ERIN TRACE, BHA, CPC

Revenue Cycle Management, Revenue Integrity, Managed Care

www.linkedin.com/pub/erin-emerson/84/5ba/430/

ad4ie7@r.postjobfree.com 904-***-****

EXECUTIVE SUMMARY

Administrator/Director of Managed Care Contracts and Director Revenue Integrity with 20+ years’ experience researching and analyzing revenue cycle management and reimbursement methodologies. Outstanding expertise in managed cared clinical and non-clinical practice management, partnering on technology enhancement projects, and building strategic relationships with physicians, insurers, and practitioners. Skilled overseeing and setting KPI’s in provider credentialing, payor enrollments, and identifying opportunities for revenue recovery. Expertise in Medicare Parts A, B and C and Medicaid compliance, government and non-government payer issues, regulations, and reporting requirements initiatives. Collaborative manager committed to developing staff for career advancement and providing professional growth opportunities.

Payer Relationships & Reimbursement Structure EPIC HB & Allscripts Resolute Billing & Charging

Medicare, Medicaid & CCSP Reimbursements GAAP & Order-to-Cash Management

Medical Terminology & Charge Master FI/MAC, DMERC & Carrier Policies

PROFESSIONAL QUALIFICATIONS

Administrative Facilitates recruitment, staff development, policy administration, compliance, and personnel policies.

Management Strictly sets and monitors established practices for confidentiality, compliance, and professional standards.

Manages change and addresses change resistance to minimize impact of contradictions and paradoxes.

Revenue Experience researching reimbursement methodologies, registration, and health information management.

Cycle Builds strong partnerships with physicians, government agencies, and health care practitioners.

Full understanding of regulatory compliance requirements for government and private insurance

Managed Care • Professional knowledge in all aspects of healthcare administration, finance, and clinical operations.

Contracts • Investigates, develops, and implements managed care savings programs to ensure revenue integrity.

• Executes contracting strategies for government and private insurers for best facility outcome.

Compliance & Broad experience with reimbursement calculation for both professional and institutional claims.

Oversight Demonstrates fiduciary responsibility through adherence to internal financial policies and procedures.

Audits and monitors documentation to ensure compliance with policies and regulatory inspection agencies.

EXPERIENCE FLAGLER HOSPITAL, ST AUGUSTINE – St. Augustine, FL (2017-2023)

REVENUE CYCLE ADMINISTRATOR, 2022-2023

Reported directly to CFO. Established and monitored revenue recognition and receivables strategic objectives and provided operational leadership for 175+ staff members in clinics, facilities, and practices. Developed and maintained policies, procedures, and workflows to ensure cash flow and reduce bad debt. Collaborated with technology partners on projects to improve GAAP compliance, analytics, and maximize patient satisfaction. Oversaw AR, monthly close processes, denials management and resubmissions. Trained, coached, mentored, and managed team on professional and career development pathways.

Revenue • Oversaw $165K in gross monthly revenue.

Cycle: • Reduced refunds from $12M to $1.2M, below KPI.

• Led meetings to clean up HIS system for AR accounts to streamline and improve efficiency.

Compliance & • Restored morale, communication, and team synergy through weekly huddles.

Oversight: • Ensured compliance with new CMS regulations in collaboration with Compliance Officer.

DIRECTOR OF CONTRACTS/MANAGED CARE, 2019-2022

Oversaw all aspects of managed care contract management including negotiation, analysis interpretation, modeling, pricing structure, performance and compliance, and audits. Developed new and existing relationships with third party payers to ensure competitive reimbursement rates and consistent contract language through the revenue cycle operations. Oversaw payer credentialing, charge master, and manage denials and appeals. Identify trends and compliance within contract parameters. Worked with hospital, physician, home health, and ambulatory contracts.

Managed Care • Created Managed Care Department & implemented system to track Payor and Vendor contracts.

Contracts: • Implemented system for Provider Enrollments with new employed and contracted physicians.

• Initiated, managed, and oversaw 90 contracts across imaging, cardiology, oncology, and other specialties

with Florida Blue, Aetna, United Healthcare, Av Med, Cigna, and Humana in addition to Medicare.

