Melissa Hernandez

**** *. ******** ***** #***, Corona, CA 92879 – 909-***-**** – acutti@r.postjobfree.com

Summary of Qualifications

Dynamic forward thinking leader that has vision for business growth and development

Strategic leader with excellent problem-solving skills and proven ability to influence change and stimulate action

Proven effective in building and maintaining new and existing professional relationships

Ability to manage complex workflows, multi-task, manage deadlines, and manage complex cross functional projects

Skilled in interpreting and analyzing data to make critical business decisions

Strong organizational and business management experience

Excellent team leader who cares about personal development and education

Exceptional oral, written, and presentation skills

Proficient in Microsoft Office, Quickbooks, Medisoft, Collaborate MD, AS400, CPR+

Professional Experience

Director of Reimbursement / Patient Financial Services (2015 - current)

Bio Scrip Infusion Services, Burbank, CA (Provider of Home Infusion Services)

Plans and manages the Reimbursement Department in compliance within all legal regulatory parameters and company policy and procedure. Holds the department accountable in meeting deadlines and specific billing and collection goals for the Western Region.

Monitors reimbursement department for efficiency, compliance, and results

Maintains updated knowledge of industry, regulatory and reimbursement issues

Reviews final daily/weekly/monthly reconciliation of all deposits

Ensures company pricing and discount policies are administered correctly

Assists in the reviews of new contracts to ensure incorporation into the system and proper staff education on contract language and pricing

Monitors electronic funds transfer (EFT) and electronic remittance advice (ERN) with focus on timely and accurate cash posting

Manages large patient accounts and key payor accounts, intervenes as appropriate to ensure timely reimbursement

Ensures billing standards, collection standards, and cash posting standards

Approves adjustments as per company policy

Assists with month-end closing as scheduled to assure timeliness

Monitors days sales outstanding (DSO) while establishing policy and procedure that result in reducing the DSO

Promotes an environment which encourages accomplishment of company and staff objectives

Coordinates with center-level management to ensure development and training of new and existing reimbursement personnel

Works collaboratively with other departments, including operations and managed care, to improve reimbursement process and results

Directs, coordinates, and evaluates reimbursement staff and carries out supervisory responsibilities

Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems

Succession planning and leadership development

Operations Manager, Revenue Cycle Management (2013 - 2015)

Pinnacle Lien Services, Provider of Medical Billing, Collections & Workers’ Compensation Lien Litigation, Corona, CA

Responsible for identifying and streamlining process efficiencies to increase productivity to ensure client growth and retention. Oversee and manage plans to grow business through sales and marketing campaigns. Drive bottom line results.

Manage profit and loss while ensuring strong financial performance and revenue growth

Engage in strategic planning with department managers and owners

Communicate effectively with third party payers / insurance companies to determine proper reimbursement

Increased service offering to established collection clients which resulted in new billing contracts and increased client base as a result of 22 newly signed collection contracts

Respond to client inquiries and referrals

Developed and created a billing collectors training guide along with a structured training program for new hires

Designed tradeshow booth graphics to capture all audience types inclusive of billing, collections and lien litigation clients

Created and designed marketing materials to effectively communicate our value proposition and service offerings

Implemented new CRM software in order to monitor lead development, follow up, and lead generation activities

Established a partnership with a staffing company to actively recruit qualified collector and workers’ compensation experienced professionals

Assisted the billing department with implementing a request for authorization process for billing clients allowing a more accurate and efficient billing and collections process

Developed a monthly case detail report to distribute to all collection clients to keep clients updated on pending cases and forthcoming revenue

Successful management of the scheduling and coordination of all educational seminars, conferences, and exhibits relevant to the industry in order to develop brand name and recognition

Develop, mentor and inspire a cohesive team

Effective leadership development

Capacity to develop effective relationships at all levels of the organization and to influence positive outcomes

Manager of Revenue Cycle, Billing and Collections (2007 - 2013)

Sunshine Medical Center, Multi-Specialty Medical Group, Garden Grove, CA

Responsible for managing an efficient revenue cycle management process within a 5 physician practice which ensured fast reimbursement, reduction in rejected claims, increased productivity, decreased accounts receivables, and a consistent cash flow.

Developed account management programs for specialty physicians including podiatry, pre-op/laboratory, MRI/imaging, chiropractic/physical therapy

Implemented new billing software to effectively collect the maximum for all payor types including PPO, Workers’ Compensation, Medicare, and Personal Injury

Created and implemented a RFA process which allowed for more accurate and efficient billing and collections

Skilled in written correspondence with appeals and payment reconsiderations which resulted in additional compensable services

Extensive collections and accounts receivable follow-up which generated increased revenue and consistent cash flow

Resolved issues associated with the billing between other departments and surgical centers by eliminating rejected or denied claims allowing for faster reimbursement

Account Executive (2005 - 2007)

Argent, Inc., Mortgage Company, Irvine, CA

Responsible for managing relationships with mortgage broker accounts to increase funding of new home purchases or refinancing.

Managed activities of accounts based on an assigned territory, allowed for market penetration for increased broker contracts and maintained monthly funding of $1-$2 million

Effectively developed and trained mortgage brokers which resulted in an increased product offering and increased monthly mortgage funding

Penetrated new business opportunities by prospecting, lead generation, qualifying opportunities, and scheduling appointments which resulted in an increased funding pipeline

Developed solutions and creative proposals to close the sale which built loyal and committed broker clients correlating to increased referrals

Medical Sales Representative (2002 - 2005)

Metrex Medical, Medical Device Manufacturer, Orange, CA

Managed a successful sales territory in Southern California selling infection prevention products to

hospitals, outpatient surgery centers, physician offices and universities.

Successfully met revenue targets by developing relationships with customers which resulted in committed and loyal sales

Delivered educational presentations to customers which resulted in a 10% increase in product usage

Converted the entire Kaiser Hospital System to the Metrex product line by working collaboratively with national accounts and marketing to win the bid

Education:

Masters in Healthcare Administration, Concentration in Leadership & Development (2012 - 2014)

University of La Verne, La Verne, CA

Bachelor of Science in Business Management (2000 - 2002)

Pepperdine University, Irvine, CA

Associates of Arts in International Business Management (1998 - 2000)

Santiago Canyon College, Orange, CA

Associations:

American College of Healthcare Executives (ACHE)

Active Member

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