1. CAROLYN JAMES
4519 Marquis Ave
Baytown, TX 77521
281-840-8312
PROFESSIONAL EXPERIENCE
Nephrology PA April 2014 – Present
Practice Manager
 Managed all aspects of multi-physician medical practice and office logistics from physician-employee-
patient scheduling, network connectivity (e.g., satellite office, laboratory) billing, insurance, physician
contracting with insurance companies-independent physician associations-hospitals, purchasing, marketing,
payroll, reconciling practice financials for accountants and financial advisors.
 Acted as a liaison between the physician, employee, and patient in a clinical setting and business setting.
 Responsible for renewing and maintaining records for physician's federaland state licensures. (e.g.,DEA,
Texas controlled substance,state medical license, malpractice insurance, long term/disability insurance)
 Developed and managed practice's in house billing and collections department increasing revenue from
deficit to over 100% accounts receivable in 1 year of management, maintaining a 98-99% AR annually.
 Implemented and ensured state and corporate regulatory policies and procedures into daily office practices,
informing and training staff members. (e.g.,HIPPA,Red Flag Rule, OSHA,ClLIA,EPIC, EMR’s)
 Optimized patient/physician /employee scheduling and time to best increase profits and accounts
receivables. Recognized the value of utilizing specialized treatments to increase revenue and high standard
of patient care.
 Managed Daily Close to include overseeing patient demographics, charges,insurance payments, and
patient payments.
 Balanced daily close by generating end of day reports against employee batches.
 Supervised billing department, front office and medical staff of 13 employees. Conducted employee staff
meetings and performance evaluations in effort to increase productivity.
 Responsible for corporate accounts payable. Reconciled and balanced financial corporate accounts working
with practice financial accountants and advisors.
 Implemented and managed employee healthcare benefits, and 401K with accountants and financial
advisors.
 Implemented a connectivity payroll system to track employee work hours, trends and scheduling.
 Proficient in QuickBooks, Excel, Word, Power Point, pdf file conversion, CPT, ICD-9 insurance billing.
 Started out as a consultant for the meaningful use and PQRS reporting process.
Digestive Health Center – Pasadena, TX Jan 2012 – Dec 2014
Practice Administrator/Business Manager
 Observation of performances of 22 employees, monitoring the procedures and policies practiced by the
organization, maintenance of financial sector and cash flow of the organization, regular administrative and
technical practices of the organization, evaluating and figuring out of office supplies and inventories,
providing good assistance for the organization team, physician, physician assistants and other employees to
bring better results, arranging for conferences, meetings, maintenance of customer care services and lot
more.
 Managed heavy daily patient volume including telephone triage, appointment scheduling, and patient
referral.
 Proficient in all documentation/record maintenance/paperwork to ensure accuracy and patient
confidentiality.
 All areas of major and minor surgical procedures performed in hospital environment.
 All personnel staff including professional, clerical, administrative, and clinical staff.
 Front desk & billing staff and related support staff including front desk coordinators, night front desk
coordinator, insurance verification coordinator and billing specialists.
Medical Edge Healthcare – Dallas, TX Jun 2006 – Jan 2012
Nursing Home/Hospital Collections /Assistant Director

2.  Assists Sr. Vice President-Billing Operations, Director of billing operations in developing long-range plans
and policies and procedures, implementing specific programs such as the Medaptus systems for Hospital
providers, maintain production, and make sure that the proper procedures are used, and solving problems.
 Selects and trains office staff for billing, evaluates their performance, approves merit increases and
promotions within the department, and monitors all disciplinary actions of staff in their assigned job duties.
 Prepares and monitors the daily work flow within the department, budgets, expenditures, billing
procedures, compliance with billing standards.
 Develop and implements cost-effective policies and procedures for the NH/Hospital department. Evaluates
staffing needs, approves staffing additions, and develops plans to meet staffing needs of each provider.
 Currently working on IDX Groupcast system, Centricity Group Management systems.
Medical Edge Healthcare – Dallas, TX Feb 2005 – Jun 2006
Medicare Insurance Follow up Consultant Manager
 Travel from location to location reviewing outstanding insurance claims.
 Contact insurance carriers for resolutions prior to patient billing. Reviews all rejected claims and appeals
when appropriate.
 Contact patients for updated insurance information when necessary and makes adjustments to patient
accounts as required. Pull Nursing Home & Hospital super bills to assure correct billing.
 Corrected and repost billed charges.
 Assure correct coding of Hospital and Nursing Home claims. Currently working on IDX Groupcast system,
Centricity Group Management systems.
Bottom-line Management/BLM – Erie, PA Jan 2003 – Jun 2006
Traveling Medical Consultant Manager/CHW Hospitals
 Travel to duff, hospitals and Dr's offices and Manage and get under control the AR & Negotiate Contracts.
 Work with all Insurance Plans (HMO and PPO) making sure that the insurance companies comply with the
contracts. I also call the insurance companies and work out contract discounts.
 Negotiate Contracts.
 Review delinquent account and determine the actions required.
 Discuss and review collection activity regularly with Collections Manager. Monitor 1st payment defaults
and non-sufficient funds items. Monitor overall account activity for collection effectiveness.
 Distribute workload to staff to ensure adequate coverage for all accounts.
 Maintain collection logs as needed.
 Review repossession requests with Collections Manager.
 Review and resolve problem accounts, skip accounts, and insurance issues.
Diversified Health Care – Richardson, TX Mar 2001 – Jan 2003
Medical Collections Manager
 Negotiate Contracts
 Review delinquent account and determine the actions required
 Discuss and review collection activity regularly with Collections Manager
 Monitor 1st payment defaults and non-sufficient funds items
 Monitor overall account activity for collection effectiveness
 Distribute workload to staff to ensure adequate coverage for all accounts
 Maintain collection logs as needed
 Review repossession requests with Collections Manager
 Review and resolve problem accounts, skip accounts, and insurance issues
 Coordinate charge off activity with loss recovery
 Continually evaluate and enhance workflow to implement Collection best practices
 Achieve satisfactory ratings regarding compliance collection practices to include Right to Privacy Act
 Familiar with physician billing and follow-ups for a collections position. HMO, PPO, 3rd party, workmen's
comp.
Dr. Sara Tranchina – Dallas, TX 1998 – 2001
Practice/Office Manager

