Valerie Pew
Fort Lauderdale,FL
Summary
Revenue cycle leader with broad healthcare finance experience in billing, denials, and collections. Known for improving cash flow, reducing accounts receivable days, mentoring billing teams, and coordinating claim follow-up, payer appeals, and workflow updates across hospital and physician billing operations.
Overview
24
24
years of professional experience
Work History
Medical Billing Lead (Temp)
Coding Concepts
01.2025 - Current
- Oversee the submission of electronic and paper insurance claims, track aging receivables, and investigate payment discrepancies or underpayments.
- Monitor, mentor, and guide billing/collections team members to meet daily work queues, productivity, and accuracy goals.
- Handled complex claim rejections, composed coding/billing appeal letters, and managed payer follow-ups to ensure timely resolution.
- Analyzed denial trends, generated key performance indicator (KPI) reports, and collaborated with providers and leadership to improve claims processing.
- Provided training and workflow updates on billing software and insurance guidelines to enhance team knowledge and compliance.
Supervisor- Third Party Claims
Broward Health Medical Center
08.2022 - 12.2024
- Ensured accurate and timely billing through proactive oversight and direction of billing and collections processes.
- Demonstrates ability to supervise, train and motivate employees, as well as a professional attitude in relating to executive management, professionals, and third-party insurance carriers.
- Provides operational oversight for the Billing Supervisor, mentoring them in their responsibilities.
- Possess complete understanding of the hospital billing/collection process to resolve complex, outstanding claims.
- Organized and led initiatives to maximize operational efficiency and optimize reimbursement, monitored denials, and provided education and reporting on their impact.
- Implemented corrective action plans to address identified operational deficiencies.
- Exhibits excellent leadership and self-direction, good judgement in handling difficult situations and good organizational, time management, interpersonal and conflict resolution skills.
- Established strong relationships with facility management to ensure effective collaboration and issue resolution.
- Maintained current knowledge of billing systems (ECW) and government payer systems, including federal and state laws and regulations.
- Implemented and monitored department budget, ensuring revenue, expenses, contribution margin, and FTEs met or exceeded targets; prepared and submitted reports; forecasted expenses and addressed negative variances.
- Understanding the contract terms and ensuring we stay within those terms.
Revenue Cycle Manager
CSI Caregiver Services
04.2019 - 08.2022
- Maximized collections from patients, payers, and guarantors through targeted collection efforts, eligibility verification, and securing proper authorization prior to service delivery.
- Manages the operations of the revenue cycle department to maximize net revenues and cash flow for all entities by managing all aspects of accounts receivable.
- Manages Revenue Cycle staff including recruitment, selection, coaching and evaluation of staff.
- Conducts periodic audits to ensure compliance with policies and procedures.
- Well-developed analytical skills and the ability to provide clarity to complex issues and synthesize large amounts of information.
- An ability to identify the root causes of issues by analyzing patterns and trends.
- Elicited high-level business requirements and created detailed functional specifications, requirement traceability matrices, workflow diagrams, and use cases for medical billing software (EPIC and Cerner).
- Ability to articulate and clearly communicate complex problems and solutions in a simple, logical and impactful manner.
- Strong interpersonal, team building, organizational and motivational skills.
- The ability to develop creative and breakthrough solutions.
- Navigated organizational change while maintaining responsibilities and demonstrating creativity and innovation in solution design.
Office Manager
Venetian Isle OBGYN
10.2003 - 03.2021
- Assisted in the increase of cash collection and the decrease of Accounts Receivables (AR) aging for designated plan(s) using effective and efficient collection techniques, including, but not limited to, the use of individual plan(s) escalation and/or appeal processes.
- Monitored claims to ensure timely submission of clean claims, improving cash flow and reducing delays.
- Investigated and resolved discrepancies in debit and credit account balances by analyzing transaction records.
- Established structured payment plans for private pay patients to facilitate their financial obligations.
- Followed up with payers and patients to expedite claim payments, enhancing revenue cycle efficiency.
- Obtained authorization from insurances for services.
