Customer Service Management
Resume:
Erika Gilbreath
Woodland Hills, CA 91303
Objective: To obtain a position within a reputable company that will allow me the ability to utilize my knowledge and experience in the area of hospital administration and management of 15+ years while enhancing the company productivity.
Work Experience:
West Hills Hospital West Hills, Ca 06/2014-Current
Patient Accounts Director
Provides direction to management staff regarding daily operations of the Admitting Department, Emergency Room Revenue Integrity, Billing, Collections, Claims, Payment and Credits, Authorization Coordination, Denial Prevention, and Back Office and Revenue Cycle functions.
8+ years’ experience directing a multi-facility healthcare business and offsite business office including Patient Financial Services and Appeals Services
Manages the front-end Revenue Cycle by meeting A/R targets, data integrity standards, and cash collection goals.
Increased Upfront Cash Collections Revenue by 30% exceeding monthly goal of $300,000.00
Reduced denial inventory by 45%.
Reports to the CFO of the hospital
Identifies, develops, and implements new system tools, programs and technology.
Perform Joint Commission Tracers to ensure regulatory compliance and guidelines
Maintains expert knowledge of principles and methods of planning, directing and maintaining compliance with HMO/PPO/POS, Charity, VOC, AIM, Medi-Cal/Medicaid, Medicare and insurance programs practices and processes.
Analyze existing and potential workflows, processes, supporting systems and procedures for opportunities related to coordination, standardization, and improved efficiency
Strong proficiency in revenue cycle operations and business processes and tools.
Meets with various committees to evaluate processes to meet regulatory standards, patient safety goals, and financial requirements.
Monitor department budget vs. actual financial results, conduct variance analyses of variance, and prepare variance summaries
Develops departmental budget and oversees utilization of resources.
Provides effective leadership to staff (direct and indirect) with particular attention to effective recruitment, mentoring and ongoing performance improvements.
Performs other duties as assigned
Kaiser Permanente Walnut Creek, Ca 01/2002-06/2014
Director of Revenue Cycle
Manages the departmental budget to meet the fiscal goals for capital, payroll and non-payroll expenses. As well as developing cost containment strategies.
Develops clinical care standards to improve patient safety and promote best practice in care delivery and case management.
Strong knowledge of medical/insurance billing procedures, Medicare, Medi-Cal, HMO, PPO,CCS, claims management, payment posting, revenue integrity, collections, unbilled A/R, case management, authorization coordination, patient registration, denial management and reimbursements.
Provides leadership to assure effective, evidence-based clinical and financial management of quality patient care.
Develop protocols and participate in the management of peer to peer referral review via group discussions or other mechanisms as determined by need.
Manages in-bound call center consisting of 60 agents (union employees).Analyzes daily, weekly, & monthly statistical reports & makes appropriate recommendations/forecasts regarding call volume & staff schedules.
Oversee the operational function of Kaiser Charity Care Programs and Patient Business Operations. As well as assists in coordinating for opening new services for the call center & developing & maintaining policies/procedures.
Facilitates/administers training and educational programs, such as professional development, systems training and train-the-trainer programs.
Implementation of key strategic organizational initiatives related to registration, revenue collection and cash handling such as facilitating implementation of Revenue Cycle front-end projects.
Oversees the development of dept standards as identified by regulatory agencies
Manages and resolves human resource, employee and department safety, and risk management issues. Performs financial and staffing analysis.
Provides human resources support to the entire functional area, including managing the hiring, salary determination and performance evaluation processes
Resolves patient, provider, & staff complaints, issues, & concerns.
Identifies and resolves service and operational problems and issues
Directs the units' participation in diversity employment programs
Represents the organizational unit on administrative matters
Recommends and implements internal policies and procedures
Ensures compliance with organization policies/procedures and regulatory agencies, effective utilization of personnel, materials, space and equipment, and effective customer service.
Manages reporting, performance and data analysis for respective groups and senior leadership.
Prepares and makes effective presentations to leadership groups as requested, while tailoring message to appropriate audience
Intermediate project management experiences (e.g., lead meetings, draft status reports, develop / manage project plans, track issues/risk logs, develop / monitor resource plans, etc).
Builds and maintains customer service and relationships with physicians, patients, and local clients
Centinela Hospital Inglewood, CA 08/1999-02/2002
Patient Business Service Supervisor
Hiring and managing Patient Business Services staff of 20 including staffing, scheduling, disciplining, training, terminating and maintaining attendance records.
Monitored daily reconciliation processes for collection of non-dues revenue and all activities related to patient check-in including customer service
Directed any activities or projects which impact or change registration/patient check-in procedures and practices.
Hands on experience with credits, account adjustments, charge and cash transfers, reconciliation, refunds, denials and appeals.
Familiarity with all lines of business performed by Patient Business Services (e.g., billing, collections, governmental programs, etc.).
Knowledge of state and federal regulations related to billing and collections
Approved and issued credits for refunds and or adjustments / transfers.
Planning, evaluating, implementing and continuously improving all aspects of credit & collection functions and processes in addition to working closely with outside collections agencies as well as performing credits, refunds and collections for the largest and most sensitive customer/client accounts.
Assisting in formulation of specific collection objectives and achievement of same while managing functions such as quality assurance, performance and goals.
Direct interaction with selected clients in resolving receivables delinquencies.
Maintained thorough and current knowledge of all federal, state, and local regulations as well as internal policies and procedures and products and services
Analyzed departmental needs and functions, e.g., billing, collections, refunds, credits, adjustments, self-pay, HMO/PPO, Medi-cal, Medicare insurances Identified and reported payer trends. Assisted internal and external customer inquiries regarding account statuses, read, analyze and interpret documents, such as procedure manuals, business process procedures and safety rules.
Knowledge and understanding of the relationship between management and union contracts.
Review collection reports to ascertain status of collections and balance outstanding while evaluating effectiveness of Collections staff. Implemented corrective action and further development plans as necessary.
With Manager, oversaw staff recruiting, training and performance while working collaboratively to problem solve and participate cross- functionally with other teams as necessary.
Take course of action for collateral recovery, such as repossession and legal action. Kept account of invoicing, and maintaining accounts within budget guidelines. Attended applicable departmental/ management meeting
Skills:
Extensive experience managing a multi-disciplinary staff of professionals, technical, exempt and non-exempt employees.
CRCR/CHFP Certification
Strong financial and analytical skills
Experience developing education and training programs
Experience with budget management/ development
Ability to adapt to constantly shifting priorities in managing a wide-range of projects.
Experience using LEAN/Transformational Care tools and methodology along with Six Sigma principles
Strong verbal and written communication skills. Excellent presentation skills.
Knowledge of UB-04, HCFA-1500, and other claim forms, claims eligibility, claims status, EDI, claims payments, and understanding of setting up and managing electronic transactions.
Knowledge of Word, Excel, Access, PowerPoint, Epic, Foundations/Mainframe,Meditech,Passport.
JACHO, HIPAA,EMTALA,OSHA,CMS,AAMI,AIM and Charity Care Programs
Education:
Westchester High School Westchester, CA
High School Diploma
California State Long Beach Long Beach, CA
BA Business Administration
References available upon request
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