Regulatory Revenue Cycle Operations Analyst
Resume:
Sylvia Guajardo
Corporate Reimbursement Revenue Analyst
North Richland Hills, Texas, United States
*******@*****.***
www.LinkedIn.com/in/Sylvia-g-1b954970
SUMMARY
Revenue cycle Regulatory Analysts with 10 + years serving as a subject matter expert (SME) for RCM program (s) and workflow (s) providing senior level analytics that leverage these measures programmatically and meaningfully. WORK EXPERIENCE
June 2017-Current
Corporate Reimbursement Revenue Analyst
Corner Stone Health Group
Dallas, Texas, United States
June 2017 - Current
Cornerstone Health Group - Dallas, TX
Revenue Cycle Reimbursement Analysts:
Monitored BD for cost reporting database workflow of CMS cost to charge ration 3m groupers. Conducted workflow practices to find solutions for less financial impacts for Month End Close. Controlled all payers contract and their rates in tech software including Commercial, State Medicaid, Workers Comp and Medicare 3m Grouper government CCR twice a year quarterly change.
(R&D)root cause for MCR short stay payment. Monitored and reported variances in data that is provided to management staff.
Utilize revenue cycle payer trend to educate Patient Access and collection team representatives on how to avoid authorization denials.
Maintained Special Projects time management for (R&D) deadline. Tracked and reported variances between OON revenue payer's and actuals which increased payers payments by 30%. Implementing CMS Web Pricer omitting the old zip files they were using improved reserves by 50%. Used DDE and Excel to identify Medicare A/P financial trends for site neutrality payments. Balanced and reconciled accounts Daily, weekly and Monthly. Monitored multi payer markets reimbursement methods to identify emerging trends on discharge. Coordinated with financial advisors to develop long-term strategies avoiding Revenue impact by providing payer reimbursement's trends.
Maintained electronic data reports tracking Medicare and managed Medicare reimbursements for DRG downgrade and LTCH criteria met for Site Neutrality standards IPPS payments. May 2016-June 2017
PFS Level IV Specialist
Christus Health
Irving, Texas, United States
Managed correspondence from multi payers.
Effectively communicated with CFOs and controllers about ongoing payers updates, for detailed accurate ledgers.
Managed complex problem-solving for upper management in order to complete projects on-time and within budget. Reconciled account information by managing audits to be updated to financial records for the month end close process for SAP.
Input financial data and produced reports using PCON Gathered, evaluated and summarized account data in detailed financial reports. Reduced financial discrepancies effectively by push through 14 - 30 day regulatory calls to payers following up on auth denials that have been appealed August 2013-May 2016
Revenue Cycle Analyst
Vibra Healthcare
Irving, Texas, United States
Communicated revenue cycle information to Collection team members in easily-understood terms. Tracked and reported variances between revenue plans and actuals. Applied quarterly evaluations of revenue cycle processes for recommendations to senior management.
Used account receivables reports to offer revenue improvement for newly purchased Hospitals. Reached out to insurance companies to verify coverage. Identified and resolved payment issues between patients and providers. Audit general ledger payment journals needed to be reconciled for financial statements. Processed multiple payer type A/P and A/R reports as needed for month end RCM close. July 2012-August 2013
Medical Records Coordinator
SCC Corp
Dallas, Texas, United States
Processed medical records requests from outside providers according to facility, state, and federal law.
Uploaded records to the patient's individual PHI vault. Kept an accurate log of requests for medical information and records. Recorded patients' medical history, status, services provided and other information necessary for compliance with reporting requirements.
Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers using HIPPA current standards. Maintained patient records systems by archiving, scanning and indexing important documents and files. Reviewed charts and flagged incomplete or inaccurate information. Analyzed complex medical records to identify discrepancies which improved and most payment denials.
Managed uploaded PHI ADR files to Medicare web portal for 1st and 2nd SNF denials. Following HIPAA Compliance's Prepared patient clinicals with payer denials including appeals for Attorneys regulatory ADJ hearings.
April 2010-July 2013
Lead Patient Access Representative
Convergent
Irving, Texas, United States
Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
Providing excellent customer service by promptly answering patient inquiries. Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
Collected and entered patient demographic and insurance data into a computer database to establish the patient's medical record.
Identified insurance payment sources and listed payers in proper sequence to establish chain of payment. Trained new staff on hospital processes and procedures. Stayed calm under pressure and successfully dealt with difficult situations. Resolved patient billing issues in line with established guidelines. Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
Addressed bad debts in line with set protocols.
Received patient deductibles and copayments and discussed options to satisfy remainder of patient financial obligations.
Processed payments using cash and credit cards, maintaining accurate records of transactions. Verified patient insurance eligibility and entered patient information into the system. Followed document protocols to safeguard confidentiality of patient records. Applied administrative knowledge and courtesy to explain procedures and services to front end staff
Delivered support to medical staff in completion of patient payments and minimized complaints Implemented software coding program to support clean claims process by 40%. EDUCATION
2018-2018
Excel
North Lake College
Irving, Texas, United States
2018
● North Lake College, Irving TX
Excel I & II
2007-2008
Certificate
High Technical Institute
Irving, Texas, United States
● High Technical Institute, Irving, TX
Certificate: Medical Billing And Coding.
Relevant Coursework: Revenue Cycle Reimbursement Analytics.
● Awarded Perfect Attendance
2007 - 2008
● AAPC Procedural Medical Coding Curriculum.
SKILLS
Account Receivables Medicaid Budget Cost Reporting Financial Reports Financial Statements Claims Payments Audit Audits Reconciliation Account Reconciliation General Ledger Forecasting Database Content Management System CMS EPIC Hipaa Hippa PFS SAP Model-View- Presenter MVP Meditech WEB Portal Archiving Coding Medical Billing Medicare Workers Comp Correspondence Medical Coding Month End Close Collection Credit Card Credit Cards Operations Time Management Problem Solving Medicare a Patient Billing Office Medical Medical Terminology Process Improvements Workflow A/P A/R Billing AAPC Data Entry Medical Records Customer Service Oriented Customer Service Scanning Healthcare Problem-Solving Medical Invoicing Scheduling Retail Sales Excel HONORS & AWARDS
Awarded Perfect Attendance
LANGUAGES
English - Intermediate
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