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Click here or scroll down to respond to this candidateCandidate's Name
Phone: PHONE NUMBER AVAILABLE Email: EMAIL AVAILABLELeader/Analytical / Results DrivenResults-driven Revenue Cycle Manager with 15 years of experience in optimizing revenue streams, enhancing financial workflows, and ensuring regulatory compliance. Proficient in streamlining billing processes, managing accounts receivable, and implementing performance improvement initiatives. Demonstrated ability to lead cross-functional teams and collaborate with key stakeholders to achieve organizational goals. Committed to maximizing revenue growth and ensuring financial stability for healthcare organizations. Skilled experience includes but not limited to; Microsoft Office, Citrix, Healthport, Soarian Financials, Cerner, NFuse, Souvera, Power Works, SSI, HMS, CredentialLink, MediTech, NextGen Georgia MMIS, Epic, Relay, AS400, WayStar, Availity, E-Services, UHC, FACS, Direct Data Entry Palmetto GBA, ICD 9, ICD 10, Electronic Medical Records, eClinicalworks, HIPPA, Payment Variance and Posting.Professional ExperienceUHS OF SUMMITRIDGE HOSPITAL LAWRENCEVILLE, GA 1/2020 PRESENTLYRevenue Cycle ManagerReport on key metrics such as cash collections, days outstanding, unbilled, denials, etc., in conjunction with the CFO. Establishes, reconciles, and maintains controls for all cash collected and posted in Patient Accounting system.Implemented a new revenue cycle management system that streamlined billing operations and increased clean claim rates by 25%, resulting in annual savings of $1.5 million.Optimized the denial management process, reducing denial rates by 30% and improving cash collection by $2 million within the first year and successfully reduced accounts receivable days by 15%, increasing cash flow by $3 million and significantly improving the overall financial health.Maintains current working knowledge of medical billing and coding, HCPCS, CPT and ICD 10 codes, required modifiers, and encounter data. Working knowledge of Medicare, Medicaid and Managed Care insurances for inpatient and outpatient in the Critical Care Sector as well as Behavioral Health.Evaluate daily workload and create work assignments for the team. Make recommendations to management on strategies for improving internal processes that maximize productivity and quality of work.LAKEVIEW BEHAVIORAL HEALTH NORCROSS, GA 11/2019 4/2023Credentialing Specialist - PRNExecuted licensure and credentialing processes for new and existing providers including but not limited to obtaining or requesting required documentation from various third-party sources and regular communication with appropriate state board representatives and the Field Management Team.Coordinated, conducted, and documented required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements.Identified, investigated, reported, tracked and followed-up on all potentially adverse information received from credentialing sources according to established guidelines, and forward to Risk Management and Medical Director for review.Processed all practitioners under the terms and conditions of the entities agreement, including files credentialed through a Certified Verification Organization (CVO).Candidate's Name
LAKEVIEW BEHAVIORAL HEALTH NORCROSS, GA 4/2019 1/2020Revenue Cycle ManagerImplemented a streamlined revenue cycle process, resulting in a 15% reduction in outstanding accounts receivable and a 10% increase in cash collections within the first 90 days.Conducted a comprehensive analysis of payer contracts, identifying opportunities for renegotiation and ultimately increasing reimbursement rates by an average of 8% across all major payers.Led a cross-functional team to optimize the charge capture process, reducing charge lag by 72 hours and improving charge accuracy by 95%, contributing to a $2 million annual increase in net revenue.Developed and implemented key performance indicators (KPIs) and reporting tools for the revenue cycle team, leading to a 20% improvement in productivity and a 25% reduction in denials over a six-month period.EMORY DECATUR HOSPITAL DECATUR, GA 12/2015 TO 4/2019Medicare/Medicaid Billing SpecialistCollaborated with team members daily to successfully improve the efficiency of the billing process. Reduced receivable aging for assigned customers by 30% within 30 days of hire. Expedited the development procedures for clearing rejected claims and managed implementation of new contracts.Conducted reporting on Medicare/Medicaid EFT as well as corrected all returned provider claims through FISS.Completed daily billing for over 125 Government, Medicare, Medicare Managed Care and Medicaid claims. Followed up and responded to all inquiries regarding the payers pertaining to eligibility, coordination/explanation of benefits and payments.NATIONAL VISION INC LAWRENCEVILLE, GA 6/2012 TO 12/2015Billing Analyst IICollaborated with the Payroll, Finance, Client Services, and other internal teams to gather data related to billing issues and work with the Billing Specialists for proper resolution.Designed and Implemented billing processes to ensure invoices reflect terms and conditions agreed to by the organization and comply with governmental rules and regulations.Developed Quantity and Quality Access Database check system that reduced the error rate from 35% to less than 3%. Increased contract volume by processing 3,000 claims monthly.EducationSouth Carolina State UniversityBachelor of Science BS Electrical and Electronics EngineeringAug 2007 May 2012 |
