Director of Revenue Cycle

FONDA SHANKS

*********@*****.*** **** Founders Way Douglasville, GA 30135 678-***-****

Professional Summary

Over 20 years of financial revenue cycle, including 5+ years of budgeting, 10+ years of project management. Management experience in Billing, Cash Posting, Collections, Denials, Reimbursement, Revenue Cycle or related patient financial activities. Extensive working knowledge and expertise in the healthcare operating environment with respect to revenue cycle, technology, medical and hospital information systems and government healthcare regulations. Demonstrates as a working director, manager, supervisor, developing and implementing new processes related to process enhancements while exceeding operations targets. Results oriented, mission driven and have the thrive to achieve in a rapidly evolving diverse culture.

Qualifications

Proven ability to plan, organize and manage multiple revenue cycle departments. Reports directly to Executive Director, Revenue Cycle Management, Chief Financial Officer and Vice President of the Revenue Cycle Department. High-performing healthcare professional with over 20 years of billing & collections, financial revenue cycle operations management for 16 hospitals in the Southern Region, over 40 multi-specialty physician practices, laboratory and disease of addiction. In depth-knowledge of healthcare revenue cycle operations at all levels. Demonstrated proficiency in managing existing operations and implementing new processes while exceeding operations targets.

Education

Mercer University, Douglasville, GA January 2018

Pursuing: Master of Science in Health Informatics

Areas of Studies: Healthcare Systems

Mercer University, Douglasville, GA

Bachelor of Arts

Areas of Studies: Organizational Leadership, Business and Human Resource

Chattahoochee Technology College, Marietta, GA

Associate of Applied Science

Areas of Studies: Organizational Leadership

Certifications

Certified Patient Account Representative, HFMA, Atlanta, GA

Certified Supervisory and Management, Chattahoochee Technical College, Marietta, GA

A+ Certified Computer Service Technician, Southern Polytechnic State University, Marietta, GA

Organizations

Yellow Belt Six Sigma, Tenet Healthcare, Alpharetta, GA

Chapter of Sigma Alpha Pi, the National Society of Leadership & Success, Marietta, GA

Delta Sigma Theta, Southern Polytechnic State University, Marietta, GA

Applications

EPIC ECARE MEDASSETS ECHO OPTUM Vital Stats

PPOINT MEDIFINANCE HPF EMDEON ACE Direct Access

EXCEL SHOWCASE NEXTGEN EPREMSIS STAR Navicure

Experience

Treatment Management Company LLC, Atlanta, GA

Director of Billing & Collection/Denials & Cash Posting, July 2017 – present

Responsible for the reporting and management of the Collections and Billing function for all Treatment Management Company treatment facilities and support centers. Provide leadership to patient financial services, financial counseling and reimbursement departments.

Ensure clinical documentation, coding, collections and reimbursement workflow process.

Communicate critical success factors necessary for the departments to support organizational goals. Plans and coordinates the maintenance and monitoring of internal controls.

Strategically identifies and communicates the critical success factors necessary for the departments to support their financial and organizational goals.

Make recommendations to ensure that the technology applications and information management systems support the billing operation.

Provides billing and technical support to teams.

Coordinates and oversees the monthly revenue reporting process.

Ensures reimbursement strategies and trend analysis and patterns are indented and executed.

Effectively manage cash collections and denials and meet developed targets.

Attends various Finance meetings and other management meetings, at the direction of the CFO.

Works closely with the Finance team to understand revenue, contractual allowance, bad debt, charity, aging and other important trends that affect financial performance.

DMPG, Atlanta, GA

CBO Manager/Acting Central Business Office Director, March 2016 – July 2017

Oversee the daily operations of accounts receivable follow-up, patient billing/collections, application systems, charge capture/charge entry/charge master maintenance, claims edits, coding integrity, denials management, float pool, payment variance analysis, refunds management, registration, data reporting and training.

Overall supervision of Payroll, Purchasing, Accounts Receivable and Accounts Payable

Design, implement and ensure continued relevance of comprehensive revenue cycle solutions for physician/hospital billing/customer services, coding, payment posting/refunds and PRN float pool.

Implement physician/hospitalist operation performance improvement tools that generated 24 million to 29 million in revenue.

Created and developed an incentive package/program for employees.

Created new front office scheduling and registration workflow process to financially secure accounts with timely authorizations and verification prior to patient arrival, and implement goal driven point of service collections initiatives within multi-specialty

Developed and manage analyst team with respect to data analytics, tool implementation, training and client deliverable during project engagements.

Train clients in reporting, revenue cycle management and system navigation to enable effective management and follow-up of outstanding accounts receivable, denials and patient registered accounts.

Lead client training and observe processes across the revenue cycle to identify opportunities for performance improvement, conduct quality audits, aging, denials, write-offs, authorizations, verification and charge capture

Support and coach clients’ senior leadership to improve emotional intelligence, process improvement, change management and interdepartmental communication

Design and implement new process flows to reduce multi-specialty specific bill holds, denials and write-offs

Conduct daily reconciliation of charge capture, missing charges and charge audit within multi-specialty to improve inappropriate and unbilled charges

Leads data analysis by ensuring efficient data collection is capture during analysis and summarizing recommendations for improvements

Create client presentation that illustrate beginning and ending performance

Manage day to day project operation budgeting to assure correct allocation of funds are within budget

Employ tracking tools and reports to measures specified functional area progress through financial metrics

Serves as a methodology and subject matter expert in patient access, revenue cycle billing activities and requirements to project team, company colleagues and client’s

Develop and implemented a workflow process to ensure payments are posted within 24 to 48 hours’ timeframe

Point of contact for practices, payers, patients, hospital administrators within assigned market

Facilitate Central Business Office monthly staff meetings.

