REVENUE CYCLE LEADER

Revenue enhancement professional recognized as team player with a proven track record for process improvement and actively fostering an environment that supports diverse individuals and perspectives, equality, dignity, and creativity.

PROFESSIONAL EXPERIENCE

Associated Retinal Consultants, LLC, Union, NJ

December 2016 to March 2019

Associated Retinal Consultants (ARC) is a specialty ophthalmology practice doing business as NJ Retina.

Director of Revenue Cycle Services

Responsible for the direct oversight of the Central Billing Office.

Managed the accounts receivable for sixteen offices and twenty-two physicians.

Increased monthly revenue on an average of 15%.

Led strategic initiatives for the onboarding of new physicians, practices and locations.

Maintained a positive and effective relationship with insurance provider representative.

Established and generated monthly reports including but not limited to, Aged Accounts Receivable, Collections by Payer, Denial by Payer, Claims Generated, Visit Type History, and Drug Usage.

Recaptured $267,000 in lost aged revenue caused by payer system error.

Collaborated with clinical leadership to achieve organizational goals.

Proactively managed process improvement projects.

Significantly reduced denials by educating front desk staff and establishing system edits and creating reports to identify upcoming appointments which were missing authorizations or referrals.

Proven ability to coach, lead, motivate, and develop work teams toward improved performance.

Ensured that the activities of the billing operations were conducted in a manner that was in compliance with Federal, State, and payer regulations, guidelines, and requirements.

Worked closely with the finance department to maintain a balanced departmental budget.

Maintains a thorough understanding of medical billing, collections, revenue cycle, CPT and ICD10 codes, HIPAA policies, insurance regulations, and the appeals process.

Reviewed and interpreted insurance payer contracts to ensure proper reimbursement.

Med-Metrix LLC, Parsippany, NJ

January 2014 to July 2016

Med-Metrix, LLC is a consulting firm providing performance management analytics, extended business office and revenue recovery services to the healthcare industry.

Director of Revenue Cycle Services

Managed a net variance AR of $6,000,000.

Averaged monthly found revenue of $500,000 to $1,250,000.

Accountable for eleven separate projects involving fifteen facilities.

Implemented seven payment variance projects:

oEstablished possible variance edits based on contract review,

oAnalyzed 835 remittance codes,

oEncouraged the open exchange of ideas to understand current processes and concerns.

Provided feedback to facilities concerning found revenue and collaborated with clients to prevent future variance concerns.

Balanced the interests of multiple clients and readily adjusted priorities to respond to client demands resulting in exceeding client expectations.

Responsible for three to five account receivable projects at a time.

Increased reimbursement and reduced the time from billing to payment.

Trained staff on APG and AP-DRG reimbursement.

Assisted the Client implementation team with interviewing hospital staff and auditing the open AR.

Assisted other departments within the company in troubleshooting system or process concerns.

Assisted in set-up and staff training of their proprietary workflow system.

Children’s Specialized Hospital, Mountainside, NJ

March 2012 to January 2014

Children’s Specialized Hospital is the preeminent provider of pediatric rehabilitation services and the largest pediatric rehabilitation health system in the United States.

Manager Patient Accounting

Stabilized cash flow.

Actively participated in weekly Revenue Cycle Meetings.

Reduced aged account receivable by 10%.

Established insurance presentation for website.

Identified and recaptured 1.7 million dollars in erroneously denied claims.

Established denial process allowing for the recapture of previously lost cash.

Identified two million dollars in lost revenue resulting from incorrect billing and coding.

Identified erroneous denials for duplicate or incidental services.

Participated in yearly budget meetings.

Maintained a balanced departmental budget.

FIDELIS CARE NEW YORK, Rego Park, NY

September 2011 to March 2012

Fidelis Care NY is one of the largest NY Medicaid managed care insurance company's.

Manager AR Finance

Oversight of the member premium billing, reconciliation and cash posting teams.

Established proper and balanced account receivable reporting for each product line, streamlined processes, established policies and procedures, and assisted in automating the billing and posting routines.

Performed stop loss billing for all product lines.

MEDASSETS INC., Mahwah, NJ

March 2007 to September 2011

MedAssets Inc. was an American healthcare performance improvement company.

Director AR Services

Directed various patient financial service projects, both full business office outsourcing and transformational projects.

Responsible for the full business office outsourcing for a 135 bed hospital and multiple AR projects.

CHILTON Medical Center, Pompton Plains, NJ

January 1994 to March 2007

Chilton Medical Center is a non-profit community hospital in Pompton Plains, NJ.

Manager, Patient Accounting November 2002 to March 2007

Manager, Business Office November 1998 to October 2002

Billing Supervisor April 1997 to November 1998

Patient Access Services Supervisor January 1994 to April 1997

EDUCATION

Bachelor of Science Degree - St. John’s University, NY

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