K

Devon Kale

937-***-****

ad25i3@r.postjobfree.com

SUMMARY

Dedicated and driven PFS Manager bringing over 26 plus years of overall knowledge and experience in PFS. Highly organized, energetic and versatile leader committed to continuous improvements. Proven history of motivating staff to work together to achieve targets. Focused with attention to detail, problem solver, exemplary communication skills, motivated to drive down AR and increase profit. Possesses a strong knowledge of the Network's Mission and best practice. Seeking a new opportunity to achieve and advance my skills in a management role. HMFA certified as 11/2023. Strong knowledge of Epic. I do not have a degree however, I do possess 25 plus years of experience in the medical field and 14 years of experience in Revenue Cycle.

SKILLS

424 E Court St Sidney, OH 45365

Analytical skills

Auditing

Benefits

Billing

Strong interpersonal skills Documentation Leadership skills

Team Leader Team building

Strong organizational skills Policies

Quality work Reporting Research Spreadsheet Supervision Supervisor

Team player and works well with others Websites

Insurance terminology Insurance plan verification

All insurance payer knowledge Critical thinking

Friendly, positive attitude Customer service Microsoft Office

Conflict resolution Team management Time management

Able to adapt schedule to department and management needs

Self-motivated Strong work ethic Medical terminology

SUMMARY OF QUALIFICATIONS

PFS Manager

Kettering Health Network 03/21 to Current

Reporting to the Patient Financial Services Director, the Patient Accounts Manager is responsible for leading and planning billing operations for Kettering Health Network. This role plays the tactical lead in carrying out the vision of the department supporting the vision and mission of the Network. This role has a full understanding of the revenue cycle, each role within the process, and its effect on the revenue cycle. Establishes standards and expectations for improvement initiatives and ensures they are aligned with Revenue Cycle initiatives. Responsible for leadership, direction, and focus on the application of patient accounts standards and principles to affect continuous improvement. Creates an environment where new ideas are encouraged.

Manages claim billing and follow-up operations by setting goals and objectives and developing strategies for achieving goals; managing staff productivity; accomplishes operating efficiency through process development/revision, system enhancement, reject/edit/ denial management, and exceptional communication with staff and customers. I do not hold any type of degree however you can visualize all the experience and knowledge I do possess.

PFS Hospital Billing Manager

Kettering Health Network

March 2021 to Jan 2024

Maintains AR days, Aging, and other AR metrics at goal levels.

Provides administrative direction to Coordinators and other personnel in the resolution of problems or difficult tasks.

Possesses skills for accepting responsibility, making decisions, directing, delegating, and supervising personnel.

Process improvement skills and the ability to develop and execute a plan of action.

Maintain and develops a competent, productive, quality conscious, engaged workforce.

Accountable for budget adherence.

Demonstrate excellent verbal and written communication skills.

Knowledge of billing requirements, revenue cycle operations, AR system skills, payer websites/systems.

Demonstrate knowledge of payer guidelines and government payment regulations.

Strong analytical skills.

Demonstrate skills in statistical analysis necessary to examine patient accounting activities and detect/resolve any related issues.

Experienced in Microsoft Word and Excel.

Ability to lead and motivate individuals and groups of people.

Ability to exercise independent judgement.

Last 2 years I have been both the Manager and supervisor due to the budget.

I have the lowest AR out of 4 Managers.

PFS Supervisor

Kettering Health Network

Dec 2019 to March 2021

Daily rounding with assigned staff.

Conduct monthly one on one's with assigned staff. Coach on performance issues.

Ensure Team Lead Competencies are conducted per frequency schedule. Time and Attendance approval, tracking, and reporting.

Administer improvement action plans and consult with Manager on resulting disciplinary actions; administer disciplinary action up to written warning.

Conduct Practice/ Department denial review sessions where applicable.

Create monthly Practice/ Department denial metric scorecards where applicable. Monitor work queue productivity.

Oversee progress of assigned projects. Manage productivity and quality of staff work.

Pull information/data for Compliance requested audits. Completing ESL's for staff.

Handle challenging and difficult accounts. Creating polices and tip sheets for team.

Research special projects and provide feedback to manager. Train new hires.

Approve adjustments.

One on one with staff needing extra assistance.

Other duties as assigned.

Non- Clinical Denial Specialist

Kettering Health Network Oct 2017 to Dec 2019 Audits denial reps.

Appeal all insurance payers from commercial to government. Appeal all inpatient psych cases.

Appeal all inpatient traditional Medicare cases. Appeal all cases that deny for no authorization. Familiar with all payer websites.

Familiar with Nthrive.

Research denials and find any denial trends.

Responsible for all aspects of patient accounts hospital and physician billing and collection processing in compliance with departmental policies and procedures. Working and completion of older, problematic accounts and handles all special projects as required and has the ability to work various government and

non-government payers including institutional/invoice billing.

Assists the team lead with training and auditing, providing knowledge and resources as it pertains to billing, follow-up and denied/rejected claims.

Assisting with research of missing payments, updating policies/procedures and participates in payer operations meeting as needed.

Must display knowledge retention through scheduled assessments. Creating policies and tip sheets

Other duties as assigned.

