Alain Sergile

Alain Sergile is technically savvy, driven, and dynamic management professional delivering the highest quality of systems training, implementation, revenue cycle management, system support, and billing expertise. She is a champion in utilization of various applications and tool and is able to analyze needs, support project implementations, and impact processes from concept to completion.

Some of her career highlights:

1. Expertise in implementations, billing, ICD-9 and CPT coding guidelines; professional with excellence in supporting operations and training.
2. Proactive collaborator and communicator with demonstrated record of building rapport with peers, coworkers, and management.
3. Excellent in the mechanism, maintenance, and classification of Medicare RBRVS-based codes, HCPCS Level I & II codes as related to the physician payment system.
4. Driven professional with a track record in supporting staff teams to deliver excellence in office administration and records management and processing.
5. Keen analyst who excels at identifying and resolving coding and billing problems. Track record of excellence managing staff teams to deliver excellence in claims and revenue management.
6. Goal-oriented, calm, patient and dedicated professional, with experience in the records management, client services, program support, and scheduling/planning.

Her Role as PROVIDER REIMBURSEMENT ANALYST included:

Conducted analysis, research, and consulting on standard practitioner and ancillary fees schedules.
Oversee standard reimbursement/data analyses
Lead network development contract negotiations.
Managed fee schedule approval process for assigned fee schedule types.
Perform industry and systems research.
Direct customer training needs.
Facilitate all pre-implementation contract rate review/analysis and provide first-level approval on standard rate exhibits.
Spearheaded credit collections, patient accounting, reporting, A/R, and billing.
Identified and resolved complex inquiries.
Led 3rd party hospital billing including accurately claim submissions, follow-ups on claim rejections, resolving complex billing issues, self-pay credit balances and insurance overpayments.
Maximized self-pay payments by making outgoing collection calls.
Communicated with Supervisor and other departments.
Updated health insurance information.
Meticulously initiated billing to insurance companies including HMOs, PPOs, Medicare, Medicaid, and commercial.

Technical Skills:
MEDITECH, IDX, BICS, MMIS, NEHEN, Outlook