ACCOUNT RECEIVABLES PROFESSIONAL

An accomplished and talented professional with a comprehensive background in healthcare Revenue Cycle Management (RCM), in hospital/physician billing, and collections management, with a proven track record. I’ve Expel great communication to work across various areas in the healthcare system to generate solutions for varied business gaps. Someone who applies creative critical thinking and strategic planning skills to my current role, while aligning with the mission and values of my organization for operational effectiveness.

Core Competencies Systems Management Skills

Proficient MS Word/Excel/PPT

Knowledge ICD-9/CPT/HCPCs

Medicare Rules and Regulations

DRG Reimbursement

Medicare Manager

Revenue Cycle Pro

Contract Management

EPIC/Allscripts/Meditech

Xactimed/Elcomp/SMS/Medisoft

Waystar/ Change Healthcare

ePremis/Change Health/Claim Source

Gammis Portal/FISS-DDE

Finthrive Contract Manager

NThrive, - xClaims Billing

Result Oriented

Denial Management

Adept in maintaining focus Optum-EFR

RAC Audit Manager

Optum Charge Audit

Budget Management

Leadership / Mentor

Initiative / Motivated

Performance-Focused

Analytical / Accurate

Solution-Oriented

Advocate of Change Mgt.

Exemplary Communicator

Dedicated / Organized

Committed to Excellence

PROFESSIONAL EXPERIENCE

Acclara RCM Solutions a Tegria Company (Remote). August 2022 – August 2023

Director of Insurance Services, Steward Healthcare, Miami Region

Project: New Acquisition of 5 Miami Hospital AR Start up

Provided executive leadership, oversight, and direction. Reported the growth and effectiveness of the AR given for billing and collections. Led a team of 48 employees, trained the team how to navigate and utilize various systems needed to establish billing and collection efforts. New start up hired all employees. And created SOP’s for operational leadership.

Within 2 months reduced the AR by $25M.

Established key indicators for concurrent focus on legacy and current AR.

Developed a matrix for trending denials, correspondence, and refunds to assure critical review is established.

Continuous daily interpretation of dashboard items for process flow and reporting.

Report to the Senior Director weekly daily operations review, implementation, aging, collections and financial management.

Displayed executive level experience leading reimbursement and regulatory reporting for multiple facilities.

Demonstrated strong analytical skills enabling complex issues to be rapidly understood and presented in an understandable manner.

Reported in senior leadership meeting AR statistics.

Tegria Consulting Group (Remote) May 2022 – August 2022

Billing Manager Consultant, Arrowhead Medical Center, Colton, CA

Project: Epic System implementation.

Responsible for establishing key performance indicators that will support the organization goals for reimbursement. Reviewed dashboard, CFB and watchlist items to give additional support for Hospital and Physician Billing reimbursement, quality review and process flow implementation.

Prioritized work queue functionality, assignment distribution, and work performance to resolve accounts timely and for proficiency.

Established productivity and quality standards for Billing and Collections to increase reimbursement.

Created several processes flows that supports Epic review and next steps for department reviews.

Trained staff on Epic flow processes, how Billing Indicators works, how and why to transfer/add accounts to work queues for review, interpreting and understanding various categories in history comments for both Billing and Collections.

Worked with cash posting department in posting paper checks and creating a process flow improvement.

Conducted work queue (68) reviews to help delineate unnecessary work queues and tweak existing to capture all accounts.

oWorked dashboard watchlist accounts for placement in work queues. These accounts are not in work queues and or status as user error or work queue needed to tweak or created to support the accounts in this area. Created a how to process flow to work these items to be visible for collections and/or billing to drive reimbursement.

Created a staffing analysis for the Collections department to meet the staffing needs of inflows and outflows of the existing work queue volumes.

Effectively, worked with the build team to establish Client Billing in Epic, RTE functionality for California IPA reporting and county codes.

