Joseph W. Lee – Healthcare Consultant740-502-9882

Josephwlee80@gmail.com62715 Sampson Rd

New Concord, OH 43762-9517

QUALIFICATIONS SUMMARY

Consult and advise with the experience to exceed management performance and healthcare financial management administration established goals. Collaborative processing of patient/member accounts generating decisions to meet operational deadlines for Healthcare Providers or Insurance Carriers using any software presented. Work well with teams or individuals both onsite and from remote locations functioning as a collector, Payer and contract resource for Entitlement Claims, Managed Care and Commercial.

Systems Experience and Skill Sets

CPSI/Paragon/FIS0/ProMedical WGS/Ulterra/ Facets/ GP00 Soarian/EDM/EpremisSMS/SSI/ DocuwareHealthquest/Paragon

Nasco/Blue SquaredEpremis/DDE

Point Click Care/Quick ClaimsMicrosoft Office Suite

PROFESSIONAL EXPERIENCE

Healthcare Consultant 08/04/2014-PresentJTS Health Partners – H. Lee Moffitt Cancer Center Tampa, FLManaged care plus commercial collections using Soarian, EDM and Epremis. Administrative support with an on-sight team of 6 as well as others working from home. Follow up to include corrections demanded from insurance carriers for less than expected payment amounts per contract references. Managing collections of recurring account balances as well as irregular visits and coordination of benefits disciplines regarding Medicare, Medicare HMO and Medicare as secondary payer then pursued collections for a regular inventory of secondary balances due after primary commercial insurance payments were collected.

Healthcare Consultant 03/03/2014-06/27/2014Expeditive LLC. – Lehigh Valley Health Network Allentown, PACollections work for healthcare interest working with commercial claims to reduce accounts receivable days using payer websites and in-house tools that accelerated cash flow. Data-mining with 10-15 Windows sessions at all times to correlate claims billed with payments and denials management from Aetna, Cigna, United Healthcare, Blue Cross, Geisinger, UMR and other commercial websites. Per diem contract with 7 additional consultants. Tools used; Accuro, Navinet, Centricity, Xclaims, MedAssets, EHMR & CA with GUI files. Administrative support for management and staff performances.

Healthcare Consultant 08/04/2013-11/25/2013Expeditive LLC. – Valley Health Winchester, VAPrepared payroll guarnishment for healthcare accounts based upon intranet/internet research using skip tracing methods in multiple facilities, AS400 and McKesson platforms. Utilized the software Equifax work number to locate patients and guarantors at places of employment. Meticulous preparation of documents for presentation in the courtroom or business offices. Prepare/support client for conversion to EPIC software.

Joseph W. Lee

Healthcare Consultant 03/17/2013 –04/05/2013Expeditive LLC. – Upland Rehabilitation and Care Center Upland, CAAs a single representative I worked with the client’s team in a clean-up project creating write-off packages from manual records with some collections work where possible using Point Click Care and Quick Claims applications along with Microsoft Office Suite.

Healthcare Consultant 2012-2013Expeditive LLC. – Mount Carmel Medical Center Columbus, OHA five member team assigned to healthcare collections after client operations migrated to Healthquest as a replacement for McKesson Star. Collected Medicare HMO accounts and performed clean up collections on accounts with COB issues to resolve such as Worker’s Compensation, Medicare Traditional and multiple Commercial plans. Interacting with client team of administrative professionals efficiently to reduce accounts receivable balances and complete 2010 collections issues.

Healthcare Consultant 2011- 2012Expeditive LLC. – Littleton Regional Hospital Littleton, NHMy team focused on collections performance while demonstrating methods to get the job done with all payer groups exceeding management goals for 14 months, generating bonuses for the staff. Established follow up methodology, synthesized note-taking in critical areas including admissions, outlined write off and adjustment measures to ensure compliance. Developed new ways to capitalize upon existing technology as well as support transition to new applications for a Critical Access Hospital. Showcased examples of HIPAA compliance and due diligence to promote higher performance goals in patient financial services staff including international collections.

Healthcare Consultant 2010 ITI Staffing – Adena Healthcare Systems Chillicothe, OhioIntegrated support of existing team for collection of healthcare claims in the commercial insurance group. We used Meditech, Quadax, Chartmax, Excel and Outlook. Claims management with billing and status plus, retro-authorization, audits and write off adjustments.

