Dawna Martin
Phone: 615-***-****
Email: adchgs@r.postjobfree.com
LinkedIn: https://www.linkedin.com/in/dawna-martin-59b64857/
SUMMARY IN YEARS OF RELATED WORK EXPERIENCE
Director -2 years
Mangement-12 years
Consulting- 15+ years
Revenue Cycle Management 8 + years
Revenue Cycle Operations 8 + years
Vendor Relations Management- 15 + years
Provider Relations- 5 years
Provider Credentialing and Contract Negotiations- 5+ years
Project Manager-8 years
Implementations-8 years
Stakeholder Management (internal/external) 14+ years
PROFILE
My work experience includes strengths in full RCM account management, strategic planning, providing decision support for project delivery, maintenance, problem solving, troubleshooting, planning and implementing procedure and programs. Proven ability to provide the most effective patient care and cost savings through analytics accounting and budgeting. Develop policies and procedures to increase revenue and the “bottom line”. Experience in provider and facility claims (HICFA 1500 & Facility Claims UB04), experience in HIIM, EHR/EMR claim management, UB04/CMS1500 billing/EDI billing.
Highly proficient in revenue cycle management and operations, requirements documenting, patient access/full revenue cycle (front end to back end), financial management/root cause analysis, identifying opportunities for strategy growth and improvement, account audits, tracking and trending, AP/AR.
I have significant experience working with all internal and external partners, vendors and proven ability in build strong relationships with all stakeholders.
SKILLS - SYSTEMS/PRODUCT KNOWLEDGE
Proven ability to provide the most effective patient care and cost savings through analysis of accounting/budgeting, policies and procedures to increase the bottom line
Care, Meditech,E-Prescribe, Icare, Doctors Access, eCW -Dental software, Emdat, Sevocity,Misys Tiger, Athena, Allscripts/Payer Path,Claim Staker, claim editing software, eclinical works EHR/EMR, Epic, Facility Scheduler,MedAssets, Star, Hyland/Onbase (Doc Imaging & Cash Automation), Sovera HIM, CareMedic, McKesson, Assistant/Patient Access Advisor, MS Office Suite and SharePoint, Facility Scheduler, CareCloud PM/EHR cloud based application, Clarizen and SalesForce and nThrive/MedAssets.
Implementation and Analysis of revenue cycle systems and accounts to ensure deduction and proper payments are applied to patient accounts by adhering to payer/provider rules and policies.
Knowledgeable with HL7 connectivity, 270/271.835/837 and direct connect sources.
Electronic and paper claim billing UB04/CMS1500 filing, including workers’ compensation, personal injury, major payers and TPA medical carriers.
Review of all CPT/ICD9 (some ICD10 knowledge), HCPCS, REV and DRG codes, UB04/CMS1500 claims
Work with Technical teams, to drive Go Live dates and overall functionality of systems.
Post insurance remittance EFT/ERA, EOB’s and follow up of all claim denials, claims that are in pending status and submitting additional documentation for denied claims as needed
Ability to prioritize, organize and provide constructive feedback to employees, stakeholders and clients
Knowledge of HIPAA guidelines, Fraud Waste and Abuse programs, State Law rules and regulations, OSHA rules and regulations for labs
Worked with all insurance carriers including TPV and insurance product knowledge in the following products: Medicare Advantage programs, VA Fee Basis, Tricare South, HMO/CHMO, OPA,OAP Plus, Choice Funds (HRA/HSA/FSA) PPO, POS
Strong background in processing medical provider/facility and vision claims with proven ability to decipher EOB, EOP’s, ERA’s, EFT’s, EDI transactions 270/271, 835/837 and review of EDI rejection reports and loop segments
PROFESSIONAL EXPERIENCE
Pivot Point/Vaco – CHS / Contract Position
PCCM Revenue Cycle Program Manager Cane Ridge, TN Nov 2018- Current
Management of operational leadership to assigned regions totaling six Shared Service Centers in AR, TX, TN, PA, FL an IN
Manage full scope of project and implementation of Charge Capture Audit (RI), CDM Master, Contact Management Technology Solutions for 108 Hospitals and 96 Physician Groups
Provide gap analysis based on discovery sessions with PFS,CCA, PA, CM and IT
Budget and Project tracking
Vendor Management
Conduct onsite meetings and training sessions for leadership and staff
Review of current workflows/ processes and procedure
Collaborate to discuss future state documentation of workflow processes and procedures.
