Process Improvement Management

KAREN CELESTINE

***** ************ *****

Houston, Texas 77084

832-***-**** ( ******@***.***

EMPLOYMENT EXPERIENCE

Over 20 years of healthcare industry experience with primary focus in

operations of Billing, Billing Call Center Operations, Quality Audit,

Process Improvement, Claim Reimbursement. Of which, over 11 years of

operational management experience with demonstrated success in leadership

and continuous process improvement.

KEY COMPETENCIES

Member centric leader that is driven by process change and implementation

of efficiency with value added results. Proven skills to analyze current

processes and identify efficiency for process improvement. Ability to make

influential recommendations to Senior Leaders that will demonstrate a

sustainable change. Strategic planning and initiative are key strengths

that led to a successful implementation of the billing call center at

Universal American; yielding 6:1 ROI within the first year of operation and

most recently, implementation of a credit card processing module geared at

continuing the reduction of accounts receivable.

EDUCATION

Bachelor of Science, Business Administration/Management

Columbia Southern University, Orange Beach, Alabama

PROFESSIONAL EXPERIENCE

THE ORTHOPEDIC SPORTS CLINIC, Houston, Texas May 2013 to Present

Sports Medicine Practice

Revenue Cycle Analyst

. Manage the revenue cycle process to maximize collections for

the practice.

. Monthly reporting for the physicians documenting revenue

collected.

. Posting payments manually and payment received

electronically.

. Validation of payments for appeals

. Handle escalated call form patient will account inquiries

and concerns

UNIVERSAL AMERICAN, Houston, Texas ( 2006- March 2013

Fortune 500 company with 2,000 employees; offers affordable healthcare

products and programs, including traditional health insurance, Medicare

managed care plans, and Medicare prescription drug benefits.

Billing Manager

. Managed a team of 19 billing specialist, 1 supervisor and a Revenue

Analyst.

. Established and maintained performance goals for the department and

the employees.

. Oversight of the monthly billing cycles to ensure premium files were

submitted to the vendor timely.

. Monitored and reconciled premium payments received via the premium

lockbox, ACH and CMS monthly files.

. Oversight of automated and manual payment posting process.

. Oversight of the Accounts Receivable to identify overpayments and past

due accounts.

. Daily oversight and performance evaluation of collection's vendor, in

addition to oversight of the on-shore delegated entity.

. Managed the workflow process to address Member concerns and

complaints.

. Handled escalated calls from Members and provided timely resolutions

to ensure customer satisfaction.

. Provided training and coaching to the staff.

ACCESS MEDIQUIP LLC, Houston, Texas ( 2001-2006

Durable Mediquip Company

Senior Revenue Analyst

. Oversight of the research and resolution of outstanding claims payment

. Monitored and reconciled claims receivables, targeting collection

activities

. Development and presentation of daily claims reimbursement

evaluations, to executive-level leadership team, via Crystal

Reporting.

. Performed claims audit review to ensure appropriate reimbursement rate

deductions were applied

. Review appeals for claims reimbursement as required.

Pain and Health Management Centers, Houston, Texas ( 1995-2001

Medicare Managed Care and Medical Management Organization.

Precertification Coordinator

. Scheduled and coordinated surgical procedures for multiple surgical

facilities in the Houston area

. Verification of current insurance benefits prior to scheduled surgical

procedures

. Monitored and reconciled claims receivables, targeting collection

activities

. Coordinated accurate submission of medical records, physician orders

and appropriate coding for billing surgical procedure

Professional References Available Upon Request

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