Provided an operational financial report for ARMC to actively operate in an optimal high level.

Mayo Clinic (Remote) Rochester, Minnesota Aug 2021 – June 2022

Senior Hospital Manager

Managed hospital and physician claim operations with a team of 150 employees with 4 direct reports (2 Supervisors, 2 Sr. Operational Analyst). Responsible for the development and execution of claim operations strategies, end-to-end claim process automation, optimization and management utilizing technology and data to improve quality and minimize process cost while developing employee one touch concept. Provide direction for the Mayo Transplant Enterprise (Florida, Minnesota/Arizona) billing, collections, and compliance for transplant claims managing a $320M+ Accounts Receivable.

Accomplished AR reduction within my first 4 months for Billed and unbilled AR by $115M ($35M Billed/$80M unbilled) across the enterprise. This reduction is reported to be the lowest reduction for Billed and Unbilled AR for the entire year of 2021.

Provide direction to professional and supervisory staff in the Revenue Cycle.

Prepare, compile, and approve the annual Medicare Cost Report.

Ensure regulatory and organizational compliance for billing guidelines.

Apply appropriate knowledge for Hospital and Physician Billing system for EPIC functionality.

Recruit and develop team members.

Perform management within areas of my responsibility to translate the department vision into meaningful and effective results.

Re-establish key performance indicators to help manage effectively and report the scope of work, staff, and outcomes.

Establish a working relationship and collaboration across business units and key stakeholders to align business objectives, such as, the internal MSU for cost reporting and Medicare claims compliant submission and IT for development and advancement for automation.

Update 5 process improvement for billing and collections across Mayo Enterprise for transplant to ensure timely completion and outcomes, alerting executive level of updates.

Provide input during strategic planning with the Revenue cycle leadership team.

Assure the integrity of revenue and billing information to assure accurate reimbursement for all billable services provided by working with the triad team to report and finalize for a positive outcome.

Manage multi-site operations and functionality providing resource with oversight in day-to-day activities.

Build teamwork and create a focus on customer service across the enterprise that fosters collaboration between physicians, administrative colleagues, and the Revenue Cycle team.

Piedmont Hospital Atlanta, GA 05/2016 – June 2021

Hospital Billing Manager 5/2016 – 7/2021

Led a team of 44 employees focusing on hospital and physician services for Vendor Management, verification team, specialty billing for collections for research, transplant and CED / LVAD claims for follow-up, denial review of under and overpayments, credits, and variances. Oversees 11 facilities for Commercial Billing, Worker’s Compensation, and auto claims that consist of 10 employees. Prepares a monthly DNFB report and increased collections for transplant and research in 2017 by 50%. Reduced the DNFB aging to a 4-day minimum and applied billing and collection knowledge for Transplant and Research accounts. Created 50+ policies and procedures for Vendor Management, Specialty (Transplant/Research), and Commercial Billing. Trained team on collection and billing processes for Transplant and Research accounts and billing procedures specific to all provider contracts. Assists in partnership for compliance billing for Research, Transplant, and Billing claims over the revenue cycle areas. Serve as Committee Chair for plan code committee. Creates policy and process for Vendor Management and collection processes. Obtains communication for billing, collections, and contract updates with Global Administrators (GADs), Mason and Heart Transplant, and Managed Care. Created changes needed for Vendor Management billing, Specialty, and Commercial Billing to ensure proper billing, collections, and process flow for proficiency and accuracy for EPIC automation. Reviews claim errors from clearinghouse (Emdeon/Waystar) to build bridge routines for automation.

Led a Research Education team meeting on selection, registration, and account protocols.

Knowledgeable on the Medicare Cost Analysis (MCA) for all research studies.

Developed a cadence to have the Dashboard Accounts Receivables snapshot be reviewed and monitored, resulting in a reduction, and bringing awareness to the departments to work and create EPIC tickets for resolution.

Reviews and understands managed care contracts for both Transplant, Commercial and Medicare Advantage plans.

