Revenue Cycle Accounts Receivable
Resume:
ad145k@r.postjobfree.com
linked.com/in/maryann-davis-a7931b73
With extensive experience as a Director of Revenue Cycle and a Contract Consultant, I process a comprehensive understanding of the revenue cycle process acquired through my tenure at diverse healthcare facilities ranging from healthcare-based institutions to physician-centered facilities, critical care access hospitals, and FQHC (Federally qualified health centers). Primary responsibilities involved conducting thorough reviews of existing procedures, workflows, and SOPs to identify any trends or root causes affecting department revenue.
CAREER HIGHLIGHT
Collected $1.5M on deeded uncollectible income across eight clinical practices; 9+ years of director of revenue experience; 4 years of payer contracting; Reduced Insurance Payer A/R aging by 11%; Reduced Bad Debt write-offs by 3% monthly; Reduced A/R 120 days by 4.7%. Ability to set priorities and meet timelines for performance expectations, while maintaining strong attention to detail and effectively managing change.
EDUCATION
MSHRM, Roosevelt University
BBA, Robert Morris University
CPM (Project Management) Villanova University
PROFESSIONAL, CONTRACT AND CONSULTING EXPERIENCE
Healthcare Initiative Leadership Recruitment & Interim Solutions June 2023 - Current
Title: Interim Manager, Patient Account Services
Windom Area Health, Critical Care Access Hospital
Design efficient policies, SOPs, and workflow goals that adhere to legal and compliance requirements and organizational standards.
Oversee revenue cycle for the Billing, follow-up, Collections, and Cash Posting process.
Managed relations with payers and providers to generate high reimbursement rates and a low level of denials.
Reduces denial write-off by 7% within 1 month.
Partner with the contract department (HB/PB) to support and negotiate new and renewal contracts (payers, vendors, outside agencies, coworkers, staff, and supporting documentation, auditing, and monitoring activities.
Facilitate frequent departmental meetings with all levels of management to review operational trends, and issues, and address concerns.
Monitor key revenue cycle performance metrics, analyze trends, and identify areas for improvement.
Discovered opportunities for process improvement through reviewing performance metric reports.
Created operational plans with concise, clear language that emphasizes key departmental goals and objectives.
Conduct billing audits
HRG Executive Interim Management & Consulting May 2021 – July 2022
Title: Interim Director, PFS
Alameda Health Systems, San Leandro, CA
Integrate Public Health System
Design efficient policies, SOP, and workflow objectives, which align with the organizational standards and adhere to legal and compliance requirements.
Provide guidance and support to revenue cycle staff, including training, performance evaluations, and professional development.
Develop a strategy around payor relations and foster strong working relationships.
Developed operational plans using clear language highlighting important departmental aims and objectives.
Ensure accurate maintenance of client records related to invoicing and bill payments.
Collaborate with cross-functional teams, including finance, billing, coding, IT, and clinical operations, etc., to streamline revenue cycle processes and enhance communication and coordination.
Developed appropriate action plans to modify results by required outcomes.
Review and analyze customer contracts and pricing, services, and negotiate as needed.
Collaborate with external vendors, payers, and other stakeholders to resolve billing and reimbursement issues and negotiate favorable contractual terms.
Stayed up to date on changes & and regulatory requirements, healthcare trends, compliance policies that impact revenue cycle operations (clinical publications, payers’ websites, CMS, Medicaid, Medicare, global regulatory agencies (HHS, OIG, DOJ, FDA), and their guidelines, policies, and standards.
Prepared financial reports identified KPI trends, variance, and root causes. Monitored, and evaluated along with monthly operational summary reports.
Native American Health Center, Oakland, CA July 2019 – Dec 2021
Interim Director, CBO & Credentialing
Federally Qualified Health Center (FQHC)
Planned, developed, organized, and put into action processes to guarantee prompt and accurate claim processing, including keeping the number of unbilled days within the predetermined range.
Implemented and created departmental best practices, policies, and standardized workflows for account receivable operations through continuous improvement initiatives.
Submitted Medicare Credit Balance Report (CMS 838)
Managed the physician credentialing process with managed care and government payers.
Participated in short and long-term goals in the Revenue Cycle operations and performance.
Coached & counseled with clear guidance to team members to complete various billing tasks properly and efficiently.
Maintained appropriate compliance with Federal, State, and local regulatory agencies and oversight bodies.
Provided recommendations for hiring, training, salary adjustments, coaching & and counsel, and personnel actions where appropriate.
Developed, and monitored KPI departmental metrics and benchmarks to measure performance.
