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Click here or scroll down to respond to this candidateSummary:A resolute, energetic, and skilled healthcare professional with 17 years of experience in overseeing daily office & business operations. Possessing a distinctive combination of strong leadership, cost management, cash flow, Candidate's Name , auditing, revenue capture, scheduling, interpersonal & problem-solving abilities, along with advanced strategic planning skills to streamline operations & boost productivity. Adept at handling multiple cases, enhancing patient care, overseeing billing & collections, along with mentoring inexperienced staff members, both clinical & non-clinical. Skilled in devising, enacting & recording effective business operation strategies.Skills:ACCOUNT PAYABLECandidate's Name
ACCOUNT RECONCILIATIONAPPEAL MANAGEMENTAUDIT PROCEDURESCLAIM REVIEWCOMMUNICATIONCORRECTIVE ACTIONCUSTOMER / PATIENT SERVICEDATA ANALYTICSDEBT COLLECTIONDENIAL MANAGEMENTDEPENDABILITYFINANCIAL REPORTINGHIPAA COMPLIANCEMEDICAL BILLINGMEDICAL TERMINOLOGYMICROSOFT EXCELMICROSOFT POWERPOINTMICROSOFT WORDMULTI-SITE MANAGEMENT / MULTITASKINGOPERATING SYSTEMSPAYMENT POSTING & RECONCILIATIONPRIORITIZING TASKSSTRATEGIC PLANNINGACTIVE LISTENINGADAPTABILITYATTENTION TO DETAILCOLLABORATION & TEAMWORKCOMPLIANCECONFLICT RESOLUTIONCONTINUAL LEARNINGCREATIVITYCRITICAL THINKINGDECISION MAKINGDETAIL ORIENTEDDISCIPLINEEMOTIONAL INTELLIGENCEIDENTIFY TRENDSINNOVATIONLEADERSHIPPOSITIVE MINDSETPROJECT MANAGEMENTPROBLEM-SOLVINGRESEARCHRESILIENCESELF MOTIVATIONTACTTIME MANAGEMENTTHRIVE UNDER PRESSUREProfessional Experience:Therapy Employee Associated Management, LLC 01/2024 - 06/2024Advanced Recovery Systems Ft. Lauderdale, FLInternal Auditor: Denial Management Fully RemoteA Nationwide Network of Treatment Centers is at your disposal, working in collaboration with healthcare providers, organizations, referral sources & individuals. Advanced Recovery Systems facilitates connections to vital addiction treatment & mental health support, aiming to restore individuals, families & communities. With centers across the U.S., we ensure assistance is available for you or someone under your care to address substance use & mental health disorders.Conducting reviews of claims for eligibility determination, engaging in financial counseling to discuss payment resolution, performing utilization reviews for prior authorization, addressing coding errors, ensuring accurate charge capture, maintaining the timeliness of billing, determining benefits explanation, ensuring accuracy in payment posting, improving recoverability & preventing denials are all essential tasks.Tasked with creating an internal operational claims audit template.Conducts root cause analysis to research error origins & prepares audit report findings for executive leadership.Advises on process improvements to facilitate issue resolution & collaborates with internal area leadership on implementing changes.Engages in oversight-monitoring activities, including the analysis of monthly reports, trending analysis & review of Monthly Timeliness Reports.Charged with developing Corrective Action Plans.Facilitates ad-hoc meetings with delegates to proactively address identified issues.Operates independently with minimal guidance.Advocates for a Culture of Safety by following policies, procedures & plans designed to prevent revenue loss.Conducts special project audits & reviews upon request from other departments or leadership.Attends Fraud & Abuse committee meetings.Possesses a thorough understanding of current Claim Department processes & procedures.Has practical knowledge of various Revenue Cycle Process Procedures.Boasts an extensive claims knowledge base built on experience.Performs on-site observational audits at different state location facilities.Holds extensive knowledge of HCFA-1500 & UB-04 claim forms, CPT Codes & Revenue Coding.Hopedale Medical Complex 09/2022 05/2023Revenue Cycle Manager Hopedale, ILThe Critical Access Hospital (CAH) has been serving the community for over 65 years. HMC boasts a 24-hour emergency room, a 25-bed acute care unit, a 59-bed nursing home & a 70-bed facility for assisted & independent living. It also houses the Midwest Vascular Institute, four satellite doctor offices, an Intensive Care Unit (ICU), orthopedic surgery, physical therapy & rehabilitation services, sports medicine, mammography & an open MRI & CT scanning capability.Responsible for the daily administrative operations of the organization, providing direct supervision to subordinate staff, including planning, assigning & organizing work, conducting interviews & hiring & training support personnel.I develop, implement, administer & evaluate the department's annual revenue action plan, successfully reducing the average days in Candidate's Name from 55 to 35 within six months.Created a comprehensive financial & operating analysis for senior management decision-making, gathering clinical practice data from a wide variety of internal & external sources.Analyzed the top denials for each payer to identify solutions that increased cash flow.Participated in strategic business planning for the department, I