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Click here or scroll down to respond to this candidateCandidate's Name
Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLECAREER SUMMARYResult oriented professional with over 15 years of revenue cycle management experience in various healthcare ecosystems. Working knowledge of healthcare regulatory requirements with a proven ability to function as a critical team member by developing and implementing successful process that will support the vision of the organization. Building relationships based on trust is key philosophy, a people-first approach, and professionalism to maintain an 90% AVG customer satisfaction score. Expertise in provider enrollment, customer service, employee training, and workflow management.PROFESSIONAL EXPERIENCEXifin February 2022-PresentManager- Client Service (Remote)Organize regularly scheduled communication with all existing clients and internal contacts to determine how BRMS can meet their business needs.Provide on-going training to team/subordinates with any new releases or development changes to include troubleshooting request.Maintain, monitor, and audit from in house to third parties network server, cloud, and SharePoint.Continuously conduct customer service workshops, presentations, and training as needed.Generate monthly and quarterly departmental reports to determine whether KPIs are being met and where there is room for improvement.Create and update providers in both CAQH profiles and in credentialing software.Ensure various client success and satisfaction with the XIFIN RCM solution.Confidence and ability to deal with high-end clients and important stakeholders.Analyze and update various databases system such as Imagine, IntelliApp, OneApp, and Laserfis.Collaborated with a teammate to successfully manage a database or participated in documenting business process.In a client facing capacity, coordinate financial metrics and reports that highlight financial performance and client profitability.Provide customer with system & workflow expertise for business optimization.Assisting in maintain and updating integrated systems: reviews technical issues and recommends solutionAssist with multiple requests for new development for all existing clients.Address, resolve and review client invoices, revise as needed & make adjustments.Reviewing client invoices; creating, revising, and adjusting as needed.Develop and oversee the implementation of client service protocols.Oversee data analysis on bi-weekly basis to ensure the team is providing the client exceptional experience.Respond to payor demographic and denial requests.Responsible for updating organizations dashboard for effective communication to the clients and staff members.Liaising with different departments about client queries, advise client services/products.Continuously interact with clients and build relationships with them while ensuring their needs are being met.Communicate with administrative and clinical managers regarding accurate and timely clinical and billing practices as related to Medicare and Medicaid guidelines.Facilitate customer-centric and metric driven culture by improving collaboration between venders and RCM operations.Support in all additional client related duties (faxes, insurance discovery, and correspondence).Radiology Partners: October 2019-February 2022Provider Enrollment Specialist Integrations(Remote)Timely initial payor enrollment and re-enrollment of practices and providers with contracted Government/Commercial Healthcare payors.Follows up with provider and payers on outstanding issues on application/approval status.Maintain and update practice enrollment tracker with all enrollment- related communication during the enrollment process.Work with the internal billing team to share approvals and work through denials and appeals.Timely revalidate and re-enroll providers with government and contracted payors.Completed CAQH Maintenance for assigned HCA Contracted Providers.Responsible for rapid and accurate submission for Integrations.Create Service Now ticket to have claims released and processed for payment timely.Process the application for a new provider through the guidelines with commercial and/or government payers as well as facilities to enroll in network.Assists provider via telephone and email to resolve credentialing and enrollment issues related to the providers file.Update provider changes, certification, and license information across all payers.Navigates multiple licensing and medical certification website to obtain updates.Ensure that established provider IDs and effective dates are communicated to appropriate billing and revenue departments.Understand specific application requirements for each payer including forms, supporting documentation and regulations.Work closely with department credentialing staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, and other documentations.Establish close working relationships within RCM departments and with various payer across all markets.Receives notification regarding new practitioners from clinics, onboarding, Medical Staff Office, and billing offices, which includes all mail, email and faxes received from PayersEnters practitioner information onto payer online systems such as PECOS and/or various enrollment portals and ensures that the information in the databases is current and accurate.Ensures the enrollment packets are appropriately signed, completed accurately, and submitted to payers with necessary attachments.Monitors the revenue claim reports and takes any necessary action (which may include sending additional information to the payer) or research root cause to allow claims to be submitted for payment.Assisted