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Click here or scroll down to respond to this candidateCORE COMPETENCIESCandidate's Name
New York, NY Street Address -490-0325 EMAIL AVAILABLE https://LINKEDIN LINK AVAILABLE Results-driven financial strategist with over 20 years of expertise in medical billing practices, reimbursement analysis, and revenue cycle management. Proven track record of transforming billing operations, enhancing financial performance, and leading teams to success in dynamic healthcare environments. Adept at navigating complex regulations, Managed Care contracting, and reimbursement models to drive strategic outcomes. A collaborative and communicative leader, skilled at inspiring teams and fostering cross-functional partnerships. Strategic Variance Analysis: Expertise in variance analysis and delivering strategic recommendations to drive financial performance and operational improvements. Revenue Cycle Optimization: Proven leadership in optimizing revenue cycles, enhancing cash flow, and ensuring timely and efficient collections. Complex Financial Management: Skilled in managing and reconciling complex financial transactions with a focus on accuracy and accountability. Regulatory Compliance Leadership: Deep understanding of insurance regulations and healthcare billing guidelines, ensuring full compliance and risk mitigation. Healthcare Law Proficiency: Extensive knowledge of healthcare laws and third-party reimbursement regulations, guiding teams to navigate complex regulatory environments. Analytical Problem Solving: Strong analytical abilities, adept at identifying financial discrepancies and implementing effective resolution strategies. Financial Accuracy and Integrity: Commitment to maintaining accuracy and completeness in financial records, driving trust and transparency in financial reporting. Advanced Financial Systems: Proficient in utilizing and leading the adoption of accounting systems and technologies to streamline financial operations. Accounts Receivable Reconciliation Medical Billing, Coding, Collection Third-Party Reimbursement Regulations Revenue Cycle Management Reimbursement And Variance Analyses Supervising And Staff Training Managed Care Contracting Customer Service HIPAA Compliance ICD-10, CPT, and Medical Terminology Hospital And Physicians Billing (UB-04, HCFA) Change Management Strategic Planning Adaptability Conflict Resolution Data Analysis Time Management Decision Making Problem-Solving Critical Thinking Interpersonal Skills Project ManagementMOUNT SINAI HOSPITAL New York, NY 12/2022 - Present Senior Financial Analyst - International Patient Services Lead Stakeholder Collaboration: Direct cross-functional collaboration with stakeholders to ensure accurate and timely billing for international patients, driving revenue integrity and patient satisfaction. Strategic Communication: Oversee the preparation and dissemination of charge summaries and payment terms to account guarantors, ensuring clear communication and understanding of financial obligations. Payment Coordination and Oversight: Lead efforts to secure timely payments from international patients, coordinating closely with hospital finance teams to optimize cash flow and reduce payment delays. Billing Process Optimization: Lead initiatives to update and enhance billing formats, ensuring prompt submission of claims to payers and improving overall billing efficiency. Accounts Receivable Management: Review and analyze accounts with outstanding balances, implementing strategic steps to resolve issues and reduce aged receivables. Financial Accuracy and Adjustments: Validate payer payments, manage complex adjustments, and prepare final billing summaries, ensuring financial accuracy and compliance. Payment Processing Leadership: Supervise the processing of payments via multiple channels, ensuring accurate deposit of funds and maintaining financial integrity. Bad Debt and Issue Resolution: Maintain proactive communication with Patient Accounting to address Bad Debt referrals and resolve payer issues, reducing financial risk. International Payment Analysis: Analyze daily reports for International Patient Services, ensuring accurate financial reporting and reflection of services provided. Third-Party Payer Negotiations: Manage relationships with international third-party payers, making strategic decisions on accepting or rejecting payment guarantees to protect financial interests. Patient Access and Satisfaction Enhancement: Collaborate with executive leadership to implement workflow PROFESSIONAL SKILLSPROFESSIONAL EXPERIENCEimprovements, enhancing patient access and overall satisfaction. Team Leadership and Development: Play a key role in hiring, training, and evaluating staff, fostering a high-performing team committed to excellence in patient financial services. NEW YORK-PRESBYTERIAN HOSPITAL New York, NY 11/2020 12/2022 Financial Representative - Patient Case Management