Manager Management

Lorena Esparza

**** ***** **

Lombard, IL ***** Cell Phone: 708-***-****

**********@***.***

OBJECTIVE:

To obtain a position in an organization that provides challenges and opportunities for growth. I would like to demonstrate my leadership and creative problem solving skills with emphasis on implementation and training of various functions and revenue-based projects through Revenue Cycle and Practice Management functions. I am skilled & experienced in RCM and have a strong knowledge of medical billing practices.

EMPLOYMENT HISTORY:

November 2011 to present Practice Manager/Revenue Cycle Manager - Drs Girgis & Associates, S.C.

Practice Manager Duties:

Oversee all aspects of an ENT Physician medical practice comprised of 2 FT ENT physicians, 1 NP, 3 FT Audiologists, and administrative staff comprised of medical billers, receptionists, medical assistants, RNs, IT Tech, Sleep techs, and CT Tech. Total staff of 26.

Ancillaries Accountable for: 2 satellite offices, Sleep Lab, CT Radiology, Hearing Aid Center, Allergy, Surgery, In House Billing Department and MSO.

Organized and scheduled all meetings and made sure to oversee shared physician calendar to make sure all meetings and appointment were inputted.

Responsible for renewal of CME's, hospital privileges, DEA certificates, licenses, insurance credentialing contracts( liaison between the PHO) and professional memberships for everyone.

Troubleshoot and resolve operational problems requiring management intervention. Issues included patient complaints, staff complaints and effectiveness and physician requests.

Liaison between attorneys, building management, Accountants, 3rd parties including ISMIE, Employee Insurance vendor, 401K Pension, Collection agencies, answering service and PHO.

Responsible for marketing of practice(strategic planning & growth): website, newspapers, magazine ads, ZocDoc, DexKnows, reputation management and visit independent physicians practices.

Processed and prepared documents and letters for Dr Girgis.

Manage all purchasing including office/medical supplies, office/medical equipment, computers hardware/software, uniforms, furnishings and evaluate all vendors and negotiate/renegotiate pricing structures. Monitor all expenses and purchases and capital budget.

Involved in the decision to transition from one EMR system to another (Mysis/Tiger to Nextgen). Certified as Nextgen SuperUser.

Handle practice financial management including cash flow, accounts receivable, accounts payable, debt financing, bank reconciliations (deposits, electronic deposits and preparation of checks in QuickBooks)

Maintained constant vigilance over operating and overhead costs.

Optimize satellite operations (LaGrange & Oak Park Offices)

In constant communication with our in-house IT employee in order to optimize better use of system and transition to new EMR/EPM system Nextgen.

Trained all medical staff on Nextgen and created flow on new system.

Created shortcuts and templates on Nextgen to make flow easier for physicians and nurses

Create month end reports for accountant & owner.

Attend all hospital meetings.

HR Management Duties:

Supervise employees providing direction, training, and support in order to have the best teams to provide the best quality care in our practice.

Conduct performance evaluations at appropriate intervals (90 day after hire date and yearly evaluations)

Terminate underperforming or insubordinate employees.

Create staff and physician schedules.

Responsible for Help Wanted Ads and all hiring.

Responsible for background checks for all new hires.

Maintained all employee records and approved all PTO and payroll for all departments.

Implemented PTO to payroll and managed employee healthcare benefits, 401K, PTO hours and also implemented extra coverage benefits for employees (Accidental Insurance, and Long Term Care insurance)

Handle all PTO requests and PTO accruals.

Involved in creating a new Office Employee Policy Manual

Create job descriptions

Keep abreast of market wages. Determine salary offers and increases so as to balance marketplace competitiveness with expense concerns.

Handle all bonus, commissions and salaries (quarterly bonus for physicians, NP & management and quarterly commissions for audiologists)

Plan and organize company events

Submit biweekly payroll.

Submit biweekly WorkComp Audit to Travellers for our company.

Interview all candidates (Nursing, Techs, audiologist, Receptionist, Billing, NP/PA and Physicians)

Revenue Cycle Management Duties:

Responsible for the management of the entire A/R. Increased collection at time of service from 45% to ~ 97%.

Responsible for performing daily Revenue audit maintenance functions to ensure compliance, accuracy, and consistency.

Manage front office operations: scheduling, insurance verification, maximize billing receivables with implementing co-pay and outstanding balance collections at time of service with proper training.

Instituted service fees and other policies to improve practice management: fees to fill out forms, missed co-pay fees, charge percentage of collection fee, deposition fees to be kept for company (if patient was/is company patient).

