Vanessa Juliet Galloway
Philadelphia,PA
Summary
A detail driven professional that is seeking a career with a healthcare organization that will utilize my skills, abilities, and education. I have a thorough knowledge of HIPAA, OSHA, JCAHO, DOH and EMTALA regulations and standards with a proven tracking record for team building and training skills.
Overview
25
25
years of professional experience
Work History
Pre-Certification Representative
City of Hope-Phoenix
03.2017 - Current
- Monitor all patient admissions and initiates insurance pre-certification process.
- Investigate all new patients for insurance pre-certification requirements.
- Receive all orders for patient testing, procedures, therapy, and initiates insurance contact for authorizations with ICD10 via Epic, Allscripts and emails.
- Communicate all insurance issues to appropriate provider care team (i.e., denials or peer to peer requests).
- Use of Epic electronic scheduling and registration system.
Physician Credentialing Analyst
Mercy Health System
07.2013 - 07.2015
- Credentialing new providers and re-credentialing. Perform primary/se Audit credentialing records. Obtain Malpractice Loss History Issue malpractice certificates of insurance. Maintain credentialing database.
- Obtain Malpractice Loss History Issue certificates of insurance, state license, DEA, and other documents in compliance with NCQA and HRSA guidelines.
- Work with Accounts Receivable Department on outstanding issues. Knowledge of 837 File submissions; ability to resolve edits and rejections for CMS1500 claims. Maintain the credentialing/Financial Summary spreadsheet for monthly meetings.
- Insurance verification for physician offices.
- Maintain the credentialing/financial summary spreadsheet for monthly meetings.
- Assist with special projects (Medicare and Medicaid Meaningful Use EHR).
- Secondary source verifications (certification, registrations, permits, educational degrees and association membership via electronic systems and software). Registered providers with CAQH, along with managing organization linking. Enter all providers’ information into Sy Med.
Patient Access Supervisor (Part-Time Weekends)
Thomas Jefferson University
05.2012 - 08.2013
- Supervise activities and personnel in all assigned Emergency Medicine Registration areas. Complies with all State and Federal laws and regulations.
- Monitors and audits the accuracy of all information obtained by ER Registrars. Enforces that all registration documents, insurance cards and photo IDs are being scanned at 97% through quality management.
- Responsible to assure new hires are trained in all aspects of their job.
- Responsible to keep staff informed of system changes or compliance issues.
- Responsible for completing performance evaluations and corrective action plans.
- Monitors front end collections for ER designated areas and ensures that Department’s goals are being met.
- Responsible for providing Ancillary Providers with necessary and accurate information.
- Assist with the registration process and help wherever the workload dictates.
- Responsible for keeping upper management informed of all significant issues.
- Submit weekly shift end report of events in the Registration areas to the Manager and Director of Patient Access.
- Perform other job-related duties as assigned by Manager or Director of Patient Access.
Billing Manager
Montgomery County Hand Center
10.2001 - 04.2013
- Manages the daily operations for Accounts receivable and account payable management. Implement strategic planning of billing and collections projects to maximize accurate reimbursement from insurance carriers and patients in accordance with local, state, and federal guidelines.
- Workers Compensation, Medicare, Managed Care, Blue Shield, MVA plans and DME billing. Developed and implementation of policies and procedures in compliance HIPAA regulations. Collaborate with the Therapy Manager, physicians, and physician assistant to address and resolve issues with billing procedures and trends.
- Use of electronic scheduling and registration system.
- ICD9, CPT AND HCPCS coding for therapy, diagnostic services, office visits and outpatient surgeries. Function as liaison between the provider and insurance carriers to negotiate group. Monitor, review, and resolve credentialing status for professional staff. Recruit, hire and train new employees on software applications. Performance appraisals.
Education
Bachelor of Science - Healthcare Administration
University of Phoenix
Philadelphia,PA02-2011
Skills
- Epic Hyperspace, SMS (Invision), IDX (Bar and Flow cast), Medical Manager (PCN), OnTrack NextGen, Availity, Meditech, Data Ark 45, PA Midas Seeker, PECOS (Medicare CMS) Promise Internet system, Jeff Chart, Power Chart ApproBar, Last Word, All Scripts, PA Promise portal, Mercy Care AZ, Rev360 systems, Microsoft Office (Word, Excel, Outlook, and Team) and NaviNet Online ERA and EFT Medical Terminology, ICD9/10, CPT and HCPCS coding, MDLogic (EMR) EDI, Kronos, and Certified IDX, Registrar, HDS, HFCA 1500, Customer Service/Accounts Receivable Management
Accomplishments
Achievement: 85% completion of an ongoing unbilled project that I have generated over three million dollars in less than 4 months of start date by maximizing the use of available technologies to improve revenue cycle workflow and maximize revenue collections.
Assist with special projects (Medicare and Medicaid Meaningful Use EHR). Working PBS with credentialing and onboarding process for a new medical practice in the state of Delaware.
Timeline
Pre-Certification Representative
City of Hope-Phoenix
03.2017 - Current
Physician Credentialing Analyst
Mercy Health System
07.2013 - 07.2015
Patient Access Supervisor (Part-Time Weekends)
Thomas Jefferson University
05.2012 - 08.2013
Billing Manager
Montgomery County Hand Center
10.2001 - 04.2013
Bachelor of Science - Healthcare Administration
University of Phoenix