Facilitated regular meetings with all levels of management to review operational trends, and issues, and address concerns.
Developed, monitored, and communicated recurring revenue cycle metrics, KPIs, and key reports, including collections, AR Aging trends, denial rates, etc.
Healthcare Resource Group Mar 2017 – June 2019
Title: Revenue Cycle Optimization Consultant
Heart of American Medical Center
Critical Care Access
University of Kansas Hospital
Short-Term Acute Care
Implemented Centralized Scheduling.
Met with the business operations department to review revenue cycle metrics, operational issues, and analytics. Identify trends & discuss short and long-term solutions as appropriate.
Designed organizational standardized policies and procedures based on industry best practices.
Establish billing and collections process controls and Denial Rate by 6%
Ensure training and developing clinical and non-clinical staff on compliance and daily operational issues.
Discovered opportunities for process improvement through reviewing performance metric reports.
Participate in departmental committees to address problems and facilitate information exchange about problems, and programs.
Recommended operating and staffing budgets for assigned areas.
Routinely monitor patient feedback and partner closely with Senior Leadership to ensure high-quality and safe clinical care is provided to the patients of the practices.
Develop, implement, and manage operational programs to meet the department determination's short- and long-term objectives.
Collaborated with cross-functional teams to review revenue cycle metrics, operational issues, and analytics. Identify trends and discuss interim and long-term solutions as appropriate.
Develop reports and metrics to monitor progress in the practices.
Utilize A/R mapping reports to identify accounts to identify and monitor trends.
Quarterly submission of Medicare Credit Report (CMS 838)
Monitor and analyze revenue cycle KPIs through reports and observations.
Develop and execute action plans to ensure timely collections and follow-up.
California Healthcare Medical Billing (CHMB) Feb 2017 – Nov 2017
Escondido, CA
Title: Client Executive
Managed and directed client communications and CHMB service interactions; liaison between assigned clients and assigned RCM team.
Strategize with division leadership frequently to evaluate operational projections and trends to implement action plans that address fluctuating performance and exceed monthly goals.
Track department-level production metrics using scorecards and dashboards to detect trends and make initiative-taking adjustments.
Collaborates with reporting analysts to develop reporting that meets the client's needs.
Managed client expectations based on appropriate service levels and effective decision-making.
Develop and implement effective revenue cycle management policies, procedures, and workflows to optimize billing, coding, claims, and reimbursement processes.
Work collaboratively with various departments within CHMB to resolve client concerns or requests.
Develop and implement effective revenue cycle management policies, procedures, and workflows to optimize billing, coding, claims, and reimbursement processes.
Performed AR Analysis and presented information to the clients, CHMB committees, and executives.
Conducted meetings with Operations to identify areas of concern and assist in the implementation of workflow changes.
Administered and managed the entire revenue cycle process for multiple companies.
Monitors key billing/collection statistics and compares to national/regional/local benchmarks including, but not limited to, net collections, days in A/R
Ensured accurate maintenance of client records related to invoicing, and bill payments.
Independent Revenue Cycle Consultant (Contract) Nov 2014 – Feb 2017
Interim Director, Revenue Cycle
ABLM, Inc
PMS – Fort Worth, TX
Children’s Hospital, Dallas TX
Forest Wake Baptist, Winston Salem
Expeditive Revenue cycle
NMFF, Chicago, IL
B.E. Smith (Interim Leadership)
Managed HIM, Patient Access, Patient Financial Services, and Credentialing & Enrollment Department.
Managed a staff of 87 FTE, eight remote Coders, and four Managers.
Revised, and implemented policies and procedures and workflow.
Managed the entered revenue cycle process for both HB and PB
Created workgroups and initiatives to build a cohesive work environment across all levels of the revenue cycle resolution. Created a denial task force team to reduce denials and write-offs due to adequate processes.
Collected $1.5M on deemed uncollectible income across five clinical practices. Identified trends and obstacles to timely and efficient collections, while making recommendations for process implementation to correct negative trends.
Reduced unapplied/undistributed cash by 65% in 4 weeks; collected $1.1M in deemed uncollectible revenue.
Identified Loss Revenue and implemented workflow and action plan(s) to close the gap.
CHRISTUS Health, Irving, TX (Contract) Mar 2014 – Oct 2014
Title: Revenue Cycle Manager
Physician Billing
Key Accomplishments:
Managed a department of 37 FTE, 1 Team Lead, and Interim manager for 28 FTE. Interviewed, selected, disciple, and employer’s complaints.
Monitored activities for seven regions: GC, ALT, NLA, Santa Rosa, SETX, SWLA, and CLA. Analyzed variances, rejections, and denial information to identify trends.