Denial Specialist

Kettering Health Network Sep 2016 to Oct 2017

Active member on the Education Steering Committee. Review current polices and work flows for denial reps. Update polices and work flows for denial reps.

Create tip sheets for denial reps. Audit denial reps.

Review adjustments.

Approve/decline adjustments posted by denial reps. Review, update, and maintain KX modifier spreadsheet.

Review, complete, and maintain referral wq, hospice wq, and potentially timely wq. Training and education of new staff.

Training and education of current staff.

Rounding with staff to see what their needs, questions, and or concerns. Building a strong team effort by encouraging and motivating team.

Strong communication skill with all staff, specialists, team leads, and managers. Assist other teams by making phone calls and having claims reprocessed for payment.

Multi tasking.

Possesses the skill to look at the big picture, problem solve, exhaust all efforts, in order to resolve account.

Strong leadership skills. Strong organizational skills.

Strong interpersonal skills not only with current team with all teams and members.

Patient Financial Services

Kettering Health Network Jan 2012 to Sep 2016

Follow Medicare Guidelines for billing. Customer Service.

Organization of billing and appeals. Printing and mailing of Medical Records. Verify Insurance.

Correcting and adding patient demographics and health insurance. Epic knowledge (Computer program).

Adjustments.

Training of new employees.

Continuing education of new programs. Demonstrates computer skills.

Familiarity with other software applications.

Ability to perform mathematical calculations quickly and accurately.

Ability to maintain sound working relationships with peers, supervisors and the general public.

Ability to challenge the status quo without jeopardizing relationships. Possess strong interpersonal and team-building skills.

Demonstrate strong goal orientation with a desire to continually improve performance.

Possess strong analytical skills.

Ability to review work for accuracy and completion. Knowledge and completion of denials.

Billing and appeals for ALL Medicare HMO payers. IME billing.

Tricare primary and secondary billing.

Works independently with minimum supervision. Can adapt to change very quickly.

Hippa compliant.

Team player with a positive attitude.

Radiology Clerk

Kettering Medical Center Dec 2010 to Jan 2012

Accurately obtain and enter patient information into hospital data system. Verifying insurances.

Completing MSP's. Completion of HCAPS.

Answering inbound phone calls from patients and doctor offices. Customer service.

Contacting physicians on call.

Calling and giving verbal reports to physicians and nursing units. Taking mobile radiology orders.

Entering mobile radiology orders. Making and pulling radiology jackets. Printing radiology films.

Making and sending radiology disks to other hospital, doctor offices, and for patients. Faxing radiology reports.

Collecting and processing of co pays and payments for patients.

Patient Access Specialist

Premier Health Partners Apr 2010 to Dec 2010

Accurately obtain and enter patient information into hospital data system. Verifying insurances.

Educating patients on their health insurance benefits. Completing MSP's.

Collecting pre-payments. Balancing cash drawer. Accountability with patient log.

Start pre-cert process for inpatients. Completion of HCAPS.

Customer service.

Registration Team Lead

Miami Valley Hospital Apr 2007 to Apr 2010

Assist clinical staff with any issues or concerns that arise during my shift. Assist co-workers with problems or issues that arise during my shift.

Arranging and organizing staff for best patient flow. Taking call.

Arranging coverage when a shift is short of staff. Stat registration.

Accurately obtain and enter patient information into hospital computer system. Financial counseling.

Assisting and completion of HCAPS, MEDICAID APPS, and CARESOURE APPS. Verifying insurance benefits.

Completing MSP's.

Obtain financial and treatment consents. Collecting co-pays.

Balancing of all co-pay collections for the ETC. Delivering collections to cashier's office.

Customer service. Stocking work supplies. Audit staff.

Training of new hires and new/updated information. Assist supervisor with time and attendance.

Report to supervisor problems in the department.

Assist supervisor with any and other duties as assigned. On Hazmat committee.

Registration

Miami Valley Hospital Jan 2005 to Apr 2007

Accurately obtain and enter patient information into hospital computer system. Provide patient information to medical staff.

Stat registration. Verifying insurance. Collection of co-pays. Balancing of cash drawer. Financial counseling.

Assisting and completing HCAPS, MEDICAID APPS, and CARESOURE APPS. Obtain financial and treatment consents.

Collecting charts.

Put together all charts for medical records.

HUC/TECH

Miami Valley Hospital Jan 2001 to Jan 2005

Placing medical orders for Doctors and Physician Assistants.

Contacting physicians on call.

Transporting patients to various rooms or departments. Clean and maintain EMS/Careflight equipment.

Retrieving blood and plasma for clinical staff.

Assisting medical staff with various duties, IE; pelvis or rectal exams. Assist in all traumas.

Documentation on patient chart.

EKG Technician

Miami Valley Hospital Jun 1998 to Jan 2001 Hospital wide).

Performing EKG's on patients.

Placing EKG Holter monitors on patients. Prepping patients for stress tests.

Inform clinical staff of abnormal test results. Collect and organize all data for physicians.

EDUCATION AND TRAINING

Sinclair Community College Dayton, Oh

1998 to 2000 with 2 years completed

West Carrollton High School May 1998 West Carrollton, OH

ACTIVITIES AND HONORS

Additional online course through HealthStream to improve and grow in current and future role's. Employee of the Month. HMFA Certified as of 11/2023.

Contact this candidate