MILLERBRADLEY D., M.Ed, CPC
97 Walnut Street - Mansfield, MA 02048
508-339-5645
ajbradm@verizon.net
PROFESSIONAL EXPERIENCE:
Harvard Pilgrim Healthcare, Quincy, MA June 2008 – Present
Payment Strategy Analyst
Recruited to ensure effective service levels by researching appeals for previously denied claims to determine if the denial is valid or provide understandable rationale for when it is not. Liaise with internal decision-makers including Benefits, Provider Relations, Medical Management, Configuration (IT), Reimbursement and Customer Service departments to develop customer-friendly programs, identify/resolve internal delivery issues and provide individual/group training as needed for quality.
Review facility and provider appeals including unlisted code pricing within a 5-day turnaround time.
Research and identify cost saving opportunities to develop new payment policies that will align company with local and national competitors.
Oversee proposal, adoption and implementation of new payment policies; review and edit existing payment policies.
Manage the quality review process of all new policies through UAT (User Acceptance Testing) and 90-day post-policy implementation testing.
Working knowledge of ICES software application using KB (knowledge base) and Ingenix rationale module to source claim edits.
South Shore Hospital, South Weymouth, MA March 2003 – May 2008
Lead Outpatient Coder
Managed staff of 14 coders.
Conducted weekly coder trainings for educational and exam preparation purposes.
Researched all denials and made changes/additions as appropriate.
Responsible for all edits, adding modifiers into all locations to decrease write-offs and to help revenue cycle.
Provided technical support to the Outpatient Coding Staff
Provided Coding Manager and Director with departmental statistics on outpatient coder productivity and un-coded figures and identified any other coding issue
Primary contact with outside departments for outpatient coding related issues.
Newton Wellesley Hospital, Newton, MA Nov 2001 – Feb 2003
Coder/Abstractor
Interpreted documentation and assigned proper ICD-9CM and CPT codes.
Provided coding support as directed by the Coding Manager.
Consulted with physicians to clarify medical record information.
Coordinated and distributed the coding staff claim denials.
Credit Control Services, Newton, MA Nov 1998 – Oct 2001
Charge Entry Manager
Prepared, reviewed and charged batches for Brigham and Women's Hospital Anesthesia Department.
Interacted with patients, insurers and medical office staff to resolve billing issues
Managed staff of 10 charge processors.
Responsible for training new employees in IDX.
Quality control for all new entries in system.
EDUCATION:
University of Massachusetts, Amherst, MA May 1991
Bachelor of Arts in Communications
Bridgewater State College, Bridgewater, MA May 1994
Masters in Elementary Education
Fisher College, Attleboro Falls, MA June 2002
Medical Coding Certificate Program
97 Walnut Street - Mansfield, MA 02048
508-339-5645
ajbradm@verizon.net
PROFESSIONAL EXPERIENCE:
Harvard Pilgrim Healthcare, Quincy, MA June 2008 – Present
Payment Strategy Analyst
Recruited to ensure effective service levels by researching appeals for previously denied claims to determine if the denial is valid or provide understandable rationale for when it is not. Liaise with internal decision-makers including Benefits, Provider Relations, Medical Management, Configuration (IT), Reimbursement and Customer Service departments to develop customer-friendly programs, identify/resolve internal delivery issues and provide individual/group training as needed for quality.
Review facility and provider appeals including unlisted code pricing within a 5-day turnaround time.
Research and identify cost saving opportunities to develop new payment policies that will align company with local and national competitors.
Oversee proposal, adoption and implementation of new payment policies; review and edit existing payment policies.
Manage the quality review process of all new policies through UAT (User Acceptance Testing) and 90-day post-policy implementation testing.
Working knowledge of ICES software application using KB (knowledge base) and Ingenix rationale module to source claim edits.
South Shore Hospital, South Weymouth, MA March 2003 – May 2008
Lead Outpatient Coder
Managed staff of 14 coders.
Conducted weekly coder trainings for educational and exam preparation purposes.
Researched all denials and made changes/additions as appropriate.
Responsible for all edits, adding modifiers into all locations to decrease write-offs and to help revenue cycle.
Provided technical support to the Outpatient Coding Staff
Provided Coding Manager and Director with departmental statistics on outpatient coder productivity and un-coded figures and identified any other coding issue
Primary contact with outside departments for outpatient coding related issues.
Newton Wellesley Hospital, Newton, MA Nov 2001 – Feb 2003
Coder/Abstractor
Interpreted documentation and assigned proper ICD-9CM and CPT codes.
Provided coding support as directed by the Coding Manager.
Consulted with physicians to clarify medical record information.
Coordinated and distributed the coding staff claim denials.
Credit Control Services, Newton, MA Nov 1998 – Oct 2001
Charge Entry Manager
Prepared, reviewed and charged batches for Brigham and Women's Hospital Anesthesia Department.
Interacted with patients, insurers and medical office staff to resolve billing issues
Managed staff of 10 charge processors.
Responsible for training new employees in IDX.
Quality control for all new entries in system.
EDUCATION:
University of Massachusetts, Amherst, MA May 1991
Bachelor of Arts in Communications
Bridgewater State College, Bridgewater, MA May 1994
Masters in Elementary Education
Fisher College, Attleboro Falls, MA June 2002
Medical Coding Certificate Program