MARISELA LICEA

**** *. ***** **** **. Sahuarita AZ 85629 – ad22sv@r.postjobfree.com

Demonstrate extensive experience in healthcare/business operations including leadership, strategic planning and implementation of performance best practices. Active knowledge of healthcare operations including revenue cycle management, health information management, patient access, information systems, including Cerner, and Meditech. Highly dependable, ethical and reliable leader that blends advanced organizational, technical and business acumen.

PROFESSIONAL SUMMARY

PROFESSIONAL EXPERIENCE

Revenue Cycle Manager

Tenet Healthcare System (Carondelet Health Network- Tucson Arizona) 04/2016-02/2020

Conducts Revenue Cycle business operational assessments to ensure consistent business practices across Carondelet Healthcare System

Works with Revenue Integrity department in collaboration with Management, to ensure optimal billing and collection practices are followed.

Monitored unbilled/un-coded claims across organization and worked proactively to ensure targets are achieved and continuous improvement

Managed 18 employees to include hiring, evaluation and termination processes

Approved account contractual adjustments, refunds and financial class revisions/changes

Completed month end process for close by the 5th of each month

Review and Monitor daily deposit completion to include GL posting

Responsible for manual charge processes (production and entry)

Analyze Late charges cause/effect working with units to reduce/minimize barriers

Coordinate monthly Audits on Charge Capture/ Record documentation providing education to staff and/or units.

Patient Access Tucson Market Director

Conifer Health Care Solutions (Carondelet Health Network-Tucson Arizona) 09/2015 – 04/2016

Responsible for Carondelet Health Network Patient Access Department to Include 2- Managers; 4- Supervisors; 1-Educator/Trainer; 3 Cashiers; 200+ Front Line Employees

Directed operations in relation to all PA functions to ensure quality data collection enabling timely billing and collections

Collaborated with all hospital units ensuring PA expectations were met for each patient they served

Developed processes to improve outcomes in relation to timeliness, quality, regulatory and customer service functions within PA

Provided Company Leaders with Benchmark data for Corporation to include Patient Access Dashboard

Developed and Maintained Patient Access Budget Standards

Explored IT needs to support enhance Patient Access experience for CHN Customers

Patient Access Director

Carondelet Health Network –December 2009 – September 2015

Tenet Health Purchased Carondelet Health Network position was transitioned to Conifer Health Systems as noted above

Patient Access Director

Carondelet Holy Cross Hospital- 2000-2009

SKILLS

Extensive knowledge on CMS, Managed Care, (United Healthcare, Blue Cross Blue Shield, etc) Medicaid, Commercial and Liability Coverage Billing Rules and Regulations, Programs and Updated processes.

Knowledgeable on Medicare payment by diagnosis related codes. (Able to analyze data and develop reporting data)

Participate with Payor Contract Negotiations with Cost Analysis data for adequate reimbursement of services

Compile payor reports and analyze account receivables trends and payment patterns enabling future revenue projections

Review any potential new services (cost analysis) to ensure positive return from all major payors.

Performs month end processes for financial close via established systems

Oversee and monitor employees to include managers, supervisors and front-line staff. Perform hiring, evaluation and termination processes as necessary.

Responsible for Medicare Audit requests on any level within the revenue cycle process

Establish actionable goals for department staff and use benchmark and dashboard to monitor successes and opportunity for improvements

Actively participate with Finance Team to establish and maintain unit budget parameters.

Experience in analyzing healthcare/revenue cycle operations, developing transformation strategies and methodologies, business process optimization, business transformations while ensuring customer focus

Demonstrates in-depth knowledge of state and federal healthcare regulations including HIPAA and reimbursement methodologies

Expertise in planning, budgeting, organizing, implementing and leading all Revenue Cycle areas with strong emphasis on Billing, Claim Submission, Claim Rejection and Coding

Vast experience in full life cycle clinical and financial system implementations

Optimizes revenue cycle applications into hospital workflow with focus on implementing standardization and best practices

Assess impact on quality of operations while optimizing overall health systems revenue cycle/HIM business processes by reducing unbilled claims, denials, delinquent medical records, and backlogs in revenue cycle work processes

Strategizes and integrates revenue cycle processes and systems with all clinical areas within EHR and healthcare financial and clinical systems

Collaborates with departmental leaders within Patient Access (Registration), Charge Capture including CDM strategy, Billing and Collections, Insurance Contract Management, Reimbursement, Cost Reporting, Case Management, Denials Management, Information Technology and other Hospital Departments

Excellent oral and written communication skills. Professional interaction within all level contacts.

Assists in developing benchmarks and performance metrics for each functional area of responsibility. Monitor functional area performance in connection with these metrics and ensure overall performance, proactively identifying opportunities for improvement and communicating these opportunities with appropriate leadership (using Revenue Cycle scorecard or performance metrics dashboard)

Work with multidisciplinary teams to optimize revenue cycle work processes for front end registration, scheduling, HIM, Care Management, Clinical Documentation Improvement, Coding, Cancer and billing

Develops process-driven workflow recommendations for Revenue Cycle engagements while acting as liaison with all hospital or practice departments and C-Suites

Well organized and able to multi-task and prioritize projects as necessary.

Extensive experience with Microsoft Office, Word, Excell, Powerpoint, Project Manager, Access

Able to assist with managing Clinical Documentation Improvement programs in numerous units within the facility

In-depth knowledge of healthcare operations including revenue cycle management, health information management, patient access, information systems, and EHR implementations including Cerner, and Meditech

Promotes cultures of quality, compliance, and continuous performance improvement by implementing best practices models and standard.

Positive management style with a contagious enthusiastic approach.

EDUCATION

The University of Arizona – Eller College of Management

Business Intelligence Techniques

Key Performance Indicators

Corporate Performance Management Metrics

Data Profiling/Transformation Methods

Analyzing Data and Presentation

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