Revenue Cycle Management ~ Training ~ Customer Service Manager ~ Process Improvement and Reengineering ~ Workflow and Gap Analysis ~ Team Building Policies and Procedures ~ Time Management ~ Budget Reporting

SUMMARY OF QUALIFICATIONS

Counseling Facilitation Revenue Cycle Operations Management Fiscal Organization Conflict - Resolution

Results-driven professional with extensive experience impacting organizational performance through execution of relationship building, financial management, business development, short/long-term strategic planning, and project management.

Management/Training: Proven track record of successfully managed personnel, finances, facility operations, and admissions while concurrently providing excellent customer care. Trained and managed new hires and existing employees, achieving significant improvements in their productivity

Communication: Ability to use strong communication, organization, and problem solving skills and to liaise with various departments, institutions, and the public to raise awareness and bring support to facilities. Established relationships with community and social organizations. Expertise in providing outstanding customer service in various platforms through rapport and relationship building.

Business & Development: Developed processes to ensure timely completion of interdepartmental projects, which included establishing activity sequence, duration estimates, and schedule development and control. Utilize skills through networking and marketing to establish new business. Instrumental in designing comprehensive plans for business growth, maintaining oversight and tracking every aspect of operations to maximize efficiency.

Healthcare/Counseling: Worked with a certified team of professionals while observing counselor/client interaction, developing a range counseling techniques. Formal study of counseling technique.

EXPERIENCE AND ACHIEVEMENTS:

2012 – 2016: The Methodist Hospital Physician Organization

Manage, Revenue Cycle – (142 plus providers’with14 practice across all specialties and 17 primary physician groups,) Managed the accounts receivables and customer service. Trained, hired and developed staff and mid-level management.

Develop, restructured and implement policies and procedures from a reporting pivot structure, relevant to billing and revenue operations. Work collaboratively with NextGen/Athena project team, director, physicians and staff to define and implement best practice for NextGen/Athena implementations. Utilize the NextGen/Athena Practice Management System to provide oversight of billing and claims items related to the operations of the practice and analyze the performance of the practice, including scheduling, front office duties, billing, claims, and system reporting.

Develop, implement, and manage quality control, follow-up, reconciliation, and audit procedures to ensure accuracy in coding, data entry, cash receivables, and billing.

Exceeding MGMA best practice percentage by 2%.

Monitor timeliness and effectiveness of revenue cycle activities, ensuring the number of day’s patient accounts are outstanding in account receivables, bad debt and credit balances are within benchmarks, decreasing days in AR to 2.5 days.

Assist management to set and achieve revenue targets. Monitor AR indicators such as net collection percentage, days in AR, bad debt, credit balances and risk adjustment scores and advice management as needed. Increasing reimbursement percentage by over 75%.

Analyze NextGen/Athena Accounts Receivable reports to prioritize activity in the monthly self-pay, collection process. Ensure effectiveness of self-pay collection efforts and maintain patient billing within the established timeframes.

Facilitate the preparation of various revenue cycle status reports for Senior Leadership. Analyze AR performance in conjunction with billing vendors and staff to highlight trends and make recommendations for improvements.

Meet with physicians, managers, and administrators as needed to discuss billing revenue cycle, contracting, and credentialing matters.

Maintain departmental compliance with all policies and procedures as outlined by the organization. Ensure billing is performed in adherence to HMPO Business Practice compliance program, and participate in internal compliance committee as required.

Actively participate in planning and administration of HMPO budget as assigned. Provide detailed projections and reports as required for development and management of budget.

Run and review reports needed to manage billing staff and call center performance.

Create and lead task force groups in strategic and operational decisions to assists business process and system development to improve revenue, increasing International collection by over 97% from Q1 of 2014 to Q1 of 2015.

Formulate project plans and definition of activities and tasks for my team; monitor and track plans to ensure desired results for the organization.

Academic Supervisor, Revenue Cycle

2010 – 2012: The Methodist Hospital Physician Organization

Worked with the Senior Management to track performance metrics for AR staff to ensure the level of quality and consistency of worked accounts were met.

Assigned and distributed accounts to team members.

Created and maintained business office policies and procedures, as it relates to revenue cycle management.

Trained staff on practice management systems, processes, and policies & procedures.

Provided timely and constructive feedback and escalation of issues to senior management and hospital account management teams.

Identified and reported trends and denials to senior management in a timely manner.

Reviewed A/R reports to perform analysis on receivables and identify issues or opportunities to improve cash turnaround and/or reduce denials.

Served as a liaison/representative for the team during the absence of the Senior Manager with clients.

Regularly attended and participated in client, company, department, and/or AR management meetings, as directed by Senior Management.

Supported the assimilation and integration of newly acquired client groups into the billing and A/R process.

Team Lead for testing and participating in simulation labs to test practice management systems and upgrades.

Developed internal controls to ensure all transactions and accounts are handled appropriately and timely.

Served as a role model and mentor to team members through demonstrating a commitment to quality, timeliness, and superior customer service.