Revised all job descriptions and created new roles to align with the Central Business Office to improve department areas within the company as well as increase growth

Implement PBX switchboard to improve patient satisfaction

Modify manual to electronic automation, uploading of claims in Navicure and downloading of ERAs files

Directs and manages 40-50 employees within DMPG physicians group of collections, credentialing, senior analyst’s, payment posting, refunds, coding, PRN float pool and customer services; setting standards and appraisal of personnel.

Piedmont Hospital Physician Group, Austell, GA

Revenue Cycle Manager, Specialty Group, Jan 2014 -March 2016

Lead and managed the revenue cycle functions for multi-specialty group for both hospital and professional operations. (Transplant, Urology, Sleep Study, DME, Critical Care, Vascular, Neuro Science, Pulmonary ENT, etc.)

Actively monitored revenue cycle daily: denials, aging, charge entry, billing of claims and appeals.

Utilized Key Performance Indicator (KPI) reports and benchmarks to evaluate/measure performance

Responsible/Resolved claim edits, retro review, Emdeon/Navicure rejections, credentialing issues and created best practices to reduce the number of denials (registration and coding)

Enhanced insurance verification, coding review, charge entry, collection and payment posting processes

Customized claim edits for multi-specialty group by payor specific

Worked closely with coding to implement training for (ICD-10)

Conducted thorough analysis of revenue cycle across multiple billing offices

Ensured correct, timely, accurate processing of all claims

Actively monitored and maintained Key Metrics for reporting.

Executed sound judgment and decision to promote accurate and timely completion of cash posting, billing and follow-up

Developed, implemented and maintained standard business analytics and prepare periodic management reports with recommendations to improve performance

Supervised and evaluated productivity and performance of staff

Analyzed financial impact of changes in coding activities, charge entries, authorization/referral issues and recommend corrective action accordingly

Established and maintained clear communication with internal and external clients

Ensured front office/practices are appropriately updated on coding/billing requirements for all payors (Medicare, Medicaid, BCBS, UHC and etc.)

Monitored new provider credentialing

Worked closely with managed care team

Developed training materials and implemented front and back end training of standard operation policies, system metrics, payor regulations and created standardize work flow processes.

Point of contact for practices, payers, patients, hospital administrators within assigned market

Directed, managed and supervised 20-30 employees within Piedmont physician group of collections, payment posting, refunds, coding and PRN float pool; setting standards and the appraisal of personnel

Conifer Health Solutions/Tenet Healthcare, Alpharetta, GA

Support Manager, Denial Management, Plan/Pre-Legal and Terms & Condition, May 2007- March 2013

Ensured and continued relevance of comprehensive revenue cycle solutions for the Southern Region hospitals with 25 to 460 beds

Supervised and develop analyst team with respect to data analytics, tool implementation, training, and client deliverable preparation during project engagements

Trained clients’ senior leadership professionals in reporting, revenue cycle management, system navigation and follow-up of outstanding AR, denials, and payor/contract update

Conducted quality audits of aging, denials, write-offs, authorizations, referrals, charges and contract variances to report/ recommend and implement process changes/improvement

Designed and implemented new appeal work-flow process to reduce denials, aging, write offs and delay in submission of appeals

Worked collaboratively with respective leadership to identify and implement best practices

Successfully supervised and managed contract and legal support for 16 hospitals in the Southern region

Managed over 40 employees including a Supervisor and 2 team leads for customer support, billing, follow-up, reimbursement, cash posting, and denials management

Oversee maintenance of the Terms and Conditions tables to ensure that contract terms were correctly applied

Actively monitor revenue cycle, track denial reports and aging

Conducted thorough analysis of revenue across multiple hospitals

Ensured creation and maintenance of all plan identifications

Develop, implement and maintain standard business analytics and prepare periodic management reports with recommendations to improve performance

Supervise and evaluate productivity and performance of staff

Analyzed financial impact of changes in coding activities, charge entries, authorization/referral issues and recommend corrective action accordingly

Worked closely with clinical nurses to dispute denials for medically necessity and retro-authorizations

Worked closely with staff to dispute technical denials (contract, timely filing, COB issues and etc.)

Facilitated educational projects successfully over the past year for Conifer Health Solutions, a revenue cycle environment, pertaining to leadership and assured proper training provided for all levels of management.

Point of contact for contract loading/negotiation, support, billing, payers, patients and hospital administrators within assigned market

Directed, managed and supervised 35-50 employees of support services, denials, collection, managed care, analyst’s and contract terms/conditions

Shepherd Center, Atlanta, GA

Patient Financial Service Supervisor, January 2000-October 2005

Conducted ongoing reviews of contract variances

Managed Accounts Receivable, billing, cash posting, switch board and financial counselors

Supervised and managed 20 employees

Conducted thorough analysis of the Accounts Receivable

Worked closely with CFO, Managed Care and member of the managed care implementation team

Validated Medicare cost report

Point of contact for contract loading/negotiation, support, billing, payers, patients and hospital administrators within assigned market

Equifax Healthcare/National Data Corporation, Physician Group, Atlanta, GA

Central Business Office Technical Support Lead, March 1994- January 2000

Provided support to onboarding physician practices

Installed and trained physicians on practice management system

Provided support to physician: eligibility verification/bill claims and coding

Provided support to reduce denials, increase cash and improve aging

Point of contact for practices, payers and patients within assigned market

Lead 25-35 employees of help desk and technical support

Reference Upon Request

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