TRACYE YOUNG
Evansville
Summary
I am a phenomenal healthcare professional with multiple years of experience in Revenue Management and credentialing. My methodology and proven history of enhancing organizational growth and internal peer development, project management and executive leadership skills within any healthcare setting. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm. Tenacity, Integrity, and Team Collaboration are my key performance indicators.
Overview
9
9
years of professional experience
Work History
Hospital, Physician, Work Comp Billing Specialist
Jorie AI
01.2024 - Current
- Identify and analyze user requirements through data analysis, procedures, and problems to improve existing processes, update existing internal facilities billing databases within Medical Records, and contracts to create payer Appeals for service performed by IP/OP, Specialty Physicians and Workers Comp services. Collaborate with RCM Ops Team to provide reporting on Denial Trends and Root cause analysis. Providing recommendations for remediation. Collaborate with the RCM Ops Team to provide the best practice recommendations for processes where accuracy, timeliness, and efficiency could be improved. Work closely with all payers to ensure the client’s needs and reimbursement rules are followed regarding payer claim dispute and appeals processes. Share with Client and document responses, implementation or reason best practice not implemented. Work as part of a team to develop and administer all underpayment and technical payer claim dispute/appeals denied workflow and processes. Develop and implement a streamlined process for when appealing unpaid claims due to payer error and to obtain and review clinical patient information and other documents impacting charges, coding, collection, and accounts receivable. Medicaid, and Commercial payers. Understand insurance terms, (i.e. HMO/PPO, MSP, Medicare Adv, EOB, etc.) and payment methodologies. Works closely with Payment Recovery Services Leadership to understand contract specifics and provide In and Out of Network contracting data to support negotiations with payers. Navigating through several payer portals verifying patient benefits, eligibility and claim payments or denials. Work closely with all payers to ensure the client’s needs and reimbursement rules are being followed. I maintain several supporting reports that are sent to leadership on a weekly basis.
Revenue Cycle Management Consultant
Reimbursement Solutions
Chicago, IL
08.2018 - 01.2024
- My role reports directly to the CFO, regarding full revenue cycle management for insurance companies billing Hospice, IPU, Palliative Care, Specialty Physicians, LTC, and Hospitals. Billing, Coding and Collections Management is performed through EHR/EMR systems such as (EPIC, Athena, MatrixCare, McKesson, PCC, HCHB, Brightree, Availity and Waystar). Subject matter expert in collecting medical records and reports from provider offices, loads data into the HEDIS application. Implement all financial reporting and projects prior to month-end close deadlines. Such as, A/R Ad-hoc reports for all contracted payers, Medicare, Commercial. Review payer contracts and fee-schedules to validate billing and reimbursement accuracy. Collaborate with the RCM Ops Team to provide the best practice recommendations for any processes where accuracy, timeliness, and efficiency could be improved. Work closely with all payers to ensure the client’s needs and reimbursement rules are followed regarding payer claim dispute and appeals processes.
Healthcare Database Revenue Analyst 1099-Contract
ProviNet Solutions
Tinley Park, IL
11.2021 - 06.2022
- In-depth overview of DRG coding, E/M and outpatient coding analysis outlined within internal full revenue cycle billing procedures for government, commercial, and private payers. Abstracting data from Medical Records to support the annual HEDIS audit and other HEDIS audits. Subject matter expert in collecting medical records and reports from provider offices, loads data into the HEDIS application. Implement all financial reporting and projects prior to month-end close deadlines. Support all aspects of the facilities month end close reporting process through EHR/EMR systems such as (EPIC, Athena, MatrixCare, McKesson, Brightree) systems.
Third-Party Medical Denial Management-1099 Contract
Jennings Terrace Nursing Home Assisted Living
Aurora, IL
10.2017 - 09.2019
- Resolve large collection projects from multiple insurance payors through various Ad-hoc reports. Maintain internal revenue trackers to ensure timely submission of internal data updates related to coding. Identify unbilled revenue discrepancies that need to be addressed and communicated internally with all department directors to obtain and analyze clinical patient information to documents impacting charges, coding, collection, and accounts receivable. Monthly A/R aging reports were generated and maintained throughout the month, to capture accurate account receivables. Submit claims to Illinois Medicaid, Florida Medicaid, and Managed Care plans for ancillary, room and board, and skilled charges, PT/OT, Enteral Therapy, and Residential and Day Therapy services. I conduct regular collaborative A/R aging meetings with the billing team and finance team, to ensure all cash balances and adjustments are posted and received on schedule. Complete credentialing and recredentialing for our agency and providers. All facilities and ancillary charges were billed through Brightree (Matrix care) EHR, a UB04 claim, and physician charges were billed on a CMS 1500 claim. All billing was submitted electronically through Change Healthcare’s clearinghouse, as well as private insurance portals depending on the payer’s reference. Collaborate with our Long-term care facilities regarding eligibility status, patient credit file issues, and proper documentation needed to process billing. Submitting the required notification paperwork for hospice election and revocation forms were submitted to IL Medicaid and Medicare, per CMS guidelines, completed a pre-claim billing analysis for accuracy and completeness; submitted claims to proper insurance entities and followed up on any issues. Follow up on claims using various systems, i.e., practice management and clearinghouse. Prepare documents for services rendered for preauthorization and translate clinical and business documentation issues. Establish a professional working relationship with several internal provider representatives. Audits current procedures to monitor and improve the efficiency of billing and collections operations. I would identify billing inconsistencies and develop internal claim auditing processes to identify errors before billing and resolve billing issues that resulted in large monthly receivables versus foreseen write-offs. Additionally, verify all patient data for eligibility or gaps in coverage, and redetermination date for accuracy for billing. All electronic 835i and 835p ERA funds were posted promptly and reconciled within the EHR, and patient payments. A vast amount of my job functions was performed remotely. This facility utilized Matrix care, Brightree and Change Health.
- Remote
Education
Associate of Applied Science - Healthcare Administration
Computer Systems Institute
IL10-2014
Skills
- Revenue Cycle Management - 9 yrs
- Denial Management - 9 yrs
- Medical Billing - 9 yrs
- A/R aging reports 9 yrs
- Claim Denial Collections
- Epic, MatrixCare, PCC, CMS - 9 yrs
- ICD-10
- UB04 Billing 9 yrs
- CMS 1500 Billing 9 yrs
- Govt Insurance 9 yrs
- Commercial Insurance 9 yrs
- Supervising Experience 5 yrs
- Medical records 9 yrs
- Credentialing Provider 9 yrs
- Time Management 9 yrs
- Cash Posting 835i/p 5 yrs
- Leadership 5 yrs
- Claim Appeals Audits requirements and industry regulations, while assisting with contract negotiations with payors Demonstrate the ability to lead multiple projects simultaneously
Timeline
Hospital, Physician, Work Comp Billing Specialist
Jorie AI
01.2024 - Current
Healthcare Database Revenue Analyst 1099-Contract
ProviNet Solutions
11.2021 - 06.2022
Revenue Cycle Management Consultant
Reimbursement Solutions
08.2018 - 01.2024
Third-Party Medical Denial Management-1099 Contract
Jennings Terrace Nursing Home Assisted Living
10.2017 - 09.2019
Associate of Applied Science - Healthcare Administration
Computer Systems Institute