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RCM hospital A/R

Location:
West Chester, Pennsylvania, United States
Posted:
April 26, 2019

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Resume:

Carmela M Monterosso

*** ****** **

West Chester, Pa 19382

C:856/834-0885 H:610/696-5767

Executive Summary

Critical Skill sets:

Strategic Planning

Project Management

Vendor Management

Charge Master Committee

Organizational Development

Revenue Cycle Management

Contract Negotiation

Leadership Development

Medicare/Medicaid

Settlement Negotiation

Insurance Negotiation

Accounting Interface (GL)

System Upgrades

Team Mentoring, Building & Leadership

Systems:

Epic, Affinity, Siemens, Meditech, McKesson, Cerner, Raintree, IDX, Premis, E Premis, Zirmed, SSI, Quadramed, Xclaim, Rubixis, Microsoft, Rumba and various contract management systems

Professional Employment History

Interim Director PFS/Revenue Analyst ECHN (staff 25) 2018 to present

Coordinate with AVP to insure collections, reduce AR and manage bussiness office staff

Manage large dollar AR to insure cash collections

Coordinate with self- pay vendor

Work with Client services at major insurance companies on contract issues regarding claims

Trend billing issues to improve clean claim rate and reduce denials

VP RCM Fox Rehabilitation (staff 112 and 1400 clinicians) 2014-2017

Manage, coordinate and restructure the RC unit to insure proper collections and reduce denial rates and secure cash.

Manage $120m in clinical revenue (1500 form)

Manage A/R, decreased staffing by 28% and increased cash by 35%, clean claim rate at 98.6%

Exceed cash projections, Medicare, third party payers and self- pay

Maintained budget

Reorganization of RCM team including patient access and the addition of outsource vendors

Director of Operations HBCS (staff 92) 2012-2014

Manage and maintain hospital clients in Wisconsin, Pennsylvania, Mississippi and New Jersey, attend monthly meetings at client sites, outsource of AR day one and aged, create policies and procedures for office staff.

Manage vendor relationships, review contracts

Consult with business office management teams including VP’s and CFO’s to help in strategic plans for cash growth and AR reductions

Work within hospital systems and HBCS systems to enhance collections

VP Healthcare Operations International Portfolio Inc. (staff 146-****-****

Manage, organize, analyses of A/R, contract, negotiate, budget, increase/decrease staff and create procedures for internal and external collections.

Manage 6 Billion dollars of healthcare debt

Manage all clients, HMA, Jackson Memorial Hospital, Cleveland Clinic, Temple and other large healthcare facilities

Exceed cash projections in self- pay, insurance, Medicare/Medicaid and all third party payers

Interface with all hospital directors, revenue cycle, executives and managed care personnel to give insight as to IPI analytical assessments based on cash received and denial management

Interfaced with 46 collection agencies and 300 attorneys that report to IPI

Divisional President VARS LLC (staff 90) 2004- 2006

Managed a hospital AR outsourcing company, staffed hospital personnel, attended PFS meetings, external cash posting, consulted, budgeted and contracted.

Managed outsource division of insurance follow up, third party, Medicare and Medicaid

Created a remittance processing unit to insure proper contractual allowances at time of posting

Consulted in revenue cycle

Increased cash flow for all clients’ cross country, Texas, New Jersey, Maryland, Washington DC and Pennsylvania

Director of Operations MD-X Solutions Inc (staff 68) 2003-2004

Managed and maintained hospital clients in New York and New Jersey, attended monthly revenue cycle meetings, outsource of AR and cash posting, create policies and procedures for business office staff.

Defined, developed and managed hospital AR to increase cash flow

Manage vendor relationships, review annual contracts with vendors

Consulted with business office management teams to help in strategic plans for cash growth

Negotiated contracts with third party collection agencies to collect bad debt

Director of PFS St. Josephs Healthcare System (staff 126-****-****

Director PFS thru Perot Systems 2001-2002

Reporting to the CFO and as the head of revenue cycle operations was responsible for reducing AR, increasing cash, automation of systems, CDM, implementing new systems, setting reserves for accounting, redesign of front end and back end process, negotiating vendor contracts and setting department goals.

Managed a 900 bed trauma facility with a 200 bed offsite acute care hospital

Created a charge master committee to improve charge entry and increase cash flow

Managed a $450 million dollar AR

Decreased our days by and increased cash

Upgraded system functions and automated cash posting, and contract management

Implemented billing scrubber and transmitted at 93% clean claim rate which intern increased cash

Created a denial management department to deal with insurance denials so claims can expeditiously turn to cash

Owner/Director A/R Quest LLC (staff 12) 1997-2001

Consult, collect, bill, train in insurance follow up, increase cash and attend hospital AR meetings.

Managed a large hospital client base to increase cash flow by outsourcing portions of AR

Met with insurance VP’s to implement beta hospital billing trials

Liaison between hospitals and major insurance companies

Additional Career

History

Credit and Collections COLECO Industries

DDA balancing Bank of Hartford

New accounts United Bank

Supervisor of Proof United Bank

Proof Department CBT Bank

Education, Awards, Membership

Manchester Community College/Banking and Finance 1982

Porter and Chester institute/Computer repair 1981

Professional Training and Certifications

Certificate in computer repair, Certificates in Banking and Finance

Memberships AAHAM, HFMA, Siemens system committee



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