Healthcare Consultant Sample Resume Format in Word Free Download -->

Healthcare Consultant Sample Resume Format in Word Free Download

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Sample Template Example of Beautiful Excellent Professional Curriculum Vitae / Resume / CV Format with Career Objective, Job Description, Skills & Work Experience for Freshers & Experienced in Word / Doc / Pdf Free Download
Scotis Paul
(224) 329-1054
E-Mail: spaul.06@ymail.com

PROFESSIONAL PROFILE:
  • Performance-driven professional with more than 20+ years of experience in healthcare and insurance industry. Clinic and hospital based services, consulting, revenue cycle management, strategic planning, trainer, auditor, fraud investigation and research for single and multi-specialty clinics and hospitals.
  • Strong leader with motivational management style and reputation for building and retaining highly motivated business office teams.
  • Results-oriented achiever with excellent track record for identifying opportunities to accelerate revenue and growth.

PROFESSIONAL AREAS OF EXPERTISE:
  • Billing Implementation.
  • Business and Medical Management for professional services and hospital services.
  • Staff Training and Development, clinic development/management.
  • Project Coordination/Management, revenue cycle operations.
  • Policy and Procedures Design and Implementation, research and analysis.
  • Productivity and Process Improvement, denial management and process development.
  • Compliance and Privacy officer.
  • Hospital & Professional Billing, Coding and Collections.
  • Claims Research/Fraud Research & Investigations, contract negotiations and provider credentialing.

COMPUTER PROGRAMS:
EMDS, FISS Medicare, Star HealthSync, McKesson, Ivan’s, Windows, DOS, Corel, Word Perfect, Quattro Pro, Lotus 123, Excel & Medical accounting software programs, QuickBooks Pro and MS Office, Medic and Optimum Vision 3.0, Artworks and NextGen, IDX Groupcast, One Healthport, Lastword, HBOC Star, E-Premis, GE Centricity Business (Flow Cast/C-Biz) Centricity Version 6 and various hospital system programs.

PROFESSIONAL EXPERIENCE:

      Healthcare Consultant, JB Medical Consulting, Washington/Texas, 1998-Present
Managed and performed revenue cycle management functions to include billing, coding & accounts receivable functions, design and implementation of verification process and policies for patient demographics and insurance data to ensure billing accuracy for services provided. Plan, organize and implement new training programs.

Healthcare Consultant, HRG, Washington, 2008-2010
Managed the performance of billing & accounts receivables functions, accurate and timely collections, verification of patient demographics and insurance data to ensure accurate billing for services provided, simultaneously manage multiple medical accounting program systems and teams while reducing account receivables for multiple facilities/clinics in multiple regions, review metrics to identify trends or areas of focus and inform Revenue Cycle Director of variances and trends. Collaborate closely with claims production and external support teams including Payer Contracting, Physician Credentialing, Cash Posting, IT, Revenue Integrity, Business Analyst and Training Teams, minimize bad debt by ensuring timely filing and follow up of unpaid claims, investigated denial reasons and trends among payors and resolved billing with payors. Manage billing and systems questions and corrections from multiple regions, facilities and clinics.
Manage employer billing statements and requests for multiple regions and states.
Implement and develop new processes as new facilities and clinics join the organization (future expectations of expansion include one new facility a month for 2010), recruit, select and manage staff to ensure operational objectives are achieved, recommend, monitor and counsel staff performance, develop performance standards and objectives.
Communicate and provide continuous education to staff regarding matters relevant to department operations/systems and optimization of the revenue cycle (e.g. applicable department cash collections, error reductions, write offs and department goals); coached and monitored staff with respect to customer service standards and expectations, and provided tools to ensure achievement of established objectives. Initiate and perform clinical assessments, business office assessments, and hospital assessments, create assessment reports and facilitate conferences with CFO’s, VP’s and executive management to review operational assessment findings, initiate and implement recommendations from assessments.


      Puget Orthopedic Rehab, PC, Washington, 2002-2004
Office Management for physical therapy and chiropractor, marketing, HIPAA and Compliance officer, design and implement financial policies, office policies, compliance policies, provider credentialing, staff training, performed chart audits, denial management oversight, HR functions.

Odessa General Surgery, Odessa Texas, 2000-2002
Manage and perform all billing, and collections for office including recouping over half a million in uncollected revenue of old AR accounts (2+years and older) in addition to 120+day old accounts, design and implement financial policies, office policies, compliance policies.
Provider credentialing, manage IT functions and staff software training functions, medical audits to ensure billing accuracy, denial management oversight, HR functions, surgical assisting, sterilization techniques, perform vital signs, injections, H&P’s, patient triage and prepare specimens for processing.

Odessa Regional Hospital, Odessa Texas 1998-2000
Billing Supervisor and responsible for updating hospital daily on all phases of                billing functions, government healthcare programs laws and changes.
Work claims on Medicare FISS System or Medicare remote system.
Plan, organize and implement new training programs for implementation of new electronic billing systems. Complete month end reports for Business office Director and worked closely with CFO to assist in special projects to identify areas of possible financial gains and identified unreimbursed financial trends. Successfully re-built billing department and retained highly motivated business office team which increased productivity and improved financial goals for fiscal year 1999 and was exceeded by 6 million dollars, credentialed physicians for professional services. Performed consulting duties for clinics associated with hospital to identify areas of deficiencies and increase revenue.

     Dr. Ruth Spiel, Neurology, Cleveland, Texas 1994-1998,
     Office Manager, transcription, collections.
     GAB Business Services, Houston and Austin Texas, Health Insurance & W/C, 1986-1994        
     Perform clerical functions for adjusting staff and worker’s comp adjuster trainee.
Texas Medical Association, Austin Texas 1982-1986, Insurance- Communication Specialists, Fraud Investigation, investigated claims for correct processing, explained policies to insured’s.                   .
Specialty Experiences: CAH hospital and RAC, Family Practice, General Surgery,      Orthopedics, Neurology, Physical Therapy, Chiropractic, Weight Loss, Oncology, Pulmonary, sleep clinic, DME and multi-specialties hospital and clinics.
Insurance Experiences: GAB Austin, Texas clerical position approved claims for payment, approved weekly worker’s comp checks for claimants. Houston, Texas rehired for adjuster trainee, worked accounts for death benefits for surviving families. Worked closely with fraud investigators and performed investigative phone recordings to see if claim was truly compensable. TMA processed premium payments, then advanced to communication specialist’s position, consisted of explaining client’s policies to them, researched claims for proper claims processing. Claims that were processed incorrectly were then forwarded over to claims supervisor for re-processing, performed research for fraud cases.

     Education:
     Centralia College, Washington State 2010
     Licensed Nursing Assistant, Washington State 2010-Current
     CPR/First Aid Infants and Adults 2010-Current
     Licensed Surgical Technologist, Washington State 2008-Current
     Kingwood College, Kingwood, TX Computers, Payer Education 1997
     Durnham Nixon Business College, Austin, TX Executive Secretary 1981

References available on request


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