researched new operational practices & made recommendations to management regarding their financial feasibility.Monitored & evaluated the provision of patient services within the practice, including all operations affecting billing & provider productivity.Managed staff performance by providing regular feedback, conducting performance reviews & holding one-on-one meetings.Managed the revenue cycle department, overseeing various duties such as account management, communications with insurance providers, collections, cash posting, contract analysis, denial management & billing.Oversaw & evaluated department billing operations to ensure compliance with appropriate procedures, applicable laws, regulations, policies, trained & updated physician staff on proper billing & coding practices.Provided consultation, leadership & expertise.Tasked with reviewing & analyzing reimbursements concerning contracts to verify that payors are remitting payments per contractual terms & conditions; responsible for providing results & action plans to address payment discrepancies, including underpayments, as well as compiling a list of denials & the status of appeals.Soderstrom Dermatology Center & Skin Institute 01/2022 08/2022Core DermatologyRevenue Cycle Manager Peoria, ILA multifaceted Dermatology & Plastic Surgery Center, which boasts 11 locations across Illinois & Iowa. At Core, formerly Soderstrom Dermatology, our mission is to empower healthier lives by delivering exceptional dermatological care. Through patient-centered excellence, innovative treatments & a commitment to the highest ethical standards, we aim to enhance the well-being & confidence of every individual we serve.Oversaw the identification of patient reimbursement issues; ensured the efficient processing of claims, denials, appeals & the resolution of billing-related problems.Collaborated with agency staff on daily operations of revenue-related functions, provided analysis, developed processes & offered insightful feedback to the Director, with a focus on identifying opportunities for improvement & achieving sustained departmental success.Educated, supervised & mentored over 20 team members in the billing revenue department.Communicated with physicians, mid-level practitioners, front & back-end office staff on the correct use of modifiers, diagnosis codes, CPT codes, HMO authorizations & timely filing issues.Managed requests for retro authorizations to eliminate delays in claim processing, which aids in maximizing revenue.Supervised & developed departmental protocols, which included attaching all essential documentation to necessary claims to minimize denials & pending cases, as well as scrutinizing Explanation of Benefits (EOBs) to guarantee maximum reimbursement.Adhered to & enforced revenue standards to contest low reimbursements & unjust denials, ensuring that Candidate's Name were optimized for maximum physician reimbursement.Oversaw the distribution of patient statements for co-insurance, deductibles & patient obligations.Drafted appeal letters for additional reimbursement & furnished monthly reports to senior management & physicians.Tasked with overseeing staffing levels to achieve objectives & key performance indicators (KPIs).Met with executive management & team leaders to discuss collection efforts, set goals & resolve issues.I keep my knowledge current regarding billing, coding compliance, reimbursement laws, regulations & industry best practices.Vision Care Center, Peoria, IL 09/2018 01/2022Director of Business Operations Peoria & Washington, ILI managed a privately owned, high-volume Optometry practice with two locations in central Illinois, overseeing all operations & P&L management for both sites, which generated significant revenue. I provided direct reports for over 32 employees & three Optometrists. I established performance indicators, operational goals, realignment initiatives, productivity enhancements & cost-saving measures. I have improved operational efficiencies, managed financial resources & operating expenses, all while maintaining budgetary constraints to ensure profitability. I monitored & analyzed Key Performance Indicators (KPIs), identified challenges, trends, inefficient processes, developed a targeted quality assurance & training curriculum. I attended daily, weekly, monthly meetings & functioned as a liaison between staff & doctors.Oversaw every aspect of daily operations, including finances, human resources, coordination, marketing, production, retail & scheduling.Develop & implement strategic plans for revenue growth, cost reduction & operational efficiency.Lead a team of over 32 employees, including three Optometrists, to meet performance targets & ensure the delivery of high-quality services.Implemented modern technologies & business processes to streamline operations, reduce costs & enhance productivity.Built & maintained effective Candidate's Name , accounts payable & cash flow monitoring systems.Fostered strong relationships with customers, vendors & regulatory agencies to ensure the success of the business.Maintained operational systems, processes & policies in support of the organization's mission.Integrated functional strategies, utilizing