Act as lead resolving escalated billing problems requiring management intervention. (Contacting management at insurance companies and pursue and fervor the timely and accurate compensation of physician charges and fee schedules. Inquiring changes to contract)

Manage in house billing department including surgery scheduler.

Knowledge of RCM within a physician's environment including healthcare billing procedures, EOB and insurance company & governmental rules on reimbursement.

Ensure that all areas of the billing department are being performed at the best level and that accounts are being worked on in a timely manner.

Evaluate the days in A/R and identify opportunities to improve. Current AR over 90 days at 9% versus 80% when I first started.

Manage daily close to include overseeing and monitoring of payments to achieve maximum reimbursement on patient demographics, charges, Lock Box and EFT deposits (insurance & patient payments) to ensure all are posted in a timely manner.

Balanced daily close by generating end of day reports against employee batches.

Implemented measures to improve cash flow ( submit claims on a daily basis vs. weeks later)

Manually audit, code and correct all daily encounters/superbills before submitting claims to be billed (before software scrubs claims)

Responsible for all refunds and write-offs.

Troubleshoot complex account errors and assists in education for resolution on denied claims and difficult accounts.

Filled in as needed to cover tasks ordinarily performed by staff: submitting electronic claims, working edits, and mailing of patient monthly statements. Posting receivables and answering patient questions on accounts. Working the front desk to schedule and verify appointments, checking in and out, answering phones, taking messages.

Analyze functions on EOB denials and credit refunds. Making sure fee schedules are properly entered and that insurance company is paying according to fee schedule. Looking out for trends in denials.

Knowledge and liaison with the PHO and knowledge of all our Managed care contracts and Fee Schedules.

Analyze a wide range of data and developing action plan for implementing new revenue strategies.

Trained Billing & Front desk staff on new EPM software, Nextgen.

Audit hospital billing at month end to make sure all billing was provided by physicians ( Go into hospital portal to check provider patient list)

Liaison for Practice for settlement with Blue Cross Blue Shield of Illinois.

MSO-Prairie Medical Management- Managed outside revenue cycle for Physical Therapy client through our MSO company.

September 2002 – April 13, 2011 Practice Manager/Revenue Cycle Manager – Neurological Care Specialists, S.C.

Practice Manager Duties:

Coordinate multiple office functions that focus on computerized scheduling, electronic billing, reimbursement, collections, accounts payable/receivable, patient records, data management, and payment plans with a demonstrated knowledge of insurance carriers, medical terminology, and CPT/ICD-9 codes. Trained front desk on importance of appropriate patient registration, collections at TOS, and knowledge of insurance verification.

Responsible for managing the Human Resources functions: Oversee staff recruitment, training, supervision, and appraisals, develop job descriptions, advertise open position announcements, and address employee issues with confidentiality.

Serve as primary point of contact for, and liaison between patients, administrative staff, technician, and physicians to facilitate proper line of communication and expedient problem resolutions.

Implement Continues Quality Improvement guidelines to measure the performance of business operations, prepare monthly financial reports, and manage credentialing verification procedures.

Coordinated the purchase of office supplies and maintenance of office supply inventory.

Approved invoice from outside vendors and submitted check requests for payment.

Handled administrative tasks like scheduling, payroll, licensure, and ensure proper maintenance of medical certifications, credentialing, insurance agreements, and State of Illinois Credentialing packet. Served as IT making sure computers, fax, copy machine, and credit card machine are working properly.

Managed 6personnel, including medical receptionists, technician, and medical billing clerk. Directly supervised all office staff in regards to: time and attendance, training, maintenance of schedules for all staff ensuring adequate coverage, and all billing activities.

Monitored physician schedules on daily basis to ensure optimum scheduling. This includes monitoring physician’s requests for time off to ensure proper physician coverage.

Assist with the development of annual practice strategic business plan to ensure practice development and additional revenue opportunities.

Filled in as needed to cover the tasks ordinarily performed by administrative support staff, working the front desk to schedule and verify appointments, checking in and out, answering phones, taking messages.

Review all patient complaints and made sure to attend to them in a timely manner.

Revenue Cycle Manager Duties:

Analyzed daily financial functions of the practice: revenue patient encounters, co-payment collection, past due amount collection, A/R, EOB denials and credit refunds. Trained employees on knowledge of insurance verification.

Responsible for the management of the entire A/R. Increased their collection at time of service from 35% to ~ 85%. Recovered 50% of outstanding A/R from previous billing company aging almost 2yrs.

