Revenue Cycle Resolutions Manager
Resume:
Kenneth Harris
*** ***** ***** *******, ** *****
*******@*****.***
Summary
• Demonstrated achiever with exceptional knowledge of business office practices, revenue cycle management, and team leadership & development.
• Skilled at learning new concepts quickly, working well under pressure, and communicating ideas clearly and effectively.
• Strong technical aptitude, advanced computer training, including knowledge of multiple networking environments and business software packages.
• Enthusiastic, innovative, motivated and driven.
Education
MS Information Systems (Information Security) 2017
In Progress
University of Alabama at Birmingham
Masters of Business Administration 2017
Strayer University (Jack Welch Management Institute)
3.75 GPA
BA Business Management & Administration 2014
Strayer University, Birmingham, AL
3.5 G.P.A.
B.S. Information Systems
University of Alabama at Birmingham, Birmingham, AL 2001
Career History & Accomplishments
Revenue Cycle Resolutions Manager, HCA/Parallon Atlanta, GA June 2014 - Present
• Assure that verified overpayment discrepancies are refunded timely & accurately.
• Perform Q/A to ensure accuracy in work.
• Facilitate quarterly government payer (Medicare, Medicaid, Tricare) cost/credit audits.
• Collaborate with the Executive Compliance Officer to identify trends and ensure adherence to government payer guidelines.
• Conduct annual employee performance appraisals.
• Identify, measure, and resolve trends caused by payer issues.
• Conduct staff meetings and trainings / Develop and mentor staff.
• Evaluation of facilities for Medicare/Medicaid & other federal payer compliance issues.
• Review & interpretation of payer contracts and COB language.
• Review of policies and implementation of process improvement through realignment and streamlining.
• Assist Patient Access functions (pre-registration, benefit verification, pre-authorization, admission/registration, service pre-payment, etc.) to ensure daily operations are maintained according to standard.
• Inform Regional Patient Access Director of any significant issues in the Patient Access area (Pre-registration delays, pre-authorization backlogs, etc.)
• Maintain and promote good customer relations with facility management, physicians and physician office staff
• Screen, interview, and hire new employees.
Pharmacy Technician Consultant, Inverness Apothecary Birmingham, AL 2012 - 2014
• Adjudication of claims, acquired prior authorizations, and denials management.
• Receive/respond to incoming calls from referral sources or potential patients, evaluate information to identify patient needs, and determine the company’s ability to meet them.
• Identify potential payer sources, verify benefits with payer sources, negotiate rates and obtain initial authorizations.
• Advising the patient of the status of coverage, financial obligation, and use of product/potential reactions.
• Collection of payments, insurance follow up, and posting of patient payments.
• Conducts audits as required from payer sources.
• Evaluation of facilities for Medicare/Medicaid & federal payer compliance.
• Tracking payer reimbursement trends and making recommendations for process improvements.
• Educating the sales staff and prescribers regarding the products offered.
Reimbursement Manager, Walgreens Infusion Services Atlanta, GA 2010 - 2012
• Revenue cycle management/review.
• Liaison for the branch to the insurance companies and other payers (government, commercial, and private).
• Prepared corporate financial reports for month end close, and cash reconciliation/controls.
• Communicates, coaches, counsels, & trains as processes, policies, and contracts change with the staff.
• Management of cash applications, bad debt, credit balances, billing, compliance, production, and insurance follow up.
• Communication with physicians and other providers to ensure consistency & dispute resolution.
• Executed audits to ensure compliance (MAC, RAC, and internal controls).
• Reviewed and assessed patient accounts for charity and other financial assistance.
• Identification of trends & areas of opportunity for process improvement.
• Reviewed contracts to ensure proper reimbursement is received.
• Conducted annual appraisals and quarterly employee evaluations.
Reimbursement Manager, Brookwood Medical Center Birmingham, AL 2007 - 2009
• Revenue cycle management
• Management of cash applications, bad debt, credit balances, billing, and insurance follow up.
• Trending cash for monthly forecasting.
• Review and approval for adjustments to patient accounts.
• Contract management to ensure proper reimbursement is received.
• Conducted audits for all cash collection points.
• Conducted meetings with the staff and other entities of the organization for communication and suggestion/implementation of process improvements.
• Communication with physicians and other providers to ensure consistency & dispute resolution.
• Reporting and monitoring unclaimed property to the state.
• Prepared corporate financial reports for month end close, and daily cash reconciliation/controls.
• Assisted Patient Access during shortages and periods of high volume.
• Collaborated with Patent Access with increasing up front collections
• Coaching, counseling, mentoring, and training staff as needed.
• Conducted annual appraisals and quarterly employee evaluations.
Best Buy, Senior Sales Consultant Atlanta, GA 2007 – Present
• Perform Audio/Video product consultations to evaluate needs, prepare proposals and present bids, including performance agreements and custom options.
• Create working relationships with designers, builders, architects, and local Best Buy stores.
• Manage relationships through CRM documentation and complete post-sale customer follow-up.
• Generate personal book of business.
• Complete all aspects of merchandising oversight.
• General responsibility for store upkeep.
Data Analyst Supervisor, HealthSouth Birmingham, AL 2000 - 2007
• Researching and balancing of daily lockboxes.
• Ensured that payments, debits, and credits are posted to patient accounts accurately and timely.
• Dispute resolution with customer service calls.
• Prepared monthly corporate reports to identify trends and statistics.
• Assists with month end GL balancing.
• Coaching, counseling, and training of staff.
• Monitoring workflow to ensure that productivity & other metrics are being met with quality & integrity.
• Review for approval all adjustments, refunds, and AP/AR requisitions before submission to corporate.
Memberships & Affiliations
• Alpha Sigma Lambda National Honor Society
• Alabama Board of Pharmacy Licensed Technician
• Modern Free & Accepted Masons of the World SRA
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