business expertise, to achieve financial & operational objectives.Monitored company policies & developed new operational procedures to increase efficiency.OSF St. Francis Healthcare Services 08/2016 09/2018Patient Access Manager, Home Health Peoria, ILA not-for-profit Catholic Healthcare Corporation operates a medical group, hospital system & other care facilities across two states (IL & MI). It oversees department operations and delivers exceptional service to patients, their families & referral sources. It manages daily activities to ensure peak performance, reliability & timely referrals. Additionally, it collaborates with the Home Care leadership team on performance, practice, compliance, analytic reporting, IT equipment, billing & denial issues.Hired, oriented, trained, assigned workloads, maintained schedules & conducted evaluations & counseling for all staff in the patient access department.Managed a department with 22 direct reports.Provided initial job training & information to new hires & assessed their ability to fulfill specific responsibilities.Developed, applied new policies & procedures within the healthcare setting.Reviewed & worked all assigned queues, such as a managers que account, an EPIC que account, along with a clean claim account before final billing.Presented best practice research findings to the director regarding the root causes of healthcare denials, underpayments & proven best practices in denial recovery management systems to improve the revenue cycle process.Monitored & achieved Revenue Cycle Management goals as well as meeting departmental budgets.Conducted audits of all Patient Access staff to ensure they met or exceeded all performance standards.Oversaw the daily operational activities of all Patient Access staff, monitored the workflows, made daily adjustments using productivity & performance measures.Contributed to overtime assessment and pinpointed issues in customer service, resolving them or initiating follow-up action.Maxim Healthcare Services 04/2012 08/2016Service Coordinator Peoria, ILHome Health & Staffing Agency, boasting over 400 offices nationwide, oversees daily operations & coordinates qualified nurses to match clients' care requirements & scheduling needs. With direct oversight of more than 120 field staff nurses, the agency ensures staff development & compliance with all company, state & federal healthcare accreditation standards. The agency collaborates closely with physicians, insurance companies & other external coordinators for discharge planning meetings.Oversaw the management of all incoming referral requests for nursing services.Established & maintained long-term relationships with each child, as well as their family or guardian & served as a continuous resource for all their home health nursing needs.Coordinated essential performance evaluations & assessments with early childhood experts bi-weekly or as required.Participated in developing and overseeing Individualized Family Service Plans to achieve developmental milestones.Conducted meetings with the interdisciplinary team to evaluate requirements & determine eligibility for pediatric patients transitioning to home care.Managed, supervised & scheduled for over 120 field staff members.Oversaw, directed & organized more than 3,200 hours of nursing services weekly.Maintained the highest level of patient/customer service ratings for three consecutive years.Addressed all internal and external concerns, complaints, and changes in care conditions effectively.Adhered to the agency's infection control & safety policies, which included educational programs, reporting procedures & implementation practices.Prior ExperienceSpoon River Home Health Client Service Specialist 09/2010 - 04/2012Bridgeway Employment Specialist 01/2008 09/2010Walgreens Pharmacy Senior Pharmacy Technician 05/2005 09/2009CVS Pharmacy Lead Pharmacy Technician 06/2002 04/2005Blessman Pharmacy Pharmacy Technician 07/2001 05/2002Complete Care Pharmacy Pharmacy Technician 01/2001 06/2001EducationWestern Illinois University Spoon River CollegeDecember 2008 December 2006Bachelor of Science Psychology Associate of Arts PsychologyBridgeway Inc.Internship 08/2006 12/2008AFFILIATIONSPsychology ClubUndergraduate Research Day: 2007 & 2008Association of Psychological Science MemberAmerican Psychology-Law Society MemberField Experience Placement: Bridgeway Inc., Macomb, IL.Outpatient therapy sessionsPlanned therapy sessionsPerformed therapy sessions with a Qualified License TherapistObserved PsychiatristMedication managementCrisis InterventionResearch Assistant Dr. Kimberley McClure, Ph.D.How Confidence Influences Detectives in the Investigations Process?The research project was accepted to the APS Convention: San Francisco, CA 2008CERTIFICATIONSPartners in LeadershipIC2it CertificationProcess Improvement (PI)RIM, LEANLITMOS I, II, IIICPhT (expired)Licensed Pharmacy Technician (expired)EHR RCMAllscriptsAthenahealthAvailityAvatarChange HealthCognizantCotivitiCPSI EvidentCranewareCrystal Practice ManagementEdgeEPICEyeMedExperian HealthInstaMedIntergyMcKessonNextGenOmega HealthcareOne Health - UHCOptumP3 HealthcareRevolution HERTransUnionTriZettoTruBridgeWaystar |