3.  Manage and maintain clinic productivity through effective management practices in accordance to
established policies and procedures.
 Manages all recruiting efforts for clinical staff including selection, interviewing, training, and orientation
Monitors and evaluates staff performance for quality purposes in addition to awarding merit increases,
promotions, disciplinary actions and maintains appropriate personnel documentation Organizes staff daily
work activities and schedules at multiple locations.
 Establish and implement goals, objectives, policies, clinic procedures and systems for assigned
administrative areas.
 Supervise billing process including credits, fees, and collections for accuracy and timely entry.
 Monitors and controls clinic expenditures, reviews and approves all invoices and maintains supply
inventory. Assures that all equipment is maintained in good repair or is replaced as needed and monitors
building for cleanliness.
 Supervises the creation, disposition, delivery and filing of medical charts and x-rays in a timely manner.
Monitors appointments, patient flow and waiting areas to improve daily productivity.
 Ensures that patients and visitors are treated courteously by all clinical staff.
 Resolves patient complaints, Ensure federal and administration compliance for quality patient care,
 Additional duties may be assigned.
 Managed projects involving information systems and strategic of operations.
 Overseen front desk administrations.
 Responsibilities include supervising clerical staff, patient scheduling, insurance authorizations and
verifications and other related duties.
 Set the doctor's up with the insurance plans so that the doctors can accept the patients that carry the
insurance.
Baylor Medical Center – Dallas, TX 1991 – 1999
Collections Supervisor
 Negotiate Contracts
 Coordinate repossession activity with remarketing
 Coordinate charge off activity with loss recovery
 Communicate with RBC Collections Manager regularly regarding collection/delinquency tends, accounts in
queues and problem accounts
 Continually evaluate and enhance workflow to implement RBC/Collection best practices
 Achieve satisfactory ratings regarding compliance collection practices to include Right to Privacy Act
 Ensure maintenance of up-to-date online documentation for all accounts
 With the assistance of the RBC Collections Manager, conduct regular performance reviews with staff * 2-4
years collections experience
 Familiar with physician billing and follow-ups for a collections position. HMO, PPO, 3rd party, workmen's
comp.
SKILLS
At least 5 – 10 years of experience that is directly related to the duties and responsibilities specified, Six
Sigma Black Belt for over 8 years, have great Call Center Supervisor Experience, able to manage 15-30
employees and Understanding of ACD metrics, KPI Reporting and Improvement Programs, experienced in
all aspects of physician/healthcare management. Supervising and coaching staff on inbound phone calls
from patients, answering questions about the patient’s statements and accounts. Heavy inbound customer
service calls center, strong healthcare background, financial experience, and ability to make decisions,
strong organizational skills, knowledge of the Medical insurance industry, Customer service oriented, Team
player and collaborative, Enjoy challenges, Strong verbal communication skills, Ability to negotiate
Medical Contracts Typing Speed: 50 Words Per Minute, Apple/Macintosh Computers, IDX Groupcast
system, Centricity Group Management, Database Software (Oracle, Access, etc), Email Software (Outlook,
etc), Internet Browser (Netscape, IE, etc), Networking/LAN Software (Novell, etc), Peripheral Devices
(Scanners, Printers, etc), Personal Computers, Presentation Software (PowerPoint, etc), Spreadsheet
Software (Lotus, Excel, etc), Word Processing Software (MS Word, etc), Medical Assisting; Medical

4. Coding; Medical Records; Medicare: Nursing work; Bookkeeping; Auditing; Credit Specialties; & Payroll
Work. The ability to meet and exceed company set goals.
EDUCATION
Silver leaves Medical Center – Garland, TX 1990 – 1991
Nursing Assistant
McKinney Educational Center – McKinney, TX 1990 – 1991
Medical Management
El Centro College – Dallas, TX 1991 – 1995
Business Management