RN, BSN
Nurse
Nashville, TN

Summary

  • Dedicated and patient-focused Registered Nurse/Healthcare Management professional with a career path in healthcare administration and nursing.
  • Certified coding and billing manager (CPC) with 15+ years of experience in high-volume physician office and outpatient settings.
  • Consistently achieve record-high customer satisfaction rankings, improvements to the bottom line and turnaround of underpaid claims.

Professional Experience

Tennessee Spine and Nerve Institute / White Bridge Family Practice / MUA of Middle Tennessee, LLC,
Nashville, TN (2012 - 2015)
RN / Billing Manager for Ambulatory Surgery Center and Multi-specialty group practice

-Ensure that third-party billing is coded and submitted correctly and that appropriate follow-up is performed -Prepare reports as requested by physicians -Maintain a close working relationship with Practice Administrator, Clinic Staff, and Physicians as a training resource. -Mentor and coach billing/front desk staff to increase reimbursemen, while improving quality patient care. -Ensure compliance and adherence to federal and insurance guidelines. -Credentialed as RN in our Ambulatory Surgery Center.

Nashville Oncology Associates, P.C.,
Nashville, TN (2007 - 2011)
Coding & Billing Manager / RN

-Managed all aspects of coding, billing, and cash applications. -Dispensed oral/injectable medications from in-office pharmacy. -Accurately coded and posted daily office charges, including IV infusions, injections, hospital charges, home health care/hospice care plan oversight, bone marrow biopsies, and pathology. -Posted daily insurance payments utilizing ERA and EFT. -Obtained prior-authorizations for chemotherapy, injectables, and oral medications while adhering to NCCN/ASCO guidelines. -Consistently researched and implemented updates from CMS, FDA, OIG/HIPAA, Coding newsletters, etc. in order to maintain current in all areas of coding, compliance, auditing, clinical issues, etc. -Reviewed physicians transcription on a daily basis to check for errors in clinical documentation; communicate findings and recommendations to physicians to ensure coding compliance. -Stayed abreast of and monitor practice performance in areas related to chart audits, coding accuracy, and billing. -Key player in implementation and enhancement of EHR system (Aria), including developing templates, updating ICD-9 and CPT codes, and drug regimens. -Guided practice in complex transition of practice management systems (Medical Manager > Centricity). -Accurately obtained, documented, and managed patient's medical history and medication history in EHR. -Implemented process, trained staff, and ensured compliance with Medicare PQRI program. -Created and administered training to physicians, practice administrator, clinical and clerical personnel in all areas of billing and coding. -Prepared and analyzed all financial reports, including end of month activity reports, and quality review reports to maintain optimal reimbursement and ensure practice compliance with applicable laws/regulations. -Significantly reduced outstanding accounts receivable and implemented policies to improve collections and increase cash flow.

St. Thomas Medical Group,
Nashville, TN (2005 - 2007)
Billing & Coding Supervisor

Advanced to an increasingly responsible position, culminating in management role with oversight for a team of 48 billing/coding personnel. Directed employees in appropriate coding/reimbursement for multiple specialties, including: Pulmonology, Gastroenterology, Podiatry, Internal Medicine, Urgent Care, Pediatrics, Radiology, Pathology, and Cardiology. Selected Contributions: Worked closely with physicians to educate them on proper documentation guidelines for E&M services as well as procedures, including: colonoscopies, bronchoscopies, thallium stress tests, cardiac tests, surgeries, etc. Performed performance evaluations, approved time-off requests, trained new employees, and handled personnel issues. Implemented a new work plan, redistributing tasks of all billing/coding representatives. This resulted in increased productivity and reimbursement. Followed up with insurance carriers and patients to expedite the recovery of payment obligations. Carefully researched and reviewed denied claims, exercising a strong working knowledge of major medical plans and leading healthcare networks. Facilitated monthly staff meetings.

Colin L. Hales, M.D., P.A.,
Port Arthur, TX (1996 - 2003)
Billing/Compliance Manager and Medical Assistant

Selected Contributions: Efficiently managed the front desk and billing office in areas of computerized processes utilizing Medical Manager to handle scheduling, charge and payment entry, collections, medical records and insurance claims. Assisted physician and Nurse Practitioners with examinations, suturing, routine physical examinations, and pelvic examinations. Performed ear irrigations, pulmonary function testing, audiograms, vision screening, EKG's, and Holter monitors. Collected and processed blood for CBC's and prothrombin time testing, interpreted strepscreens, urinalysis and microalbumin testing in-office. Administered IM and SQ injections to patients and monitored for drug reaction. Maintained day-to-day office compliance with OSHA and CLIA. Obtained patient's vital signs and triaged to exam rooms; applied/changed dressings. Ensured open lines of communication and accurate charting procedures; updated computerized patient data. Managed all aspects of accounts receivable and billing operations. Developed and maintained practice clinical and billing procedure manual. Reviewed A/R reports continuously to evaluate and improve collection efforts. Prepared and deposited all payments daily. Greeted patients at front desk, checked patients in and out as needed. Prepared and analyzed end of month activity reports, and quality review reports.

Education

Belmont University
Bachelor of Science (December, 2006)

National Nursing Honor Society, Sigma Theta Tau.

Licensure & Certifications

Certified Professional Coder (CPC), American Academy of Professional Coders. 2007

Recommendations

Feedback

Have any comments or suggestions for Nurses Lounge? We would love to hear from you.
Our network provides nurse employers, schools and associations with the ability to create groups and successfully communicate news, announcements, and events seamlessly to their members.

Nurses use our network to collaborate, exchange professional advice, and share new ideas.