| Candidate Information | | Title | Revenue Cycle Management | | Target Location | US-GA-Atlanta |
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Click here or scroll down to respond to this candidateACCOUNT RECEIVABLES PROFESSIONALAn accomplished and talented professional with a comprehensive background in healthcare Revenue Cycle Management (RCM), in hospital/physician billing, and collections management, with a proven track record. Ive Expel great communication to work across various areas in the healthcare system to generate solutions for varied business gaps. Someone who applies creative critical thinking and strategic planning skills to my current role, while aligning with the mission and values of my organization for operational effectiveness.Core Competencies Systems Management SkillsProficient MS Word/Excel/PPTKnowledge ICD-9/CPT/HCPCsMedicare Rules and RegulationsDRG ReimbursementProficient: MS Pivot, VLOOKUPRev Cycle Pro, Medicare Mgr.Contract ManagementDenial ManagementEPIC/AllscriptsMeditech Expanse 61Xactimed/Elcomp/SMS/MedisoftWaystar/ Change HealthcareePremis/Change HC/One SourceGammis Portal/FISS-DDEFinthrive Contract ManagerBilling: NThrive, XClaimsEligibility: One source, NaviNet, AvailityLeader/Mentor, Performance FocusAnalytical/AccurateChange ManagementExemplary CommunicatorDedicated / Organized / MotivatedCommitted to ExcellenceResult OrientedVendor ManagementBudget ManagementPROFESSIONAL EXPERIENCEAntheneum February 2024 PresentRCM Consultant, London, United KingdomProvide Revenue Cycle knowledge to various clients oversees to bridge any gaps to overcome any complex project challenges for billing, cash posting, authorization, and coding issues. Serves as a subject matter expert for documentation issues, policy and facilitation of solutions.Respond to business problems for revenue cycle management that includes, building and structuring an AR team, coding essentials, billing clearinghouse functions, reporting, and requests to the client.Ensure to give the most valuable knowledge with clear and precise information for various healthcare market, such as, CDI dynamics, outsourcing, customer service, and selection of insurance markets.Tracks and document work performed and adhere to status reporting expectations.Engage in hourly meetings to help develop a business opportunity to effectively create a business process for a favorable outcome.Identify opportunities for improvement of existing and/or new information to drive value for the RCM platform.Provide high standards of healthcare billing, coding, denial management, and EMR information to clients to assist in making business decisions.Engage in additional specific duties related to the project aa may be required and dictated by individual client these functions are documented on a per-contract basis in the clients state of work.Acclara RCM Solutions a Tegria Company (Remote) August 2022 August 2023Director of Insurance Services, Steward Healthcare, Miami RegionProject: New Acquisition of 5 Miami Hospital AR Start upProvided executive leadership, oversight, and direction for both hospital and physician accounts. Reported the growth and effectiveness of the AR given for billing and collections. Led a team of 48 employees. The AR responsibility was for accounts 180+ days inhouse and offshore vendor (appeals and AR collections for 300+ days.). New start up hired all employees. And created policy and procedures for operational processes for both inhouse and offshore vendor.Within 2 months reduced the AR aging 180-220 days by $25M.Created key indicator reporting for the vendor bi-weekly reporting.; which included reporting information along with inhouse key indicators for financial reporting to leadership.Conducted weekly meetings with vendor to follow-up on outstanding accounts, reports, or any questions for follow up.Reviewed vendor and inhouse team quality and production for any improvement needed to accomplish collection goals.Established key indicators for concurrent focus on legacy accounts and current AR.Developed a matrix for trending denials, correspondence, and refunds to assure critical review is established.Continuous daily interpretation of dashboard items for process flow and reporting.Report to leadership weekly daily operations, implementation, aging, collections, & financial management.Displayed executive level experience leading reimbursement and regulatory reporting for multiple facilities.Demonstrated strong analytical skills enabling complex issues to be rapidly understood and presented.Worked collaboratively with all department stakeholders on improvement to provide education cross functionality, in addition to reporting AR statistics to senior leadership.Tegria Consulting Group (Remote) May 2022 August 2022Billing Manager Consultant, Arrowhead Medical Center, Colton, CAProject: Epic System Optimization.Responsible for establishing key performance indicators that will support the organization goals for reimbursement. Reviewed dashboard, CFB and watchlist items to give additional support for Hospital and Physician Billing reimbursement, quality review and process flow implementation. Prioritized work queue functionality, assignment distribution, and work performance to resolve accounts timely and for proficiency.Established productivity and quality standards for Billing and Collections to increase reimbursement.Created several processes flows that supports Epic review and next steps for department reviews.Trained staff on Epic flow processes, how Billing Indicators works, how and why to transfer/add accounts to work queues for review, interpreting and understanding various categories in history comments for both Billing and Collections.Worked with the clients cross-functional internal IT teams and vendors to troubleshoot technical and functional issues to resolution.Ensured system changes follow change management procedures and protocols, creating and maintaining all documentation for all assigned applications, and developing, planning, and executing testing for supported applications.Worked with cash posting department in posting paper checks and creating a process flow improvement.Conducted