Improve Cash Flow – Trained physician practice to better collect payments up front at the time of service, as well as to collect outstanding balances. Evaluate the days in A/R and identify opportunities to improve. Analyze functions on EOB denials and credit refunds.

Monitor Payments to Achieve Maximum Reimbursement – Making sure fee schedules are properly entered and that insurance company is paying according to fee schedule. Also, making sure not to apply inappropriate insurance discounts and posting accurate receivables/revenue. Monitored lock-box deposits.Ensured payments & adjustments are posted accurately by poster.

Collections – Making sure to work accounts diligently and efficiently to ensure money is coming in faster and increasing cash flow and reducing A/R before turning over to any collection agency. Worked monthly A/R reports, analyzed/resolved unreconciled payments.

Proper Coding for Maximum Reimbursement – having proper coding entails positive results. Also, submitting proper coding and documentation results in quick maximized reimbursement. I was responsible for all coding.

Charge Capture – starts with patient registration, proper training of front desk will eliminate various errors; it all starts there. I trained my staff on this. Entering of charges making sure every encounter is not missed and properly coded. Review check-in and check-out procedures. I was responsible for in-patient/out-patient charge reconciliation.

Improved monthly A/R collection turnaround verses charges from 50% to ~75%

Responsible for submitting electronic claims, working edits, and mailing of patient monthly statements. Posting receivables and answering patient questions on accounts.

October 2001 – March 2002 Billing/Patient Service Rep Supervisor- Pediagroup Associates, S.C.

Recovered 40 % of Accounts Receivable aging over 6 months from insurance companies after the termination of the previous billing company

Increased time of service collection by 50% and increased their payments on accounts at TOS by 35%

Maintained accurate patient registration data to assure prompt/correct billing and collection and verified insurance benefits for optimal reimbursement

Monitored lock-box deposits, posted receivables, and worked monthly A/R

Trained the front desk with proper procedures on TOS and POA collection, patient registration, cash management, and customer service

Implemented check-in/check-out to facilitate patient flow and a better working area

Ensured that the front desk had knowledge of all participating managed care contracts and made them aware of in and out of network policies and procedures

In charge of transitioning accounts to a different medical software and proper credentialing of physicians

Entered daily in-patient and outpatient charges for 3 physicians

Responsible for the submission of electronic and paper claims and monthly patient statements

January 2000 – October 2001 Project Leader Coordinator/Midwest Medical-Sameday Surgery

Provided and created cash flow projections for the company to assist them in operational and debt decision-making

Recovered 50% of outstanding accounts receivable aging 2yrs from prior billing company

Liaison between the account representatives, off-sites and supervisor: issues and staff performance

Monitored daily activities for 6 sites; including charge entry, deposits, daily edits, and claim submission

Oversaw 4 account reps and monitored lock-box deposits, posting of receivables, working Accounts Receivable reports

Prepared month-end analysis reports for management

August 1996 – January 2000 Assistant Practice Manager/MacNeal Health Network

Trained staff on IDX/Scheduling and Billing, Accounts Receivable, and CPT/ICD9 coding

Implemented check-in/check-out to facilitate patient flow and a better working area

Maintained accurate patient registration data to assure prompt/correct billing and collection and verified insurance

benefits for optimal reimbursement

In charge of payroll, overtime, paid time off, sick leave and coverage of staff

Responsible for timely outpatient and in-patient charge entry

Increased time of service collections by 80% and payments on account by 70%

Responsible for the ordering of supplies

Created monthly staff and physician schedules to maximize productivity

Monitored charge capture, cash collections, deposits and physician productivity

Prepared month-end variance reports

Analyzed and prepared monthly account reconciliation for two practices

Organized the set up of two Multi-Family Practices in Berwyn and Cicero, IL

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ADDITIONAL SKILLS:

Microsoft Software (Excel, PowerPoint, Word)

QuickBooks

Proficient in English and Spanish

CPT and ICD-9 coding

Medical Software (IDX, Medisoft, Versaform,NextGen, EPIC, Mysis/Tiger, Nextgen)

EDUCATION:

University of Illinois at Chicago - Liberal Arts

College of DuPage - A.A.S. (w/ Honors) in Business Management

College of DuPage - Physician office Coding/Billing Certificate (w/ Honors)

References

Armita Bijari, M.D. 630-***-****

Neurological Care Specialists, S.C.

Kerry DiSanto, M.D. 630-***-****

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