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Quality Assurance Revenue Cycle

Location:
Sarasota, FL
Posted:
April 22, 2024

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Resume:

Jessica DaRosa

Sarasota, FL LinkedIn 619-***-**** ad46mb@r.postjobfree.com

SUMMARY OF QUALIFICATIONS:

● Facilitating proper employee documentation and records and compiling reports as needed.

● Creating, reviewing, and filing sensitive HR documents (absence/PTO requests, verbal/written warnings, termination letters, etc.) and maintaining confidentially.

● Providing advice and assistance to employees and managers on HR policies, programs, and procedures, and union negotiations.

● Has facilitated onboarding / offboarding and assisted with exit interviews.

● Work closely with stakeholders to measure and drive employee metrics incollections, quality assurance, authorizations, denial prevention, turnover, and employee satisfaction survey results.

● Lead out of State Medicaid complex claims for multiple organizations with a successful rate of payments by appeals.

● Strong knowledge of MS Office Suite as well as HR-relevant tools. Experian, Bamboo, Athena

(crossover and implementation), Kronos, Taleo, Craneware, ICIMS, Meditech, Dragon (certified training for physician practices), Passport, HDX, RL System, Frontline, Strata, Diveport, Proclaim, Midas Risk Management System, API Timekeeping, Microsoft Office, Windows, Paycom,

● Loaded and maintained fee schedules, contracts, and chargemasters

● Contract negotiations and vendor management.

● Experience in analyzing data and programming.

● Bi-lingual in Portuguese.

● Highly analytical, detail-oriented, strong problem-solving,

● Cultivated knowledge in the front and back end of the revenue cycle, expert knowledge of State and Federal regulations

Work Experience

Vibrant Consulting LLC. L.A. and San Diego Counties Revenue Cycle Consulting and HR Operations December 2017 – Present

• Streamlined the financial counseling process to maximize productivity and reduce denials on the backend.

• Established business continuity plans for financial recovery in the event of a disaster.

• Created/Updated job descriptions and collaborated with various unions to establish a strong workforce.

• Established policies and procedures to align with State and Federal Regulations.

• Generated reports for tracking and onboarding.

• Background clearances (TSA, FAA, Criminal, and drug and alcohol).

• Recruitment for Pilots and Flight Attendants.

• Loaded and maintained fee schedules, contracts, and chargemasters

• Created training documents and job aids for newly hired HR representatives. Palomar Health Escondido & Poway, CA

Senior District Director, Patient Access April 2020 – September 2022

• Measured and drove metrics in POS collections, quality assurance, authorizations, denials, and patient satisfaction.

• Increased facility compliance with forms, documents, contracts, signage, policies and procedures.

• Executed a robust training program for staff to be successful in their positions while upholding the mission, vision, and values of the organization.

• Developed and negotiated contracts, letters of agreement with payers and providers.

• Project Manager for Experian implementation and integration with Cerner.

• Reduced self-pay population by 17% through securing Covered California certification for the organization and developing strong relations with Medi-Cal social workers for Medi-Cal eligibility and HPE. Tri-City Medical Center Oceanside, CA

Director, Patient Access August 2014 - December 2017

● Oversee daily operations.

● Reduced staff from 77 to 50 by changing job descriptions and duties and optimizing flow with all PAS positions by working with IT and centralized scheduling to reduce redundancy. Saved the organization

$1,218,672

● Transformed departmental culture using Studer tools; AIDET role-plays and observations

● Revised and negotiated with SEIU for Patient Access staff job descriptions; added additional job duties to lean staffing

● Coached/trained nine offsite staff

● Successfully increased Conditions of Admission (COA) compliancy from 68% to 100%

● Drafted and implemented policies and procedures to improve satisfaction with contracts

● Eliminated use of outdated forms and reduced paper by implementing e-signature at the facility

● Substantially increased employee morale resulting in an overall reduction in complaints, grievances, callouts, and turnover

● Restructured employee onboarding and training process Community Health Systems Fallbrook, CA

Director, Patient Access September 2001 – August 2014

● Developed professional relationships with physician offices throughout San Diego and Riverside Counties. Recruited, hired, and termed employees.

● Built and maintained contract management and chargemaster software as

● Built virtual beds facility-wide

● Developed missed collection opportunities report

● Attained # 1 hospital in the Division, three years in a row

● Substantially decreased bad debt by creating a policy and procedure that required employees to collect on bad debt accounts

● Implemented centralized scheduling in 3 CHS facilities

● Year after year, consistently scored above average in leadership communication based on employee survey results

Certifications & Education

UC Berkeley – Certificate in Human Resource Management- in progress Florida State University – Certificate in Employment and HR Law- in progress NAHAM – Certified Healthcare Access Manager (CHAM) HFMA – Certified Revenue Cycle Representative (CRCR) FEMA – Certified IS-00100. a, HC, IS- 00200.a, IS-00700.a IS-00800.b Charter University – BBA

Charter University- MBA



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