Financial Reconciliation Leadership: Led the generation and analysis of ongoing financial reconciliation reports, identifying and addressing denied and underpaid claims to optimize revenue recovery. Denials Management and Resolution: Monitored and managed claim denials and underpayments, ensuring timely resolution through strategic intervention and collaboration with relevant departments. Root Cause Analysis and Problem-Solving: Conducted in-depth root cause analysis of claim issues and spearheaded cross- departmental collaboration to implement effective solutions, reducing recurring issues. Complex Claims Management: Expertly addressed and resolved complex claims issues across multiple Managed Care Organizations (MCOs), driving successful outcomes in challenging cases. Strategic Collaboration with Clinical Teams: Partnered with clinical teams to secure necessary referrals and authorizations, strengthening claims appeals and ensuring compliance with payer requirements. Performance Reporting and Analysis: Produced comprehensive monthly and annual financial performance reports for executive management, providing actionable insights to drive strategic decisions. Financial Risk Management: Recommended strategic write-offs for uncollectible accounts to management, balancing financial integrity with operational efficiency. Payment Tracking and Denial Overturns: Oversaw the tracking of payments for overturned denials, ensuring accurate financial reporting and maximizing revenue recovery. System Implementation Leadership: Assisted in the implementation of system updates and configurations, ensuring smooth transitions and minimal disruption to financial operations. Workflow Enhancement and Patient Satisfaction: Collaborated with leadership to refine and enhance workflows, leading to improved patient access, satisfaction, and overall operational efficiency. NEW YORK-PRESBYTERIAN HOSPITAL New York, NY 06/2009 11/2020 Financial Representative - Global Services Cost Estimation and Financial Summaries: Led the preparation of detailed treatment cost estimates and comprehensive account summaries, ensuring transparency and accuracy in patient financial communications. Revenue Enhancement through Accurate Billing: Drove revenue growth by leading the accurate submission of hospital and physician bills to diverse payment guarantors, ensuring timely collections and maximizing financial returns. Data Analysis and Accounts Receivable Tracking: Analyzed and tracked statistical data related to accounts receivable, providing insights that informed strategic financial decisions and improved cash flow management. Complex Issue Resolution: Proactively resolved complex financial and billing issues by facilitating clear communication between patients and insurance companies, ensuring positive outcomes and maintaining high levels of satisfaction. Insurance Billing and Compliance: Directed the billing process to insurance companies, ensuring correct coding and adherence to regulatory standards, which resulted in timely and accurate collections. Employee Training and Development: Assisted with the training of new employees on organizational processes and policies, fostering a knowledgeable and efficient team that consistently met performance standards. Patient Financial Communication: Clarified hospital financial policies with patients, addressing and resolving financial concerns promptly, which enhanced patient trust and satisfaction. International Collections Management: Managed the submission of files to international collection agencies, ensuring effective communication and successful recovery of outstanding payments. Provider Training and Compliance Leadership: Led the training of providers on billing procedures, authorization requirements, regulations, and financial planning for treatment plans, ensuring compliance and streamlined financial operations. WEILL CORNELL MEDICAL COLLEGE New York, NY 05/2005- 06/2009 Account Administrator Claims Processing: Directed the processing and tracking of claims for PPO, HMO, Medicare, and Medicaid, ensuring accurate handling of both primary and secondary claims. Data Management and Analysis: Oversaw the entry of physician services data into the IDX system, conducting thorough analysis to ensure data integrity and optimize financial reporting. Charge Correction and Compliance: Led the review of encounter forms for completeness, implementing charge corrections as needed to maintain compliance and accuracy in billing practices. EDUCATION ASHFORD UNIVERSITY San Diego, CA 2020Master of Business Administration (MBA) with a Major in Organizational Leadership TOURO COLLEGE New York, NY 2018Bachelor of Science (BS) with a Major in Psychology KINGSBOROUGH COMMUNITY COLLEGE Brooklyn, NYAssociate in Arts (AA) with a Major in Liberal Arts and Sciences GLOBAL INSTITUTE OF TECHNOLOGY New York, NYDiploma in Medical Billing and Coding N.H.A. Medical Billing and Coding Specialist |
