Project Manager Customer Service
Resume:
LINN ROCHE, B.A.
Chicago, Il *****
*********@*****.***
OBJECTIVE
Seeking a dynamic leadership position with a company that values a result-
driven business professional with experience in medical billing, revenue
cycle management, (front end to back) accounting, customer service,
implementation, project management and call center management.
Professional Experience
Mercy Hospital and Medical Center
1/13 to current
Director of Physician Revenue
. Responsible for entire revenue cycle process for 250 employed
physicians from all specialties'.
. Responsible for 4 teams, Billing, Collection, Credentialing and
Registration. These teams are in the main hospital, FQHC and or one
of 11 satellites. Total of 32 employees
. Reviewed and enhanced workflow for all areas of responsibility
. Share responsibility with the Director of Clinical Operations, for the
day to day operations of the three FQHC sites.
. Responsible for hiring, training, mentoring and reviews of all staff.
. Responsible for the oversight and audits of all partner vendors
. Increased billed charges by $1,000,000 a month
. Decreased denials by 21%
. Project managed a complete rework of all workflow on out-sourced
services to improve reporting, DAR, denials, and cash posting.
. Revamped entire credentialing process to ensure all 250 providers were
credentialed correctly. Revised onboarding process to ensure timely
credentialing
. Developed, implemented and carried out new provider orientation and
mentoring program.
Amaji Healthcare Systems
5/11 to 6/12
Director of Revenue Cycle Management and Operations
. Responsible for entire set up of this start up business as related to
revenue cycle, document control, scheduling and call center operations
. Initiated, designed, wrote and implemented all policies and procedures
and process flow for revenue cycle, scheduling, transcription and call
center operations.
. Project managed EMR integration with billing and transcription
software
. Responsible for oversight of all new client implementation
. Developed scheduling process for mobile providers
. Project Manager for transcription deployment in India
. Responsible for all compliance training and policies
Fresenius Medical Care
9/11 to 12/12
Manager of Billing Operations
. Responsible for three teams, Insurance Verification, Document Control
and Billing, consisting of 2 Supervisors and 24 team members.
. My teams were responsible for all front end operations for 147
dialysis clinics
. Implemented processes that have reduced the number and dollar amount
associated with an insurance change. Reduced the percent of untimely
insurance changes by 63% and the variance associated with the change
by $212,000 a month.
. Assessed each teammates duties and implemented production matrix.
. Created a weekly Cash Shortfall report that identifies all billing and
system issues that have an impact on cash
. To improve communications with field operations, I implemented a
monthly call, where challenges and successes are discussed.
. Project Managed with the Director of Financial Counselors, all new
processes to ensure consistent process and timely streamlined workflow
between our two departments.
. Responsible for all government reporting.
. Responsible for obtaining all numbers associated with billing and when
received, the set up of each clinic for billing.
. Selected to serve on two Six Sigma committees that are responsible for
the complete overhaul of front end process in billing offices and
clinics
. Took on the additional responsibility of all secondary claims
collection.
DaVita VillageHealth
5/08-5/11
Reimbursement Manager/Manager Enrollment and Provider Services/Manager Call
Center/Project Manager- New Project Development
. Took the revenue process from manual to automated
. Responsible for the payment of claims in all 50 states, Canada and
Mexico. Mastered Fee Schedules for same
. Trained staff and claims auditors in all areas of billing: Physician,
(all specialties), facility and drug claims.
. Oversaw all delegated entities. Implement audit procedures to ensure
payment of claims were done in timely manner paid correctly, according
to Medicare guidelines, and no interest or penalties were paid.
. Was PM from Operations side for the automation of member's medical
records.
. Ensure CMS compliance of all claims presented for payment on behalf of
members.
. Manage four departments: Claims, Disease Management, Enrollment and
Customer Service. Ensure CMS compliance of all departments.
. Responsible for hiring, training and scheduling of staff for all four
areas
. Ensure all policy and procedures and DLPs were current and adhered to
for each area of operations.
. Responsible for all RAPS, LICS, RX and MMR monthly reconciliations and
CMS submissions.
. Given the added responsibilities of daily operations for three CMS
demonstration projects and five commercial disease management clients.
. Manage all aspects of claims and appeals, enrollment, call center,
membership maintenance, member communications and field staff support.
. Managed a staff of 15 in the central office and 3 in the field.
Supported field staff of 74 nurses, operationally, who were providing
disease management services to patients.
. Worked with IT to identify processes that could be automated, designed
said processes and saw projects through to implementation.
. Overcame obstacles of unwilling staff, limited budget and exceptions
by payer.
