Gwendolyn Moore
Bloomfield,CT
Summary
Experienced Medical Billing Director and Management Hardworking and motivated Medical Billing management and Directing with 30 years of experience and record of success in accounts receivable. Solid history balancing team performance, customer service targets and business objectives. Dedicated to working closely with employees to maximize productivity and optimize procedures. Decisive leader with good planning and organizational skills.
Overview
32
32
years of professional experience
Work History
Manager
Medical, Management Service
08.2015 - Current
- Instituted Electronic billing systems, Electronic Health Systems, Florida Shared System, and Health Pro, Provider Electronic Solutions, Dentrix and set up electronic billing requirements for HCFA 1500, UB04 and ADA for electronic billing
- NPI Registration with various insurance companies
- Managed medical billing staff of 28 and managed 2 Supervisors for cash application and behavioral health billing
- Tripled receivable collection, receivables started at 2.3 million a year
- I implemented strategies to increase accounts receivable and streamline claims to reduce denials because of these changes revenue increased to 14.9 million over the years
- Implemented procedure stream line providers' credentials
- Credentialed new providers with various insurance companies and update provider's information in the CAQH and add providers to the PHO and the IPA
- Register Trading Partner Agreement for Medicaid Electronic billing and registered providers with Blue Cross and Blue shield Federal to allow electronic billing software
- Set up protocol to increase collections for self-pay patients
- Set up a collection procedure and implemented the Express bill
- These changes increased patient collections from 0 to approximately $500,000 a year
- Maintained and upgraded system data base for billing changes to insure clean claims
- Upgraded diagnosis code table and set up procedure codes for OBGYN, Pediatrics, Adult Medicine, Optometry, Podiatry, Behavioral Health, Geriatrics, Adolescent Medicine and Dental
- Set up billing tickler system for Behavioral Health Group sessions attendance and authorizations
- Created training manuals for registration and organized training session for all departments' and created policy and procedures for the sliding fee scale for those who qualified for reduce pricing services
- Organized special projects to increase receivable collections
- Quarterly reporting for Medicare Credit Balance report and tracking flu shots for the Medicare Cost report
- Cycle
- Responsible for running and reviewing Accounts receivable reports
- Education and training on all aspects of denials and follow-up.
Manager of Operations
ADP Advanced MD
01.2014 - 07.2015
- Educated staff on the implementation process for new client on credentialing of new provider for hospital and professional services for multiple states and multiple specialties
- Monitored the aging reports, creating detailed reports, Created PIP to improve performance on reducing denials to increasing revenue
- Responsible for running and reviewing financial reports implementing strategies to reduce accounts receivables
- Responsible for procedure creation and compliance and proper use of modifiers
- Maintained staff, Human Resources for payroll, time, vacation and reviews
- Implemented policies and procedures to improve denial follow-up
- Education and training on all aspects of medical billing process
- ICD-9 and CPT coding
- Modifiers and proper use
- Managed a staff of 13
- Educated various department on the billing process
- Restructured accounts receivable work flow to reduce denials and seek out trend to correct future denials for various insurance companies
- Managed the following specialties for various states: Cardiology/Adults and Children, Obstetrics and Gynecology, Vascular Surgeons, Orthopedics, Ophthalmology, Pulmonary, Internal Medicine, Gastroenterology, ENT.
Director
Medical Billing Management Services, LLC
01.2011 - 01.2014
- Implement electronic billing system, credentialing of new providers for hospital and professional services, monitoring of aging accounts, creating detailed reports, Month End closing and balancing, provider and intake staff training, update systems modules with procedures and diagnosis codes
- Managed Medicare billing and electronic posting for Medicare
- Managed staff, auditing accounts; verified registration information, set-up for new patient accounts and data entry of patient's demographics for billing purposes
- Followed up on denials with insurance types such as, Medicaid, Medicare, Blue Cross & Blue Shield, and other commercial plans
- Responsible for running and reviewing financial reports implementing strategies to reduce accounts receivables.