Revenue • Increased physician participation by 18% over two years and facility increased rate by 4%.

Cycle • Identified and recovered $600K missing revenue to date in 2022.

ERIN TRACE, BHA, CPC Page 2

EXPERIENCE FLAGLER HOSPITAL ST AUGUSTINE, continued

REVENUE INTEGRITY MANAGER/DIRECTOR, 2017-2019

Managed team responsible for managing government and third-party payor audits, including RAC, MAC, MIC, and charge audits. Analyzed and interpreted managed care contracts; ensured professional and facility billable charges are captured and coded completely and accurately. Researched billing and coding requirements, evaluated and integrated new technology and formularies. Established protocols, policies and procedures, and training materials. Participated in internal and external contracted payor discussions and negotiations regarding clinical coding and charging standards. Managed annual CDM rate increases.

Compliance & • Oversaw hospital and physician Chargemasters annual code updates, new code technologies, and reviews

Oversight: to ensure charge capture, accurate coding, and billing.

• Implemented strategic pricing which brought in $2M additional incremental net, reduced Charge Audit

Takebacks, ensured competitive shoppable rates, and consistent rebuild supply chain markup.

SHANDS JACKSONVILLE MEDICAL – Jacksonville, FL (2013-2017)

MANAGER, REVENUE INTEGRITY

Oversee team researching and analyzing reimbursement methodologies, revenue cycle management, and health information systems. Audit charges against reimbursement and records documentation and resolve issues with fiscal intermediaries. Coordinate and lead multi-department projects, provide education and direction on current and emerging regulations, and execute initiatives in conjunction with Director of Patient Financial Services.

Revenue • Certified on EPIC HB Resolute billing and Charging, 2013.

Cycle: • Managed charging for five oncology clinics (21 Century) acquired by UF Health.

• Implemented and standardized processes which improved quality and reduced claim denials.

Administrative • P&L accountability of $365K departmental budget.

Management: • Led 10-member revenue integrity team.

• Investigated and approved CPT/HCPC code changes before addition to CDM; maintained CDM database.

• Evaluated performance, identified and remediated skill gaps, and fostered professional development.

C2C SOLUTIONS – Jacksonville, FL (2009-2013)

RECONSIDERATION PROJECT ANALYST, 2009-Present

Audit, oversight, anti-fraud, and abuse monitoring for Medicare/Medicaid claims reimbursements. Reviewed and wrote reconsideration decisions in support of determination after reviewing case records and claims. Conducted on-the-record second level appeals in line with polices. Prepared releasable documents in compliance with Privacy Act and submitted decisions within deadlines. Researched Medicare reimbursement policies and regulations for multiple service types including DME, Parts A and B, and CPT and HCPCS coding. Resolved payment disputes based on medical records reviews.

Compliance & • Handle on average of 80 decisions and appeals monthly, including Part A or Part B Medicare claims.

Oversight: • Certified AAPC Coder, ICD9 & ICD10 proficiency with SQL reporting competencies.

• Negotiate disputes and communicate with patients, physicians, and health care practitioners.

Additional experience as Reimbursement Auditor, Recalculation Auditor and Claims examiner to ensure proper reimbursement for hospital medical claims. Reviewed records to ensure thoroughness, accuracy, and compliance with government payor/private insurer regulations.

EDUCATION UNIVERSITY OF NORTH FLORIDA – Jacksonville, FL

BACHELOR OF SCIENCE, HEALTH ADMINISTRATION

ROSS MEDICAL CAREER INSTITUTE – Saginaw, MI

HEALTH/MEDICAL ASSISTANT CERTIFICATION

AMERICAN ASSOCIATION OF PROFESSIONAL CODERS – Salt Lake City, UT

CERTIFIED PROFESSIONAL CODER

AFFILIATION • Secretary Treasurer, American Association of Professional Coders, Jacksonville Fl Chapter

TRAINING • SPHR Coursework • Pre-Nursing • Accounting I & II

• Anatomy & Physiology • Medical Terminology • Certified AAPC

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