work queue (68) reviews to help delineate unnecessary work queues and tweak existing to capture all accounts.Reduced dashboard Watchlist of accounts for placement in work queues. These accounts are not in work queues and or status as user error or work queue needed to tweak or created to support the accounts in this area. Created a how to process flow to work these items to be visible for collections and/or billing to drive reimbursement.Created a staffing analysis for the Collections department to meet the staffing needs of inflows and outflows of the existing work queue volumes.Effectively, worked with the build team to establish Client Billing in Epic, RTE functionality for California IPA reporting and county codes.Provided an operational financial report for ARMC to actively operate in an optimal high level.Caduceus USA Atlanta, GA May 2022 August 2022Director of Operations (3 mo. contract)Performed operational focus on account receivables process flow for collections, billing and posting process improvement for increased reimbursement for the Revenue Cycle Management (RCM) team with inhouse and offshore teams. Maximized reimbursement and deliver actionable insights into the financial health of the clinic.Improved Inhouse collections by 45% and better for Aging accounts 151-300 days by improving processes, procedures, and reporting.Improved Offshore collections by 15% and aging @ 300 days by improving processes, procedures, and reporting.Constructed a timeline for RCM stabilization for both inhouse team and Offshore client. Provided layered support and ownership of the Customer patient accounts on an interim basis to bring key performance indicators within designated benchmark ranges.Restructured the offshore to have designated personnel to provide immediate support in resolving outstanding accounts and addressing root cause issues for authorization, collections, and cash posting.Corresponded with the offshore team weekly to discuss operational activities to support in the reduction on open AR accounts.Assigned and prioritized patient accounts work associated with uncollectible AR.Supported follow-up activities to prioritize incoming work on the work queues and drive cash collections.Paired with Leadership, provided guidance on the structure and staffing levels in the Patient Accounts department so that the team can operate optimally after engagement ended.Provided system training and process and procedure documents on how work queue usage, billing claims, cash posting and utilization of the charge master to help resolve denials.Created a training plan development for rapid billing and collections work down given upper leadership support.Mayo Clinic (Remote) Rochester, Minnesota Aug 2021 May 2022Senior Hospital ManagerManaged hospital and physician claim operations with a team of 150 employees with 4 direct reports (2 Supervisors, 2 Sr. Operational Analyst). Responsible for the development and execution of claim operations strategies, end-to-end claim process automation, Epic optimization and management utilizing data to improve quality and minimize process cost while developing employee one touch concept. Provide direction for the Mayo Transplant Enterprise (Florida, Minnesota/Arizona) billing, collections, and compliance for transplant claims managing a $320M Accounts Receivable.Accomplished AR reduction within 4 months for billed and unbilled AR by $115M ($35M Billed/$80M unbilled) across the enterprise. This reduction is reported to be the lowest reduction for Billed and Unbilled AR for 2021.Provide professional supervisory direction to staff and teams in understanding their need to help develop workflows for work queues for Revenue Cycle.Prepare, compile, and approve the annual Medicare Cost Report.Ensure regulatory and organizational compliance for billing guidelines.Apply appropriate knowledge for Hospital and Physician Billing system for EPIC functionality.Recruit, hire and develop employees understanding of job details, process and procedure during the onboarding process.Perform management functions responsibility to translate the department vision into meaningful and effective results.Re-establish key performance indicators to help manage effectively and report the scope of work, staff, and outcomes.Establish a working relationship and collaboration across business units and key stakeholders to align business objectives, such as, the internal MSU for cost reporting and Medicare claims compliant submission and IT for development and advancement for automation.Update 5 process improvement for billing and collections across Mayo Enterprise for transplant to ensure timely completion and outcomes, alerting executive level of updates.Provide input during strategic planning with the Revenue cycle leadership team for billing expertise for a successful outcome.Assure the integrity of revenue and billing information to assure accurate reimbursement for all billable services provided by working with the triad team to report and finalize for a positive outcome.Manage multi-site operations and functionality providing resource with oversight in day-to-day activities.Build teamwork and create a focus on customer service across the enterprise that fosters collaboration between physicians, administrative colleagues, and the Revenue Cycle team.Piedmont Hospital Atlanta, GA 05/2016 June 2021Hospital Billing Manager 5/2016 7/2021Led a team of 44 employees focusing on hospital and physician services for Vendor Management, verification team, specialty billing for collections for research, transplant and CED / LVAD claims for follow-up, denial review under and overpayments, credits, and variances. Oversees 11 facilities for Commercial Billing, Workers Compensation, and auto claims that consist of 10 employees. Prepares a monthly DNFB report and increased collections for transplant and research in 2017 by 50%. Reduced the DNFB aging to a 4-day minimum and applied billing and collection knowledge for Transplant and Research accounts. Created 50+ policies and procedures for Vendor Management, Specialty (Transplant/Research), and Commercial Billing. Trained team on collection and billing processes for