Run Steering Committee meetings with Executives and all internal / external stakeholders.
Rezult Group- CareCloud / Contract Position
Senior RCM Implementation Manager Miami, FL / Oct 2017- Oct 2018
Manage full project and Implementation of CareCloud (Cloud Based) Practice Management, EHR. & EMR Systems Concierge/Saas products for Acute Care/Ambulatory Care, Hospital and Physician Clinics of multiple specialties
Pre-Assessment and Gap Analysis of current workflow policies and procedures. Work with facility/Clinic leadership and end users to learn processes and workflow to solve any functionality issues with the new PM & EMR software to include product/software requirements needed for application functionality
Financial & Clinical systems training
Revenue Cycle (Charge Capture & Coding)
Charge Master/Master Fee Schedule imports and review for optimal reimbursement rates
Case Creation for Enhancement requests
Registration & Billing
Go-Live Support and Post Go-Live Support
Travel 80-90%
B&G Staffing-HCA / Contract Position
RCM & WFP Implementation Manager Franklin, TN / Feb 2017- July 2017
Revenue Cycle Operations (clinical staffing and scheduling)
Work with WPC staff and team members to implement and train centralized scheduling and staffing processes within Hospital Organization
Provide feedback based on observation of current process for improvement opportunities
Participate in team meetings / Drive change management for improved processes
Assist in Creation of Vision work-flow documents regarding WPC processes
Review and provide input on process work-flow documents.
Developed working relationships within the implementation team and facility leadership
Developed training manual for training on Facility Scheduler
Developed Employee/Staff quick reference guide when using Facility Scheduler
State of Oregon /Contact Position
Project Manager Salem, OR/ Nov 2016- Feb 2017
Drive performance process improvement regarding HIPPA guidelines for stability of PHI
Developed and Implemented standard process for working within state guidelines and regulations
Analysis and troubleshooting complex system issues
Third Party Management/ Review system access agreements and data usage agreements to devise a more compliant communication system
Emid’s / Change Healthcare /Contract Position
Revenue Cycle Implementation Analyst/ Project Manager Nashville, TN/ Feb 2016-Aug 2016
Managed relationships with key stakeholders and decision makers
Work Directly with Clients to analyze and determine appropriate revenue cycle products through entire implementation/migration cycle. Prepared requirement documents
Oversee accurate and timely installation and conversion of client data
Test the revenue cycle products/systems and perform the testing process/UAT
Consulted on the installation of client site software/equipment, technical requirements and coordinated with technical support to resolve issues
Coordinated and executed revenue cycle system configuration and adaptation to meet each client’s needs
Provide cross functional design guidance, accommodations as well as pre and post implementation testing oversight
Preformed analysis of custom reporting and system interface requirements
Ensured successful “hand off” to appropriate departments for on-going support following implementation
Participated in project planning efforts
o Participated in scheduling development, monitoring and reporting the status to members of the project team leadership
o Conducted and coordinated client training via WebEx or on-site
S3 /CIGNA Healthspring / Contract Position
IT Services Senior Specialist Nashville, TN/ Nov 2015 - Feb 2016
Provided Risk Analysis with Business Impact in on-boarding process of new Third Party Vendors
Direction and Management of Meetings with IT and PFS staff
Created and documented processes to ensure efficient Third Party Vendors on-boarding
Ensure consistent Process Evaluation was applied in all areas
Ensure the TPM Service Strategy Best Practices were documented and applied
Leveraged performance data to drive analysis, awareness and service improvements where possible
Established and implemented Corrective Action Plans where necessary
Drove communication to enhance value of Third-Party Management on both sides of the spectrum
Strengthened relationships with internal departments through increased visibility to Third-Party performance
Drove TPM profile growth through the use of internal and external customer-facing scorecards and dashboards