Manager
Summit Technologies - West Hartford, CT
01.2010 - 01.2011
- Implemented electronic billing systems
- Credentialing of new providers, monitoring of aging accounts, creating detailed reports, Month End closing and balancing, provider and intake staff training, update systems modules with procedures and diagnosis codes, monitored Medicare billing and electronic posting for Medicare
- Monitored staff by auditing accounts; verified registration information, set-up for new patient accounts and data entry of patient's demographics for billing purposes
- Followed up on denials with insurance types such as, Medicaid, Medicare A and B, Blue Cross & Blue Shield, and other commercial plans
- Responsible for running and reviewing financial reports implementing strategies to reduce accounts receivables.
Medical Billing Manager/Director
Community Health Service Inc - Hartford, CT
01.2001 - 01.2010
- Manage a staff of 14, ICD and CPT4 coding delegating assignments, maintain electronic system, Credentialing of new providers for hospital and professional billing, monitoring of aging accounts, creating detailed reports, Month End closing and balancing, provider and intake staff training, update systems modules with procedures and diagnosis codes, monitored Medicare billing and electronic posting for Medicare part A and B
- Monitored staff by auditing accounts; verified registration information, set-up for new patient accounts and data entry of patient's demographics for billing purposes
- Managed Follow-up of denials with insurance types such as, Medicaid, Medicaid HMO's Medicare and Commercial Insurances
- Responsible for running and reviewing financial reports implementing strategies to reduce accounts receivables.
Patient Accounts Manager/Collections Liaison
New Britain General Hospital, Hospital Billing & Collections Services - New Britain, CT
01.1999 - 01.2001
- Managed a staff of 6 for a clean-up project for New Britain General Hospital
- Collected over 10 million in bad debt revenue
- Prepared time cards for payroll
- Managed Collections, data entry, customer service, multiple general office procedures.
Patient Accounts Supervisor/Collections Representative
Reid Treatment Center Inc - Avon, CT
01.1998 - 01.1999
- Managed billing office for mental health billing and collections, cash application and authorization, appeals and authorization for Behavioral Health Services.
Patient Account Manager/Collections Manager and Liaison
CPH Staffing - Farmington, CT
01.1995 - 01.1998
- Assigned to temporary projects with various health facilities to manage medical billing accounts and clean up receivables
- My contract was purchased on both assignments assigned by the agency listed above
- My position onboarding with the following companies: CHS and HBCS were Medical Billing Manager and Director.
Account Manager
Innovative Medical Records Services - Hartford, CT
01.1992 - 01.1995
- Liaison between Mount Sinai, Saint Francis Hospital Medical records and billing of medical records requested for lawyers.
Education
Health Service Administration -
Baker College Flint, Michigan
03.2024
Salem University Massachusetts
01.2015
FOX Institute of business
01.1992
Skills
- Marketing
- Project management
- Staff development
- Capital improvement planning
- Sales Techniques
Timeline
Manager
Medical, Management Service
08.2015 - Current
Manager of Operations
ADP Advanced MD
01.2014 - 07.2015
Director
Medical Billing Management Services, LLC
01.2011 - 01.2014
Manager
Summit Technologies - West Hartford, CT
01.2010 - 01.2011
Medical Billing Manager/Director
Community Health Service Inc - Hartford, CT
01.2001 - 01.2010
Patient Accounts Manager/Collections Liaison
New Britain General Hospital, Hospital Billing & Collections Services - New Britain, CT
01.1999 - 01.2001
Patient Accounts Supervisor/Collections Representative
Reid Treatment Center Inc - Avon, CT
01.1998 - 01.1999
Patient Account Manager/Collections Manager and Liaison
CPH Staffing - Farmington, CT
01.1995 - 01.1998
Account Manager
Innovative Medical Records Services - Hartford, CT
01.1992 - 01.1995
Health Service Administration -
Baker College Flint, Michigan
Salem University Massachusetts
FOX Institute of business
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