preventing correct payments
  • Implement corrective action to prevent revenue loss
  • Restructured the weekly process for capturing the financial information from the MRI Centers
  • Brief Corporate Management weekly regarding financial performance of the MRI centers.
  • Enhanced collections efficiency by implementing and monitoring strategic collections plans.
  • Improved team productivity through ongoing coaching, training.
  • Interviewed and assisted in selection of candidates for collections positions on team of ten.
  • Scheduled regular team meetings to review goals, analyze results data, discuss challenges faced during the collection process.
  • Ensured compliance with federal, state, and company regulations in all collection activities.
  • Spearheaded process improvements that led to faster resolution of delinquent accounts.
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Achieved performance goals on consistent basis.

Lead Patient Account Representative

Houston Healthcare
01.2015 - 03.2017
  • Led the Managed Medicare Team to increase cash collections from 85% monthly to goal of 90.5% and the Aged Team from 93% to 96%
  • Ran metric reports from Collect Logix and Meditech monthly to determine uncollected revenue and trends for audit purposes
  • Root cause analysis on uncollected high dollar accounts.
  • Develop corrective actions from the date analysis
  • Brief CFO monthly regarding audit analysis results and corrective actions
  • Utilize root cause analysis results for training opportunities
  • Collaborate with Teams and Departments within the hospital to proactively improve follow-up/collection processes
  • Contribute to the development of standard collection processes for The Managed Medicare and Aged Team.
  • Prevent unnecessary loss of revenue due to late or incomplete billing by meticulously tracking all accounts and ensuring timely submission accurate claims.
  • Collaborated with team members to identify trends in unpaid claims and develop strategies for resolution.
  • Trained new employees on medical billing software, policies, and procedures.
  • Promoted a positive work environment by consistently demonstrating professionalism, mutual respect, and cooperation with fellow team members.
  • Ensured compliance with industry regulations by staying up-to-date on changes to medical billing procedures and guidelines.
  • Maintained excellent relationships with insurance representatives to expedite claims processing and secure timely reimbursements for services rendered.

Claim Specialist

Houston Healthcare
04.2008 - 01.2015
  • Reconcile unbilled accounts to resolve pre-billing issues in accordance with the 72-hour rule
  • Accurately file inpatient and outpatient facility claim to multiple payers
  • Review Medicare secondary claims for conditional claim filing
  • Review, resolve, and trend claim errors captured by the billing system
  • Utilize data from claim errors to contribute to the implementation of new claim edits
  • Resolve claim errors to maintain a daily clean claim rate of 90% or better
  • Proactively investigate Medicare billing updates
  • Assist in UB04 claim transition from 4010 to 5010 format
  • Contribute to the successful implementation of Quadax.

Education

Associate of Arts General -

Georgia Military College, Warner Robins, GA
01.2002

Skills

  • Organizational abilities
  • Revenue Cycle Management
  • Healthcare Reimbursement
  • Denial Management
  • Medical Billing
  • Workflow Management
  • Proficiency in Epic, Meditech, Emdeon
  • Training and mentoring
  • Performance Improvement
  • Attention to Detail
  • Interpersonal Communication
  • Billing Procedures

Strengthsandabilities


  • Able to diagnose complex issues impacting revenue collection.
  • Able to adapt to continuously changing industry standards.
  • Work well with diverse individuals.
  • Proficient with Microsoft Office, including Excel
  • Understand Medicare IPPS- DRG and OPPS payment methodologies.

Certification

CPAR - CFC

Timeline

Medical Billing Analyst - Atrium Healthcare System
06.2021 - Current
Quality Analyst - Atrium- Navicent Health
08.2017 - 06.2021
Billing/ Collections Supervisor - MRI Management
03.2017 - 07.2017
Lead Patient Account Representative - Houston Healthcare
01.2015 - 03.2017
Claim Specialist - Houston Healthcare
04.2008 - 01.2015
Georgia Military College - Associate of Arts General,

Similar Profiles

CREATE PROFILE
Tessa Wade