. Results were an increase in enrollment of 17%, payer reports and
therefore billing being generated 6 days sooner each month. The
technology has allowed for the nurses in the field to touch each new
patient 3 days earlier, allowing for an improved ROI of $3,121 to the
payer.
. Due to budget constraints used an existing Landacorp system and
designed enhancement windows within the existing system. Enrollment
nurses increased their calls by 32%, as these windows allow real time
documentation for both enrollment and clinical operations.
St. Paul's House and Healthcare Center, Chicago, IL
10/06-1/08
Consultant
. Retained by the former Chairman of the Board to review and collect on
old accounts.
. Collected outstanding debt from all payer sources and put policies
into place to reform billing and collection.
. Reviewed all billing, collection and accounting procedures.
Implemented fee schedules and billing practices for payers in all
states.
. Implemented and developed policies and procedures for entire revenue
cycle process including billing, collection, accounts payable, cash
management, resident registration, insurance verification, payroll and
monthly fiscal reporting.
. Evaluated employees and assess needs of department. Trained employees
on Achieve Software to ensure software use was maximized.
. Identified and re-billed unpaid claims to the proper payer source.
Ensured validity of billing system.
. Developed and used reports to identify denied unpaid and delayed
claims.
. Implemented processes to review reports on a daily basis. Contacted
insurance carriers and resolved issues. Increased cash-flow by 23
days.
. Implemented charge capture procedures to ensure full reimbursement,
realized a 4% increase in revenue.
. Recovered over $1,000,000 in accounts over 1 year old.
. Implemented supply system, via McKesson. Inventoried and housed all
supplies in a central location. Reduced expenses and theft.
. Ensured residents who qualify for HFC were enrolled and/or the proper
paperwork was started. Reduced self-pay and bad debt by 9 months.
. Acted as interim Director of Fiscal Operations
Promedical Billing, Inc., Chicago, IL
1992-2006
President
. Founded a full service million dollar billing, collections and
practice management (revenue cycle) company. Practices included
Surgeons, Anesthesia, Podiatry, DME, Home Health, Trauma, ER,
Dialysis, Psychiatry, OB/GYN and General Medicine.
. Managed and collected Accounts Receivables averaging $225,000 a month
. Prepared, designed and properly executed patient registration, patient
pre-certifications and all forms necessary to provide proper and
correct billing and collection action.
. Ensured laws and regulations were strictly enforced for all states and
foreign billing.
. Experience with Medicare, HFC, Commercial, HMO, Self Pay and Work Comp
carriers.
. Transitioned all work comp providers through the new work comp laws
and fees schedule.
. Reviewed and implemented policies and procedures associated with the
timely billing and collections of accounts.
. Utilized Alpha II coding system to ensure all charges were captured.
. Improved client cash flow by pre-certification and benefit
verification, reducing outstanding account receivables by 45 days for
the average practice.
. Managed day-to-day practice cash flows. Claims and file/information
transferred electronically.
. Directed accounts until paid. Instituted policies to enhance cash
flow, such as issuing patient statements at the time of posting,
rather than monthly. These policies increased revenue by 21% for the
average practice
. Ensured HIPAA compliance for clients. Wrote a HIPAA Policy and
Procedure manuals which was presented at a workshop for clients and
staff. Designed HIPAA compliant patient registration, designee,
release of records and confidential health record forms.
. Managed staff of five. Directed and trained staff to complete duties
to support individual clients.
. Negotiated with vendors on behalf of clients and self.
. Negotiated with Healthcare Providers and Systems for contracting
purposes.
Advocate Good Samaritan Hospital, Downers Grove, IL
1988-1992
Manager of Physician and Outpatient Billing Services
. Developed and implemented a new billing department for the hospital.
. Conceived, developed and initiated policies, procedures and best
practices to create and manage growth to profit center.
. Initiated marketing activities to increase annual sales to a new
client base. Presented Business Plan to new clients.
. Hired, trained and supervised a department staff of 7.
. Implemented new software and computer system conversion.
. Responsible for all accounts payable activities.
. Supervised accounts receivable staff. Reduced 30 days in A/R by
training staff to collect funds at time of service verify insurance
and implement collection policies.
Education
Alverno College, Milwaukee, WI
. BA- Business Management and Communications- 1983
AWARDS
Core Value Award for Team
August 2009
Received the distinguished Core Value award for Team. DaVita VillageHealth
has 7 core values, and if leadership deems a teammate has demonstrated one
of the core values they are recognized at the annual meeting. I was
presented with the Team Core Value award for teammate retention (100%) and
positive attitude that showed in all teammates that report to me.
REFERENCES
Available upon request
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