BEATRICE LYNNE KASCHAK
Fleming Island
Summary
Dynamic Operations Claims Manager specializing in developing strategic goals and improving operational efficiency within healthcare billing. Expertise in compliance management, team mentoring, and fostering strong vendor relationships, resulting in enhanced workflow and revenue integrity.
Overview
19
19
years of professional experience
Work History
Operations Claims Manager
Ascension/St. Vincent’s Specialty Practices
Jacksonville
12.2020 - Current
- Ensured compliance with applicable laws, regulations, policies, and procedures for claims processing.
- Reviewed and approved complex claim settlements within policy guidelines.
- Facilitated staffing activities including hiring, training, evaluations, and educational initiatives.
- Trained team members to maintain high productivity and performance metrics.
- Monitored objectives to evaluate workflow effectiveness while facilitating training and mentoring.
- Facilitated team meetings to discuss complex cases, share best practices, and coordinate multi-disciplinary response strategies.
- Conducted meetings to discuss issues and find pertinent solutions to problems.
- Ensured compliance with all applicable laws, regulations, policies and procedures related to claims processing.
- Monitored objectives to determine effectiveness of workflows, facilitating training, and mentoring for improvement.
- Provided technical support to staff members regarding system upgrades or changes in procedure.
- Conducted regular audits of the department's performance metrics to ensure accuracy.
- Managed team members effectively to meet high production standards with accurate results.
- Analyzed data from previous claims to identify trends and areas for improvement.
- Developed procedures to streamline the claims process, improving overall efficiency.
- Resolved escalated customer issues by providing effective solutions in a timely manner.
- Motivated team members to maintain targeted turnaround time to obtain processing goals.
- Prepared detailed reports on claim status and activities for management review.
- Implemented process improvements to streamline claims review workflows.
- Coordinated communication between insurance companies and healthcare teams.
- Developed training materials to enhance staff knowledge of claims processes.
- Analyzed claim data to identify trends and areas for improvement.
- Trained and mentored staff on best practices for claims handling.
Billing Coding Supervisor
Ascension/St. Vincent’s Family Medicine Center Residency
Jacksonville
07.2015 - 12.2020
- Managed billing/coding staff performance, enhancing staff satisfaction and resolving conflicts.
- Analyzed and managed denials to ensure timely resolution of claims in HOLD buckets and reports.
- Provides billing education to staff ensuring regulatory and compliance billing guidelines followed.
- Audits provider and billing staff charges for accuracy, reviews CPT & diagnosis code edits.
- Assists patients with escalated billing concerns and engages with various payor provider relations for claim denial issues for resolution.
- Led billing staff, fostering team building and updating billing policies, procedures, and guidelines.
- Ensures new CPT codes entered in fee schedule for proper billing, compliance.
- Tracked billing and collection activities to ensure operational efficiency.
- Trains new billing staff, conducts E/M provider audits, provides education.
- Participated in DYAD committee to improve process workflows.
- Works with credentialing JOC teams for claim denial issues with payers.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Accurately selected proper descriptive code when more than one anatomical location indicated.
- Verified signatures and checked medical charts for accuracy and completion.
- Manages deliverables ensuring timeliness (charge entry lag) and goals achieved meeting metrics for billing/coding tasks in processing claims.
Billing Coding Trainer
Ascension/St
Jacksonville
07.2014 - 07.2015
- Provide support/education in Billing/Coding to multiple Primary Care offices, trained staff and management the proper billing procedures, and workflow.
- Provided training to improve staff and provider competency in billing and coding practices, enhancing overall operational effectiveness.
- Reviewed claim denials for accuracy, ensuring correct diagnosis and procedure codes to support timely reimbursements.
- Resolved reimbursement issues to achieve complete adjudication of claims, consistently meeting payer guidelines.
- Researches, interprets commercial carrier and government payer rules, regulations, and method to ensure proper billing in reducing A/R cycle.
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Conducted day-to-day tasks accurately and efficiently.
Practice Office Manager
St. Vincent's Internal Medicine Primary Care
Jacksonville
05.2012 - 07.2014
- Coordinated clinical and administrative flow to ensure maximum efficiency in providing excellent care.
- Managed physician schedule and facilitated staff training sessions to enhance operational workflow.
- Ensured staff members excel in achieving their goals.
- Manage time and attendance, payroll, approve time off.
- Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
- Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.
- Ensured medical instruments were in optimal condition for use.
- Created and managed purchase orders for office and medical supplies.
- Scrub claims to ensure proper coding, ensure office policies and procedures are adhered by staff.
- Capture daily, weekly copay reports, and other reporting data for practice workflow.
- Maintained records of physicians' licensure and staff requirements, fostering high performance and strong relationships with staff, physicians, and community within the Ministry.
- Oversees office inventory activities by ordering and requisitions, stocking, and shipment receiving.
- Coached new hires on company processes while overseeing employee performance to maximize productivity.
- Evaluated employee records and productivity to complete employee evaluations.
Charge Coding Auditor Lead
North Florida Cancer Specialist
Jacksonville
10.2007 - 05.2012
- Obtained authorizations and pre-certifications for chemotherapy plans per medical policy guidelines, ensuring timely therapy initiation.
- Secured prior authorizations for chemotherapy and non-chemotherapy oral medications from insurers, streamlining communication with pharmacy department.
- Identified and resolved discrepancies in lab and Pyxis reports, reconciling scheduled chemotherapy infusions and completing coding and charge audits within 24 hours.
- Audited daily schedules against procedure counts in EMR and PM systems, ensuring accurate billing of claims.
- Checked insurance benefits and authorizations prior to each therapy session.
- Logged drug authorizations into patient charts utilizing electronic medical records.
- Reconciled daily schedules with pharmacy Pyxis and lab error reports, creating organized folders for documentation.
- Reported discrepancies to director and facility site manager, collaborating with EMR support team.
Education
Billing Certification -
AAPC
Jacksonville, FL01-2009
CPMA - Certified Professional Medical Auditor
AAPC
Jacksonville, FL01-2009
AA - Paralegal
Florida Community College of Jacksonville, Jones Business College
01-1988
Law Studies - Paralegal
Jones College
Jacksonville, FLLean Green Belt -
Six Sigma
Skills
- Claims processing
- Revenue cycle management
- Certified professional coder expertise
- Regulatory compliance
- Claims auditing
- Risk management
- Reporting analysis
- Error resolution
- Strategic planning
- Performance management
- Goal achievement
- Team leadership
- Staff onboarding
- Collaboration and teamwork
- Time management
Timeline
Operations Claims Manager
Ascension/St. Vincent’s Specialty Practices
12.2020 - Current
Billing Coding Supervisor
Ascension/St. Vincent’s Family Medicine Center Residency
07.2015 - 12.2020
Billing Coding Trainer
Ascension/St
07.2014 - 07.2015
Practice Office Manager
St. Vincent's Internal Medicine Primary Care
05.2012 - 07.2014
Charge Coding Auditor Lead
North Florida Cancer Specialist
10.2007 - 05.2012
Billing Certification -
AAPC
CPMA - Certified Professional Medical Auditor
AAPC
AA - Paralegal
Florida Community College of Jacksonville, Jones Business College
Law Studies - Paralegal
Jones College
Lean Green Belt -
Six Sigma