Provided education to reduce medical necessity billing edits and denials. Provided leadership, and guidance and effectively managed the day-to-day operations, analyzed the accounts receivables, and bad debt through reviewing key indicators.
Negotiated contracts with non-participating providers. Developed and watched productivity logs to identify performance and penetration. Prioritized, planned, and directed work assignments. One-on-one meetings with staff, as well as spearheading periodic team meetings and discussions.
Prepared facility's operational summary reports based on audit findings. Audit managed care contracts and applicable rules and regulations. Weekly meeting with the Director and VP of Operations to forecast staffing development, IPOs, and volume trends.
Monthly and random A3 audits. Updated, and revised procedures and workflows. Reviewed and approved write-off adjustments limit of $9000 .
US Renal Care, Plano, TX (Contract) Jan 2014 – Mar 2014
Hemodialysis Facility
Title: Interim Reimbursement Manager
Key Accomplishments:
Managed 18 FTEs, 1 Supervisor, and 1 Team Lead. Managed the Managed Care activities of multiple practices in geographically diverse locations to ensure efficient office operations.
Contracted negotiations with non-participating providers including LOA letters. Interviewed, selected, trained, supervised, evaluated, counseled, and recommended termination of assigned employees. Negotiated and monitored contract rates with non-participating carriers.
Reviewed and approved adjustment limit of $10.000 . Provided ongoing revenue accounting oversight to the Department and the Finance and Accounting arm of the Medical Center and Clinics.
Weekly meetings with managers, collectors on/off-site locations, Directors, and VP to forecast staffing development and IPOs. Monitored and measured employee performance & penetration. Tracked denial log for root causes and variances.
Prepared department summaries based on audit findings/root causes. Analyzed data and developed an overall approach for trending issues and volume trends. Monitored 835 and 837 upfront rejections, edits, prompt EFT payments, and evaluated opportunities for improving the work processes.
UT Southwestern, Dallas, TX Mar 2011 – Dec 2013
Academic Medical Center
Title: Physician Collections Manager
Managed 21 FTE, two supervisors. Interviewed, selected, trained, supervised, evaluated, counseled, and recommended termination of assigned employees. Managed sixteen offsite physicians’ clinics.
Led and directed the revenue cycle team.
Served as a departmental representative on committees and meetings. Interacted with all levels of key managers to address and resolve complex issues that impact AR and offer recommendations for improvement. Reviewed and approved adjustments of $10.000 .
Aided with cash management projections and forecasting activities. Tracked and monitored 835 and 837 files. Educated the clients, monitored performance goals prepared for & conducted monthly meetings.
Collaborate with external vendors, payers, and other stakeholders to resolve billing and reimbursement issues and negotiate favorable contractual terms.
Monitor key revenue cycle performance metrics, analyze trends, and identify areas for improvement.
Attended monthly meetings with clinical staff, and the IT Department to review & identify issues that impact loss revenue.
Prepared department operational reports based on audit findings, root causes, and variances. Developed budget targets for clinical department practices. Ensured compliance with applicable laws, regulations, policies, and procedures.
Worked closely with IT to develop analytic dashboards to produce real-time data for operations including denials, metrics, cash collections, productivity, etc.
TECHNICAL PLATFORM
EHR: Epic, Allscripts, SSI, Prime Suite, Meditech
PMS: EPIC, Allscripts, IDX, IDX Web, Centricity, Eprism, OON Booking, AS400, Wake-One, Waterfall, Meditech, Eprism, LDA, QMS, Caremedic, ARCC, Track Manager,
Accounting: Kronos, ADP, PeopleSoft, Exponent,
Clearinghouse: Collect logic, Payer Path, Availity, Clear Claim Connection/Logic, Pay Span
Coding System: Encoder.pro, Super coder, Optium360, Med Asset, McKesson
Reporting: Clarity, HBI, Real Med, Curve PMD
Scanner: AccuDoc, On Base, Laser fiche
Insurance Portal: NC Track Portal, Track Tracer, Navicure, Novitas, Noridian, NGSMedicare
Database: MS Word, Excel, PowerPoint, Outlook, SharePoint, Publisher
PROFESSIONAL SOCIETY
oAmerican Association of Healthcare Administrative Management (AAHAM) 2015
oHealthcare Financial Management Association (HFMA) 2016
oSociety for Human Resource Management (SHRM) 2009
oAmerican Academy of Professional Coders (AAPC) 2011
oMedical Group Management Association (MGMA) 2016
oWorld at Work (2019)
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