Risk Adjustment Revenue Cycle
Resume:
Favien Mayans Cal
Westlake, Fl 33470
*******@***.***
OBJECTIVE
Experienced Revenue Cycle Manager adept at increasing work flow efficiency & profitability through functional & technical analysis that specializes in cost reduction and operational improvements. Strengths are strong leadership skills with analytical & organizational skills coupled with a keen ability to coordinate the efforts of many to exceed practice goals, efficient work habits with high energy, & motivating team leader with a personable communication style focused on high quality & timely results.
Authorized to work in the US for any employer.
PROFESSIONAL EXPERIENCE
CareMax- Managed Healthcare Partners June 2019- Present
Director of Billing & Coding
Direct supervision of the Coding Manager, Auditing Manager, Billing Manager, and Clinical Documentation Trainer make up the management team that leads 85+ staff members.
Working closely with clinical leaders and the compliance unit to ensure coding standards are met for optimization of appropriate and accurate coding practices.
Contributing with the VP of Clinical Strategy and Operations in the development of company coding workflows, and Policies & Procedures for state and national levels.
Overseeing of the training program provided to the staff for adherence of Best Documentation Practices, Official ICD-10 Coding guidelines and HCC-CMS and HCC-HHS Risk Adjustment Data Validation rules.
Responsible for implementing effective Pre and Post Visit Reviews processes for all new acquisitions or MSO relationships.
Performance management responsibility for all direct reports.
Support build healthy partnerships with several contracted health plans. Some of the departments attributes are coordinate access to health plans’ chart retrieval request, participated in Joint Operating Committee meeting and working closely with the Medicare Risk Adjustment Advocates.
Responsible for the effectiveness of the medical coders’ communication skills with providers by ensuring compliance with coder recommendations and provider query rules.
Validate quality audits performed by health plan partners and dispute any irregularities.
In coordination with Business Intelligence validate the integrity of the encounter reconciliation program and create the deletion of any diagnosis that did not meet the risk adjustment submission requirements.
Monitor the impact of innovations and changes in programs, policies, and procedures for the Billing & Coding Department.
Provide developer with Data Storage System modifications to improve data accessibility and create clinical reports for the Chief Medical Officer.
Monitors and maintains acceptable accounts receivables associated with un-coded charts.
Inter-American Medical Centers Group, LLC. July 2012 – 05/31/2019
Coding Manager
Promoted to manage 30+ on-site and off-site certified coders for Risk Adjustment & fee-for service that served as a liaison between 13 medical groups and 43+ providers. Furthermore, the overseeing of a Medical Risk Adjustment (MRA) Auditing team who conducted Bi-annual internal chart reviews, worked on COC reports and assisted with support to the medical coders. Educational programs designing and implementation for the coders and medical auditors on how to embrace Best Documentation Practices, Official ICD-10 Coding guidelines and HCC-CMS and HCC-HHS Risk Adjustment Data Validation rules.
Established multiple educational tools with compliance endorsement for providers on clinical documentation.
Implemented standardized Pre & Post Visit Reviews and workflows, including a five-day grace period, for timely and accurate encounter submission.
Monitor and Maintains RCM revenue processes, including charge and payment posting, rejections/denial management and collections of day to day transactions.
Performance management responsibility on 30+ medical coders and 4 internal auditors.
Spearheads complex transition from capitation to fee-for-service for multi-specialty physician group, and providing direction local and national coverage determination.
Monitor coding trends, identifying missing opportunities and developing action plan for prevention control.
Doctors ER Services, Inc. - Miami, Florida July 2005 – 06/30/2012
Chart Auditor/Facilitator
Emergency room physician medical coding of approximately 2000 visits per month.
Internal chart audits for proper clinical documentation and utilization of codes.
Develop and produce spreadsheets with narrative to present to executive management.
Physician training on improvements for clinical documentation.
Prepare, analyze and file monthly claims report.
Process all new hired provider’s Medicare Enrollments for credentialing.
Policy and procedure development.
Regulatory of Compliance Policies and Procedures.
Medical Care Consortium, Inc. (HCCI) – Miami, Florida July 1999 – June 2005
Accounts Receivable Manager
Supervised staff of six: four Billing Clerks and two professional Reimbursement Analyst positions.
Post and reconcile day to day A/R transactions.
Reconcile and review open claims reports to ensure timely collections of accounts.
Internal chart audits for accuracy in clinical documentation and utilization of codes.
Develop and produce spreadsheets with narrative to present to executive management.
Yearly Billing and Medical Coding training on Best Documentation Practices, Official ICD-10 Coding guidelines.
Prepare, analyze and file monthly claims report.
Process all new hired provider’s Medicare & Medicaid Enrollments for credentialing.
Inventory control and purchasing of office supplies.
Payroll processing
Policy and procedure development
Special project coordination
Regulatory Compliance
PCA/FPA Medical Management of Florida- Miami, Florida July 1987 – May 2005
Accounts Receivable Supervisor
Supervised staff of eight: two Billing Clerks, four A/R Coordinators and two professional Reimbursement Analyst positions
Post and reconcile all A/R transactions
Reconcile and review open claims reports to ensure timely collections of accounts
Provide system support for the clinicians, maintain system integrity for practice management system, and update utilization data.
Internal chart audits for accuracy in documentation and utilization of codes
Generate hospital census reports for medical directors to analysis.
Develop and produce spreadsheets and narrative reports to present productivity A/R summary to executive management
Yearly Billing and Medical Coding training on Best Documentation Practices, Official ICD-10 Coding guidelines.
Prepare, analyze, and produce monthly RCM reports
Process all new hired provider’s Medicare & Medicaid Enrollments for credentialing.
EDUCATION
Miami Dade Community College, Miami, Florida
Associates in Arts Degree, Health Service Management, met all perquisite requirements
CERTIFICATIONS
Certified Professional Coder (CPC)
Certified Professional Medical Auditor (CPMA)
Certified Risk Coder (CRC)
Clinical Documentation Expert Outpatient (CDEO)
Certified Physician Practice Management (CPPM)
COMPUTER SKILLS
MS Word, Excel and PowerPoint; Several Patient Management System (PMS)
References available upon request
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