Revenue Cycle Pharmacy Billing

MARIA CHRISTIAN

Prosper TX, ***** Cell: 213-***-****

Email: ad5eyi@r.postjobfree.com LinkedIn: www.linkedin.com/in/mariachristian PROFESSIONAL PROFILE

Experienced professional with a strong focus on specialty pharmacy billing, complemented by expertise in healthcare administration, team leadership, and customer relationship management. Equipped with comprehensive knowledge of government and commercial insurance policies, adept at navigating complex billing systems to optimize financial processes. With proven analytical abilities and effective communication skills, well-prepared to excel in Revenue Cycle Management, particularly in the realm of specialty pharmacy billing. Thriving in dynamic environments, poised to contribute my talents to drive success in this advancement opportunity. EDUCATION

University of Toledo B.S. - Nursing

WORK EXPERIENCE

Cantex Continuing Care Addison, TX

Lead Benefit Verification Specialist December 2023 – Present

• Compiled and distributed morning reports to various groups within the Carelink Department

• Coordinated with multiple operations to ensure that information/reports required are submitted timely

• Documented referrals/inquires accurate in CRM and Vision

• Developed and maintained the referral/inquiry logs for all submissions to the Carelink department

• Hosted conference calls when needed to gather information needed across the departments

• Maintained and sent daily activity reports to leadership of all submissions and admissions through the Carelink department.

• Facilitated strategic physician relationships and assist in the development of physician advisory boards

• Developed and maintained strong relationships with referral hospital personnel US1 RCM Plano, TX

Revenue Cycle Manager December 2022 – November 2023

• Directed and oversaw the entire revenue cycle process, including billing, coding, collections, and reimbursement.

• Developed and implemented strategies to optimize revenue generation and improve cash flow.

• Conducted regular audits to ensure compliance with coding and billing regulations.

• Analyzed key performance indicators (KPIs) to identify areas for improvement and implement corrective actions.

• Lead and mentored a team of revenue cycle professionals, providing guidance and training as needed.

• Collaborated with various departments to streamline processes and enhance overall financial performance.

• Monitored and reported on key performance metrics to executive leadership. Paragon Healthcare Plano, TX

Patient Access Manager March 2021 – November 2022

• Assisted in the supervision and training of Patient Access Representatives, including training on pharmacy billing procedures and protocols.

• Communicated and provided patient-centered solutions for inquiries and grievances related to pharmacy billing.

• Addressed complex patient inquiries and resolved escalated issues in a timely and professional manner, specifically related to pharmacy billing concerns.

• Analyzed key performance indicators (KPIs) related to pharmacy billing to identify areas for improvement and implement corrective actions.

• Conducted quality checks on pharmacy billing data to ensure accuracy and compliance with policies and regulations.

• Coordinated with other departments to streamline pharmacy billing processes and improve overall efficiency.

• Processed pharmacy referrals, coordinated billing and deliveries, and ensured accurate documentation of pharmacy-related transactions.

• Verified patient insurance benefits for pharmacy services, explaining coverage details and access options.

• Obtained and documented prior authorizations for pharmacy services, collaborating with the clinical team, pharmacists, and payors to ensure timely approvals. Village Health Partners Plano, TX

Denial/Grievance Manager September 2017 – March 2021

• Managed claims recovery in the healthcare revenue cycle, achieving revenue goals through contract analysis and resolution strategies

• Conducted daily analysis of patient accounts, identifying errors and resolving issues based on root cause analysis and payor guidelines

• Independently performed insurance verification, eligibility checks, and preauthorization

• Investigated denied claims, analyzing patient charts to determine appeal eligibility and recouping significant revenue

RELEVANT SKILLS

• Billing (including Specialty Pharmacy Billing)

• Team Leadership

• Performance Management

• Customer Relationship Management

• Grievance Resolution

• Case Management

• Data Analysis

• Grievance Management Systems

• Healthcare Analytics (Epic)

• Strategic Planning

• Risk Management

• Problem Solving

• Attention to Detail

• Customer Management Systems

• Process Improvement

• Medical Coding

• Claims Processing

• Revenue Cycle Reporting

• Clinical Process Improvement

Contact this candidate