Make necessary updates to contract modeling for appropriate adjustments and implementation.

Directs provider relations call to rectify provider claim issues for collections.

Develops a relationship with Auto and Workman’s Compensation Vendors for billing and collection compliance.

Cultivated working responsibilities between Case Management, Medical Records, Charge Description Master, and various clinics for correction and implementation for better billing and collections outcome.

Performs weekly productivity and QA measures for complete documentation on accounts.

Consults with employees on their job performance and work / life balance.

Meets daily with supervisors on production and quality analysis opportunities for team improvement and assessment.

Applies knowledge of all-payer bases: Commercial, Auto, Worker’s Compensation, Medicare, Medicaid, and VA.

Dekalb Medical Center Decatur, GA 10/2012- 04/2016

Billing and Government AR Collections Manager

Directed a team of 30 employees for billing of all insurances and government (Medicaid/Medicare) AR Collections. Established reporting and billing for Patient Financial revenue cycle team. Created billing processes applicable for system edits / correction for our host patient accounting system. Reviewed and monitored denials for government payers and assisted with any non-government denials. Reduced billing edits by 75%, resulting in increased cash collections. Maintained an 88% clean claim rate for monthly claim submissions and maintained government AR at 120 days to 20% of entire AR. Provided training on system issues and edits for PFS department.

Played an integral role of the Implementation team for various systems.

Instrumental in billing and collections for Auto and Worker’s Comp claims.

Complied with all billing regulations for managed care contracts and government regulations.

Provided policy and regulation for payers.

Developed working responsibilities between Case Management, Medical Records, Charge Description Master, and various clinics to correct and implement better billing and collections outcomes.

Grady Memorial Hospital Atlanta, GA 10/2011 – 10/2012

Billing Supervisor

Provided outstanding billing knowledge and compliance. Led a team of ten billers and three Medicare follow-up representatives in billing and collections for Medicare, Medicaid, all commercial insurances, and Georgia Crime Victims payers. Shared monthly billing reports and goals to the Billing Manager. Reduced billing error rate by 12%, increasing clean claim rate to 88%. Performed productivity and QA and complete documentation on accounts.

Consulted with employees on production and quality analysis opportunities.

Monitored billing software for functionality, updates, and performance.

Built bridge routines and claim reports for functionality for performance for all payers and service types.

Oversaw all Medicare billing and collections updates for implementation.

Schneider Regional Medical Center St. Thomas, Virgin Islands 07/2005 – 09/2011

Director of Patient Accounts

Performed revenue cycle management in billing and collections for the operations of an acute care hospital, cancer institute, and ambulatory facility. Prepared Budget and AR management reports to the CFO on billing and collections for all facilities. Supervised 31 employees comprised of two managers, four supervisors, and 25 staffed positions for the book of business of billing, collecting, and cash posting that procured $10M in monthly revenue and $4.8M in collections. Reduced AR days from 333 days to 97 days in two years. Implemented the electronic billing system to third-party payers for billing procedures and charge capture procedures, increasing reimbursement by 60%. Developed policies and procedures to support the billing and collections processes. Collaborated on policies that affected the billing and collection process with other disciplines in the Revenue Cycle department. Trained staff on collection and billing procedures.

Created an environment conducive to increased collections and billing.

Managed the budget for the business office and approved refunds and adjustments of $1500+.

Oversaw the cash posting area for proper posting and balancing.

Reviewed all vendor invoices for completeness and accuracy for payment.

Led meetings with clinical staff and vendors for continual process and performance improvement.

Negotiated contracts with collection agencies for third-party collections and insurances.

Re-organized the Cash Office, resulting in greater efficiency and increased cash collections.

EDUCATION

Clark Atlanta University, Atlanta, GA Bachelor of Science in Health Information Management 05/1994

University of Phoenix. Phoenix, AZ Master Healthcare Administration 05/2007

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