Revenue Cycle Cross Functional
Resume:
TENIQUA CHANCELLOR
OBJECTIVE
High performing manager with a passion for healthcare. 12 years impacting positive organizational outcomes through excellent relationship building and listening skills establishing effective working relationships with patients, employees and the general public.
SKILLS & ABILITIES
Confident in ability to collaborate with cross-functional teams to solve complex, high stakes problems. Committed to continuous improvement and contributing to team success.
EXPERIENCE
2021-Present Texas Oncology Houston, TX
Revenue Cycle Supervisor
Supervises the daily business functions of the patient visit from point of entry to accurate adjudication of the patients' accounts. Scope of responsibilities includes appointment scheduling, insurance eligibility processes; charge processing; claim submission and processing; payment processing; collections and accounts receivable management; denial management; reporting of results and analysis; concurrent and retrospective auditing; proper coding; credentialing; customer services relative to revenue cycle; training and development relative to revenue cycle; analytics, and all other revenue cycle management activities. Resolves escalated and unique revenue cycle issues.
Responsible for quality work, meeting deadlines, and adherence to the Practices Standard Operating Procedures (SOPs); regularly audits staffs work to ensure compliance.
Monthly, prepares revenue cycle financial analysis, including aged accounts. Monitors and assesses business metrics to refine processes and improve Guides individuals and teams toward priorities; clarifies roles and responsibilities of others; coordinates resources to meet objectives. Stream goals down to staff’s annual objectives.
Champions new initiatives: acts as a catalyst of change and stimulates others to change; paves the way for needed changes; manages implementation effectively. Steps forward to address difficult issues; puts self on the line to deal with important problems; takes ownership and accountability.
Develops, implements, and maintains the Practice's revenue cycle training materials. Conducts training of SOPs, systems, metrics, government regulations, etc.
Responsible for the overall coordination of front office duties to include scheduling, check-in, and co-pay/co-insurance collection.
Attracts high caliber people, accurately assesses strengths and development needs of employees; provides timely, specific feedback and helpful coaching; provides challenging assignments and opportunities for development. Responsible for interviewing, recommending hires, assessing performance, recommending salary changes, and progressive discipline. Enforces adherence to the practice policies.
2010-2021 Dr. Jonathan Redmon, MD, FACS Humble, TX
Office Manager
Responsible for the financial performance of the revenue cycle
Supervision of patient scheduling, registration, financial counseling, medical records, billing and collection, data entry and processing, and cash posting
Coordination of the day to day operations of the practice
Promoting excellent customer service by all levels of the staff
Develops, implements, and maintains office policies and procedures
Interviews, hires, and trains a productive medical office team and conducts performance reviews
Maintains and manages all filing and organizational systems for the practice
Ensures patient satisfaction, including troubleshooting when there is a complaint and developing process improvements to prevent recurrences.
Ensures regulatory compliance with HIPAA, OSHA, labor laws, and other federal, state, and local regulations.
Coordinates staff meetings for administrative and clinical staff
Coordinates logistics for internal and external meetings and conferences
Ensures staffing is appropriate for day to day operations
Assists in special projects
Assists in recruiting clinicians
2010-2010 Diabetes of America Houston, TX
Payment Poster/Assistant to Chief Financial Officer
Post office visit and physical therapy payments for multiple locations
Post online credit card payments for insurance balances
Post live check folder
Complete and balance batches by the end of each business day
Verity all payments have been posted to the PM system by month end
Transfer credit balances to appropriate dates of service
Process request for refunds and submit approval
Back up support for front desk reconciliation
Assist with the distribution of mail
Other miscellaneous tasks delegated by Billing Manager/CFO
Assist the CFO with all duties in operations/finance
2004-2010 Oncology Consultants Houston, TX
Payment Poster/Billing back up
Retrieve, generate and save EOB's (4010 & PDF) from payer websites.
Create batch in NextGen to post for each day of deposit
Posting from bank reports daily and live/refunds/NFS Checks.
Enter status and reason codes if applicable for each line item.
Email collectors and cc supervisors/managers for denials
Email Patient A/R Collector(s) for any patient balance of $500 or more
Balance Nextgen total to bank daily report and print batch listing report
Post Zero Payments EOBs
Post Write-Offs per Supervisor and/or Manager approval.
Prepare live checks for deposits
Patient A/R Clean up
Corrections
Turn in balance batch to bookkeepers
Notify revenue cycle manager and revenue cycle specialist of fee schedule discrepancies and/or trends.
Completing mid-month and end of the month deadline
Correct Balance Control Issues
All Job functions must be completed with a minimum number of errors
Performs other duties as assigned
Assists with special projects as needed
Understand and adhere to policies and procedures
Accept and incorporate changes or new ideas into daily work
Provide service in a responsive, timely and accurate manner to both clients and colleagues
Cooperate with team members to accomplish departments goals
Interact professionally with clients and fellow employees
2003-2004 Memorial Hermann Surgery Center Houston, TX
Insurance Verification Specialist
Verify eligibility and benefits plus load insurance for patients with a change of insurance.
Work schedules and add-ons to identify patients that need re-verifications.
Determines patient's responsibility if applicable electronically and/or by phone
Notify appropriate parties on all insurance changes.
Work all responses with errors; check all Medicare to see if patient is on a Medicare replacement; check to verify plan hasn't changed; check to verify network hasn't changed.
Enters all insurance information clearly and accurately into medical billing system.
Any other duties requested by management.
2002-2003 United Healthcare Houston, TX
Customer Care Representative
Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (EG. benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
Skilled in problem solving to quickly assess current state and formulate recommendations
1999-2002 Magellan Behavioral Health Dallas, TX
Customer Care Associate/Claims Processor II
Adjudicates claims and adjustments as required.
Resolves claims edits and suspended claims.
Maintains and updates required reference materials to adjudicate claims.
Provides backup support to other team/group members in the performance of job duties as assigned.
Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assists in the mentoring and training of new staff.
Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
Educates providers on how to submit claims and when/where to submit a treatment plan.
Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
Informs providers and members on Magellan's appeal process.
Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.
Links or makes routine referrals and triage decisions not requiring clinical judgment.
Performs necessary follow-up tasks to ensure member or provider needs are completely met.
Provides information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.
Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
Refers patients/EAP clients to the Magellan's Care Management team for a provider, EAP affiliate, or Facility.
Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
Support team members and participate in team activities to help build a high-performance team.
Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
EDUCATION
1991-1993 Southern University Baton Rouge, LA
Undergraduate studies
1991 Skyline High School Dallas, TX
Diploma
REFERENCES
Dr. Jonathan Redmon, MD
Physician, Humble, TX
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