leadership high dollars enrollments across all markets/ states.MEDNAX, Inc. (Sunrise, FL) August 2006 October 2019National Provider Enrollment SpecialistTimely initial and re-enrollments of practices and providers with national contracted health plans.Communicate providers participating status to internal departments for timely billing and patient scheduling.Conduct follow up with various health plans to obtain enrollment confirmation and approval status for government and commercial line of businesses.Assist with special enrollment projects for various department and health plans.Establish relationships with providers offices to ensure timely return of application with provider signature.Creation of monthly, quarterly, and annual rosters for contracted health plans to report adds, changes, terminations, and active providers.Coordinate with the Credentialing team to obtain credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but not limited to medical degree, (DEA) number, state license, board certifications, CV, malpractice insurance, and state insurance form.Responsible for tracking and updating expiring provider credentials including state license, DEA, and annual training programs within provider data system.Analyzes reports for physician enrollment, re-enrollment and dis-enrollment to measure timely completion in accordance to contract agreements.Develop and maintain relationships with physicians and allied health providers.Identify issues that require additional research and validate PE discrepancies and complete appropriate follow up.Map new or revised enrollment applications within provider data system.Upload new contract details for enrollment purpose within the provider data system.Business System SpecialistProvided executives with analytics and decision-support tools used as the basis for reorganization, consolidation, and relocation strategies.Created database, which merged information from accounting and billing departments to sync information and alleviate need for multiple spreadsheets and reports, saving 20 work hours weekly.Partnered with developers to automate manual processes, saving time and money while decreasing errors. Credited as a primary driving force behind a 5% increase in margins this fiscal year.Collaborated with vendors across the organization to ensure business and technology alignment. Propose solutions meeting defined specifications and needs.Liaise between business and technical personnel to ensure a mutual understanding of processes and applications.Provided input into developing and modifying systems to meet client needs and develop business specifications to support these modifications.Communicated clients business requirements by constructing easy-to-understand data and process models.Identified and reconcile errors in client data to ensure accurate business requirements.Took ownership of projects from beginning to end. Is autonomous worker who specializes in completeness and accuracy.Strong analytical skills, ability to identify problem, research issues, and provide solutions.Completed in-depth analyses for business optimization projects boosting revenue by 11.8%.Regional Billing AnalystAnalyzed contracts to ensure contract and invoicing are following appropriate guidelines, and regulations.Identified any issues that may affect billing and determined the proper course of action.Followed up with internal and external personnel regarding outstanding issues.Completed monthly reconciliation analysis to report income projections to management.Performed general administrative duties including filing, photocopying, typing, and maintaining databases.Followed up on claims status, investigated and resolved obstacles for prompt reimbursement.Maintained good practices in standard methodologies and processes to deliver integrated solutions.Identified and reported any payer trends, denial patterns and delays to management.Adhered to state, federal and HIPAA laws and guidelines regarding patient records and collections.Provided reports related to individual, billing, and collection productivity/activity.Posted adjustments, payments and follow up notes to financial system as appropriate.Contacted providers for copies of invoices to balance against pay outs for services.Conducted research regarding pay out discrepancies.Managed departmental day-to-day front office operations, monitored, and prioritized workflow, surgery schedules, and general patient flow.Ensured services were in alignment with professional standards and state and federal regulatory requirements.Functioned as a floater to provide back up to all front office staff.COMPUTER SKILLSMicrosoft Office: MS Excel, MS Word, MS PowerPoint, Pivot Table/ NexGen/ OBR/ GPMS/ MedSuite/ Intellicred/ImagineEDUCATIONBroward College, Fort Lauderdale, FloridaInformation TechnologyMontgomery College, Rockville, MarylandBusiness AdministrationWatkins Mill High School, Gaithersburg, MarylandGraduated, 1999ACHIEVEMENTSMEDNAX, Inc.s Employee of the Year Winner in 2015Personal Basketball achievements -VOLUNTEER WORKWISE Youth Basketball League, Laurel, MD CurrentCoaching position Team of 12 kids ranging from age 10-12, co-edAAU Youth Travel Basketball, Miramar, FloridaCoaching position team of 16 kids ranging from age 13-16, boysYouth Enrichment Center, Miramar, Florida 2014- 2021Coach position team of 10 kids ranging from 8-10, 12-14, 14-16 boysLead team to first place finish in local tournaments, implement effective offensive and defense strategiesProvided individual training to players on shooting, ball handling, and defense techniques resulting in improved performanceBuilt strong relationships with players and parents, resulting in positive and impactful experience in all involved |