- Rectified billing errors, edits, and overlaps, and submitted claims electronically each day.
- Recognized payor issues or trends that informed strategies for enhancing revenue cycle management.
- Reviewed payment variances and remittances for timely resolution, ensuring accurate processing of patient and insurance refunds.
- Evaluated practitioners' applications and documentation to determine their eligibility for participation.
- Gathered relevant information from NPDB applicants and their malpractice insurers for credentialing purposes.
Credit Resolution Analyst/Patient Account Rep Manager
Conifer Health/ Tenet Physicians
01.2014 - 03.2019
- Performed processing functions necessary to ensure timely and accurate Medicaid and Medicare insurance billing using EPIC Hospital Billing.
- Identified and resolved medical billing, coding, and insurance discrepancies, ensuring accurate claims processing.
- Served as initial contact for managing and resolving account inquiries.
- Performed account resolution activities on accounts receivable for all Tenet/Vanguard facilities.
- Generated weekly and monthly reports to uphold billing accuracy and support timely resolution.
- Refined EPIC Billing workflows to align with Conifer's specifications.
- Electronically submitted inpatient and outpatient hospital claims through Cerner and EPIC Billing.
- Used EPIC for monitoring, chart auditing, claims management and workflow management.
- Encrypted medical charges through the standard CMS codes using ICD-10
Billing Supervisor
Florida Woman Care/Unified Physician
12.2010 - 01.2014
- Processed and verified claims with managed care, commercial, and private insurances, including Medicaid and Medicare.
- Prepared and submitted clean claims for various OBGYN providers through the Athena software.
- Received and posted payments from clients, insurance companies, and organization accounts.
- Facilitated reimbursement process for all drugs and vaccines administered to clients by completing necessary paperwork.
- Assigned clinical codes for reimbursement and data analysis using classification software to ensure accuracy and compliance.
- Ensured physician profiles in database were accurate and up to date.
- Recorded data electronically for collection, storage, analysis, recovery, and reporting.
Lead Billing Analyst
Florida Medicaid
04.2003 - 12.2010
- Analyzed claim for up-billing and balance billing.
- Reported instances of provider fraud related to pathology billing to ensure compliance and integrity.
- Execute and release weekly check-runs allocated to Medicaid providers.
- Provided recommendations to regions to facilitate informed decision-making.
- Evaluated program policies and assessed impacts of proposed changes or new regulations on operations.
Education
Associate of Science - Health Care Administration
City College
Fort Lauderdale, FL01-2003
Skills
- ICD 10, CPT, HCPCs, Medical terminology, Insurance terminology, HIPAA, Patient confidentiality, Data Entry, Data Management, EHR, extensive knowledge of commercial and private insurance claims, CA-Medicare and Medicaid, GA-Medicare and Medicaid, CA- Managed Medicare and Medicaid, AZ- Medicaid, UB, CMS-1500
- Epic billing
- Claim adjudication
- EPIC Billing Systems, NEXTGEN, Athena, Medics Premier, Emdeon, Edge Med, Medicaid, Medicare, KIPU, Salesforce, Cerner, GAMMIS, Availity, Navi Net, Palmetto GBA, Cardinal, OPTUM, Pace Setter, Sun Wave, Kareo, Practice Fusion, ECW
- Denial management
- Claim denial management
Personal Information
Title: Revenue Cycle Manager
Timeline
Medical Billing Lead (Temp)
Coding Concepts
01.2025 - Current
Supervisor- Third Party Claims
Broward Health Medical Center
08.2022 - 12.2024
Revenue Cycle Manager
CSI Caregiver Services
04.2019 - 08.2022
Credit Resolution Analyst/Patient Account Rep Manager
Conifer Health/ Tenet Physicians
01.2014 - 03.2019
Billing Supervisor
Florida Woman Care/Unified Physician
12.2010 - 01.2014
Office Manager
Venetian Isle OBGYN
10.2003 - 03.2021
Lead Billing Analyst
Florida Medicaid
04.2003 - 12.2010
Associate of Science - Health Care Administration
City College