Tresa Evans
Merrillville,IN
Summary
Results-driven insurance and compliance professional with over 20 years of experience in investigating and processing medical insurance claims across physician, hospital, home health, and hospice settings. Expertise includes analyzing claims, interpreting policies, and negotiating effective payment solutions. A proven track record in managing multiple high-priority projects while delivering outstanding customer service. Strong communication and planning skills complement a methodical approach to compliance-related roles.
Overview
19
19
years of professional experience
Work History
Billing & Compliance Manager
Visiting Nurse Association of Northwest Indiana
Valparaiso, IN
09.2017 - Current
- Process Development: Create processes for the Compliance and Billing department to ensure efficient and accurate operations
- Chart Reviews: Conduct thorough chart reviews to verify that all services provided align with billing records
- Claim Audits: Perform regular claim audits to ensure that claims are accurate and complete before submission
- Accounts Receivables Reports: Prepare reports for the Controller on accounts receivables, providing valuable insights into the department's financial performance
- ADR Process Support: Assist the Clinical Director with the Appeal and Dispute Resolution (ADR) process, ensuring that patient complaints are addressed promptly and fairly
- Compliance and Regulatory Knowledge: Stay up-to-date on the latest rules and regulations governing Medicare, Medicaid, and Managed Care, ensuring that the department remains compliant and in good standing.
Billing Manager
Providence Life Services
Tinley Park, IL
03.2013 - 09.2017
- Timely billing: Ensure that all claims are billed in a timely manner to minimize delays and maximize revenue
- Financial reporting: Run all necessary financial reports to monitor collections, identify trends, and make informed decisions to optimize revenue
- Billing assistance: Provide support to staff members with billing-related tasks, such as resolving issues, answering questions, and offering guidance
- Process development: Create and implement procedures to streamline the billing process, improve efficiency, and reduce errors
- Monthly closing: Complete the monthly closing process, reconciling accounts and reporting to the Controller
- Regulatory compliance: Stay up-to-date with Medicare guidelines for Home Health and Hospice to ensure accurate billing and compliance with regulations
- Staff training: Provide training and support to staff members to ensure they are knowledgeable about regulations, billing procedures, and best practices.
Medical Billing Manager
CareCollaborative Home Health
Chicago, IL
11.2010 - 03.2013
- Analyzing Claims for Billing: Review patient charts and medical records to ensure accurate and complete billing information
- Verify the completeness and accuracy of patient demographic information, including name, address, date of birth, and insurance information
- Check for any inconsistencies or discrepancies in the billing information, and resolve any issues promptly
- Ensure that all necessary documentation is included in the billing packet, such as Progress Notes, Treatment Plans, and Therapy Notes
- Verify that the correct CPT/ICD-10 codes are used for each service or treatment
- Auditing Therapy Claims: Review therapy claims to ensure that the frequency of therapy sessions meets the required frequency for Medicare billing
- Verify that each therapy session has been documented and coded correctly
- Check for any gaps in therapy sessions, and address any issues promptly
- Ensure that all necessary documentation is included in the therapy claim, such as Progress Notes and Treatment Plans.
Home Health & Hospice Team Lead
Family Home Health & Family Centered Hospice
Addison, IL
01.2006 - 11.2010
- Handled all Hospice billing
- Audited each claim to make sure it met the Medicare guidelines for billing
- Maintained all room and board billing and invoices to be paid to the nursing homes for the hospice patients
- Audited all hospice inpatient claims and invoices to insure that they were invoiced correctly
- Billed all Home Health claims and made all corrections to any rejected claims
- Completed any insurance verification for various insurance payors
- Helped to keep medical records in order for billing purposes
- Outcomes:
- Implemented the electronic billing for Medicaid
- Helped the Administrator oversee the Medicare and Medicaid billing systems by setting up new employees with ids and passwords
- Became a team lead of the department and thoroughly trained staff in home health and billing procedures
Education
Major in Business Administration - Business Law, Business Management
SOUTH UNIVERSITY ONLINE
Savannah, GA05.2010
Skills
- Conducting regular audits
- Knowledge of Medicare and Medicaid Regulations
- Developing and implementing quality control measures
- Ensure Staff complies with Medicare/Insurance Regulations
- Policy Interpretation
- Confidential Records Management
- Excellent leadership and team working skills
- Audits management
- Investigative skills
- Regulatory examinations
- Compliance documentation
- Audit oversight
- Quality controls
- Regulatory compliance oversight
- Staff training
- Data gathering and reporting
- Process development
- Compliance initiatives
- Analytical problem solving
- Process management
Computers
- Microsoft Applications
- Homecare Homebase EMR
- HealthWise EMR
- Palmetto eServices
- WayStar
- NIPPES
Timeline
Billing & Compliance Manager
Visiting Nurse Association of Northwest Indiana
09.2017 - Current
Billing Manager
Providence Life Services
03.2013 - 09.2017
Medical Billing Manager
CareCollaborative Home Health
11.2010 - 03.2013
Home Health & Hospice Team Lead
Family Home Health & Family Centered Hospice
01.2006 - 11.2010
Major in Business Administration - Business Law, Business Management
SOUTH UNIVERSITY ONLINE
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