Oversaw the daily operations of the Charge Entry, Accounts Receivable and Self pay units.

Distributed charge entry batches to staff to maintain internal controls and ensure that batches are entered timely.

Team Lead/Senior Biller

2007 – 2010: The Methodist Hospital Physician Organization

Assisted with the overall supervision of denials by monitoring trends. Provided feedback to management regarding trends.

Worked with the Coding Department in regards to Compliance Rules and Regulations.

Collaborated with several HMPO departments to ensure billing processes were efficient.

Worked with Senior Leadership to develop committees to streamline billing processes across all HMPO department clients.

Team Lead that provided operation support, training, coaching and mentoring to coworkers to ensure daily productivity standards were met.

Analyzed payer trends to enhance the performance of billing operations by running reports and conducting audits on findings.

Medical Billing/Supervisor Collection

2004 – 2006: ARM

Houston, Texas

Oversaw and streamlined billing process.

Scheduled and organized work assignments.

Prioritized and delegated job tasks to ensure project milestones were met and completed timely.

Ensured work was performed accurately and efficiently by developing quality measures to audit end product.

Ensured denials were researched and re-billed promptly.

Supervised, trained and motivated direct reports.

Maintained training and policy and procedures manual.

Audited department functions for compliance and streamlining.

Customer Service Manager

1998 – 2004: United Airlines

O’Hare Airport Chicago, IL

Trained, supervised and mentored 55 customer service agents.

Motivated staff to meet and exceed customer service goals and objectives by developing effective incentives.

Trained employee’s successful sales and closing techniques.

Authorized final approval on all promotional sales, and special arrangements.

Monitored and reported sales volume, financial and business transactions.

Provided technical guidance and interpreted company policies to assist ticket agents in performing functional tasks to enhance the customer service experience.

Developed relationships with Premium Customers to generate additional profit for company with increase and repeat membership.

EDUCATION:

B. S. Health Management Degree, Grand Canyon University

CERTIFICATION

Epic Certified – Resolute Professional Billing Insurance Follow-up

Leadership Development Series 2013

Prosci Change Management Course 2014

Completed Individual and Management Team Birkman Assessment

Experian 2015

SKILLS

Athena, EHR/EPM

Next Gen EPM/EMR/ICS

E-Clinical

Excel

Microsoft

Windows

CURRENT DUTIES AND ACCOMPLISHMENTS

Created standardized departmental policies and procedures for AR follow-up for PO managed practices

Created standardized departmental policies and procedures for Customer Services for PO managed practices

Develop and implemented policies and workflows for International Accounts/Services on an Enterprise level resulting an increase of revenue from 1.0 million to 1.2 million averaging a 16%

Develop and implemented standard workflows and policies for external clients increasing revenue by over 40%

Develop and implemented Transplant centralized workflow in coordination with Corporate Financial reports

Develop and Implemented operational workflows for Wellness to include standard financial reports, bi-weekly meetings, reviewing of contracts and advise on future services

Develop and implemented workplace specific policies in conjunction with HR policies

Develop and Implement ICU charge entry and reconcile process for CVICU, WBICU and NICU

Develop and provide guidance for professional career growth with Team Leads.

Develop and implemented Metrics to measure staff productivity

Develop and Implement workflow process for patient portal billing questions with

Ensure staff has appropriate access to multiple payer website to ensure efficiency in follow-up and denial resolute billing

Meet with JEG biweekly to monitor and discuss legacy AR per PO contract

Data validation including correction of patient account balance for JEG transitional workflow

Prepared data for Huron and CBO development

Prepared data for Internal Audits and provided staff development action plan

Participate in weekly conference with Athena Account Manager reviewing health status of AR

Bi-weekly meeting with Manage Care and Credentialing to ensure proper contracting and reconcile discrepancy in payer reimbursement

Managed Customer Service department in effort to meet the patient satisfactory initiative

Assistant with Pay-To-Address and Bank Name project for Athena Mail Box transition

Manage coder’s day to day operations, provide oversight in auditing and education development

Assist cash applications and payment posting with month end and projects

Oversee and coordinate monthly staff meeting for the AR and Customer Team

Participate in Epic SME (validation) sessions, meetings and workgroups in the development process of CBO

Participate/Coordinate monthly manager meeting for team building and with staff and department

Provide additional specific revenue cycle training to internal and external staff as well as one on one time for staff development

Monthly/Weekly revenue cycle support either on site, WebEX or conference call. (Administrative, Operational Manager, Staff) to include Charge entry, Denial Assessment, Coding and trending issues

Participate in Texas Medicaid and ICD-10 testing for 2015 live

Coordinate/Present at monthly Revenue Cycle Forum meeting

Constant monitoring and staying abreast with industry standards and regulations as it relates to billing and coding

Assist/Troubleshoot Revenue Cycle Help Desk through ticket inquiries from practices regarding access, claim resolution, TOS, self-pay adjustment voids and other related

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