Transplant and Research accounts and billing procedures specific to all provider contracts. Assists in partnership for compliance billing for Research, Transplant, and Billing claims over the revenue cycle areas. Serve as Committee Chair for plan code committee. Creates policy and process for Vendor Management and collection processes. Obtains communication for billing, collections, and contract updates with Global Administrators (GADs), Mason and Heart Transplant, and Managed Care. Created changes needed for Vendor Management billing, Specialty, and Commercial Billing to ensure proper billing, collections, and process flow for proficiency and accuracy for EPIC automation. Reviews claim errors from clearinghouse (Emdeon/Waystar) to build bridge routines for automation.Led a Research Education team meeting on selection, registration, and account protocols.Knowledgeable on the Medicare Cost Analysis (MCA) for all research studies.Developed a cadence to have the Dashboard Accounts Receivables snapshot be reviewed and monitored, resulting in a reduction, and bringing awareness to the departments to work and create EPIC tickets for resolution.Reviews and understands managed care contracts for both Transplant, Commercial and Medicare Advantage plans.Make necessary updates to contract modeling for appropriate adjustments and implementation.Directs provider relations call to rectify provider claim issues for collections.Develops a relationship with Auto and Workmans Compensation Vendors for billing and collection compliance.Cultivated working responsibilities between Case Management, Medical Records, Charge Description Master, and various clinics for correction and implementation for better billing and collections outcome.Ensured system changes follow change management procedures and protocols, creating and maintaining all documentation for all assigned applications, and developing, planning, and executing testing for supported applications.Performs weekly productivity and QA measures for complete documentation on accounts.Consults with employees on their job performance and work / life balance.Meets daily with supervisors on production and quality analysis opportunities for team improvement and assessment.Applies knowledge of all-payer bases: Commercial, Auto, Workers Compensation, Medicare, Medicaid, and VA.Dekalb Medical Center Decatur, GA 10/2012- 04/2016Billing and Government AR Collections ManagerDirected a team of 30 employees for billing of all insurances and government (Medicaid/Medicare) AR Collections. Established reporting and billing for Patient Financial revenue cycle team. Created billing processes applicable for system edits / correction for our host patient accounting system. Reviewed and monitored denials for government payers and assisted with any non-government denials. Reduced billing edits by 75%, resulting in increased cash collections. Maintained an 88% clean claim rate for monthly claim submissions and maintained government AR at 120 days to 20% of entire AR. Provided training on system issues and edits for PFS department.Played an integral role of the Implementation team for various systems.Instrumental in billing and collections for Auto and Workers Comp claims.Complied with all billing regulations for managed care contracts and government regulations.Provided policy and regulation for payers.Developed working responsibilities between Case Management, Medical Records, Charge Description Master, and various clinics to correct and implement better billing and collections outcomes.Grady Memorial Hospital Atlanta, GA 10/2011 10/2012Billing SupervisorProvided outstanding billing knowledge and compliance. Led a team of ten billers and three Medicare follow-up representatives in billing and collections for Medicare, Medicaid, all commercial insurances, and Georgia Crime Victims payers. Shared monthly billing reports and goals to the Billing Manager. Reduced billing error rate by 12%, increasing clean claim rate to 88%. Performed productivity and QA and complete documentation on accounts.Consulted with employees on production and quality analysis opportunities.Monitored billing software for functionality, updates, and performance.Built bridge routines and claim reports for functionality for performance for all payers and service types.Oversaw all Medicare billing and collections updates for implementation.Schneider Regional Medical Center St. Thomas, Virgin Islands 07/2005 09/2011Director of Patient AccountsPerformed revenue cycle management in billing and collections for the operations of an acute care hospital, cancer institute, and ambulatory facility. Prepared Budget and AR management reports to the CFO on billing and collections for all facilities. Supervised 31 employees comprised of two managers, four supervisors, and 25 staffed positions for the book of business of billing, collecting, and cash posting that procured $10M in monthly revenue and $4.8M in collections. Reduced AR days from 333 days to 97 days in two years. Implemented the electronic billing system to third-party payers for billing procedures and charge capture procedures, increasing reimbursement by 60%. Developed policies and procedures to support the billing and collections processes. Collaborated on policies that affected the billing and collection process with other disciplines in the Revenue Cycle department. Trained staff on collection and billing procedures.Created an environment conducive to increased collections and billing.Managed the budget for the business office and approved refunds and adjustments of $1500+.Oversaw the cash posting area for proper posting and balancing.Reviewed all vendor invoices for completeness and accuracy for payment.Led meetings with clinical staff and vendors for continual process and performance improvement.Negotiated contracts with collection agencies for third-party collections and insurances.Re-organized the Cash Office, resulting in greater efficiency and increased cash collections.EDUCATIONClark Atlanta University, Atlanta, GA Bachelor of Science in Health Information Management 05/1994University of Phoenix. Phoenix, AZ Master Healthcare Administration 05/2007 |