Field Service Administrator 2008 & 2009 Perot Systems – Anthem/Wellpoint BCBS Host Plan Columbus, OhioClaims clearing house contract to reduce inventory of healthcare claims in a price and ship process covering a 5 state area, Ohio, Wisconsin, Indiana, Kentucky, Missouri from multiple healthcare providers including hospitals, clinics and physician offices requiring coordination with various BCBS home plans. Performances included communication with the home plans to assess benefit levels and process claims for payment at their local office forwarding all necessary documentation or requesting it from the providers. This contract was completed ahead of schedule generating a second contract with the same group which involved correspondence from healthcare providers to BCBS home plans for medical records requested and submitted, it was performed as a work at home project from start to finish. Additionally a contract with California Blue Cross claims was presented for pricing HCFA claims with special payment rules within Blue Cross contract provisions, including calculations for anesthesia charges, DME charges comparison of rent or purchase choices and various payment rates between CA, NV and CO providers. We used Facets/GP00, Ulterra, WGS, Blue squared and NASCO for these processes.

Joseph W. Lee

Patient Account Representative 2006-2007 NESCO Financial Services – Mt. Carmel Hospital Columbus, OhioAdministrative support within the Commercial claims department streamlining follow up methods and collections from commercial insurance plans. Responsibilities included satisfaction of insurance carrier requirements for coordination of benefits with Medicare coverage both as primary and secondary payer. Also worked with auto and liability or casualty claims for Medicare beneficiaries. Reviewed registration records for ABN, insurance cards, verification of coverage and telephone notes for precertification or preauthorization and COB. Coordinated adjustment of non-covered charges to calculate patient balances and actuate dunning statements. McKesson/SMS software was used for these patient accounting processes.

Medicare Biller 2005 Medix Staffing Solutions – St Luke’s Medical Center Phoenix, AZOne of two people responsible for billing Medicare claims of Hospital, Wound Care and clinic facilities. Coordinated adjustment of account balances for payers verified with Explanation of Medicare Benefits. Obtained Medifax for Medicaid patients, performed collections with the commercial insurance department for the high dollar group and exceeded collections goals for several months consecutively. Epremis was used for electronic billing, Lotus notes for inner office communications and Microsoft Word for patient correspondence.

Field Services Administrator 2003-2004 Affiliated Computer Services – Catholic Healthcare West Phoenix, AZResponsible for Medicare, Medicaid and other government payer claims collections. Set records in collections then exceeded goals for several months. Multiple certificates of software management skills earned for training in software alterations performed by EDS/Perot Systems of client software. Manually sorted some claims from the print room for special handling using SSI and SMS patient accounting and insurance billing. Certificates earned in HIPAA training.

Government Biller 2003Primestaff, LLC. – Catholic Healthcare West Phoenix, AZChildren’s Rehabilitative Services billing and collections using Rehab Manager set the standing record for highest dollar amount ever collected from Children’s Rehabilitation Services (CRS.) Managed multiple other claims groups which required special handling for Children’s Protective Services, Healthcare Mandate, cyclical claims which needed special calculations of hourly services, observation and monitoring. Performed follow up with select groups of healthcare payers in multiple states with multiple payers such as Victims of Crime and Border Children’s Health and a variety of charity payers also performed international collections. SSI and SMS were used for patient accounting and insurance billing.

Patient Account Representative 1996- 2002 Banner Health Systems Phoenix, AZPromoted twice, first from cash posting department to Medicaid (AHCCCS) billing and collections for review and completion of registration records as needed, developed expertise with insurance contact, patient record corrections and cash payments at the time of registration then promoted to Medicare secondary billing reviewed admitting information for coordination of benefits. We used DDE as well as hard copy follow up methods, utilized Docuware for image scanning and records management which

Joseph W. Leeincluded the upgrade from a Microfiche system. Multiple facilities’ claims in different states were processed using Healthquest, MSAP, SSI, Medifax, telephone and hard copy documentation.

Administrative Support Clerk 1996 Temporary Employment Service - Samaritan Health Systems Phoenix, AZBalanced bank deposits to patient accounts with outstanding balances for multiple hospitals with a team of 20 people using both digital and hard copy records. Reviewed registration records for patient identities, insurance coverage and account balances and properly distributed bulk insurance payments to patient accounts. This cash posting function was performed with diligence and expertise within a group of 10-12 people then some of us were rewarded with an offer of permanent employment and a rewarding career change. Healthquest and MSAP were used for this assignment.

Administrative Support Clerk 1996 Temporary Employment Service - American Red Cross Phoenix, AZData entry for the transfer of inventory records to a computer system in California.

EDUCATION

Some College Coursework Completed, 147 college credit hoursColorado Technical University Online, CTU, Colorado Springs, CO

Bachelor of Science in Business Administration Healthcare Management Current student projecting graduation date September 2015, current GPA 3.58

Some College Coursework CompletedComputer Science, UTEP, El Paso, TX

27 credit hours, April 1994

Computerized Office AdministrationVideo Technical Institute Business Computer School, Dallas, TX

Diploma, April 1984, 3.8 GPA