Maintained current information on Internal SharePoint site
Ensured data is made available for Third-Party QBR events as required
Managed Third-Party relationships and identified areas of improvement as needed
Ensure any changes to Third-Party profiles were communicated to the business units in a timely manner
Provide input as required during Third-Party contract/SOW/SLA reviews
Serve as Third-Party Management representative in initial SOW requirements gathering
Serve as Third-Party Management authority on SOW input and communication
Validated business documentation such as proposals, contracts, SOW’s and vendor quotes as required
Work with business stakeholders to define business needs during project intake process
Apex- CHS /Contract Position
Interim Director /Project Manager Franklin, TN / April 2015- Dec 2015
Revenue Cycle Operations (cash/payment automation) w/ IT & PFS
Implementation of Hyland/Onbase cash automation system process for 9 SSC’s
Managed relationships with key stakeholders and decision makers
Prepared requirements documents
Direction and Management of staff through the IT and PFS departments to increase communication
Assisted Vendor in the preparation of business requirements
Coordinated with vendor to obtain access to client system for application builds in Meditech
Consult with management and personnel to identify, define and document current operational processes and procedures
Facilitated discovery sessions as needed, worked with PM, vendor and departmental end-users in the analysis, design and configuration for the new Revenue Cycle Management Systems/ Hyland Onbase- document retrieval program
Proven ability to provide the most effective patient care, and cost savings through analysis of accounting/budgeting, policies and procedures to increase the “bottom line”
Advent Health Partners
Business Analyst/Claims Appeal Analyst/ Nashville, TN / May 2013- April 2015
Revenue Cycle Management (clinical appeals)
Work with all levels of personnel, assisted with software installations, provided application and system training
Hyland Onbase/ Document imaging - retrieval
Athena Application / Utilizing Data and Meta Data pick lists for verification of patient information ie. Clinical documents, medical information shared by the vendor.
Performed software troubleshooting with VP of Operations and IT Department
Assisted in creating documentation for work-flow policies and procedures for multiple health management systems
Knowledge of EHR/EMR, HPF, Onbase(document imaging), Artiva, Mckesson, MedAssets, CareMedic/ER, STAR Systems and many more
Reviewed UB04 for rework and potential appeal of denied or underpaid claims
Work on all projects assigned via the operations manager /division manager
Proven ability to appeal claims through analysis of clinical documentation to obtain reimbursement of underpaid or denied claims to increase revenue for clients
Frist Cardiology
Practice Manager Nashville, TN / Oct 2012- March 2013
Consulting (ER,OR, Outpatient and DNFB claims for Centennial Hospital)
Revenue Cycle Management and Operations (front end/back end)
Provider Credentialing and Contract Negotiations
Direct and manage staff
Held regular meeting with doctors, nurses and admin staff
Increased teamwork and personal accountability
Led staff training and goal setting
Increased Revenue and patient retention
Conducted annual performance evaluations, restructuring and termination of staff
Maintained credentialing in ECW, Meditech and other internal systems for all providers including contract negotiation of new fee schedules with all insurance carries for maximum revenue
Managed supply orders, created and implemented forms for pre certifications for procedures and medications
Act as the liaison with all outreach clinics and hospital administration
Oral Surgical Institute/ADOT/SSC Companies
Systems Manager- Medical- Dental Insurance Billing Nashville, TN Dec 2011-June 2012
Consult with (patients)
Revenue Cycle Management and Operations (front end/back end)
Provider Credentialing and Contract Negotiation
Direct and manage staff
Account audits, daily charge audits
Performed electronic medical and dental billing in ECW and other systems
Led staff training and development
Created and implemented policy and procedure manual
ead of collections team/SME
Executed tracking and trending of aging PTR and insurance A/R
Act as liaison between all practices, IT vendors and EDI vendors
HHC Chiropractic/CAM Chiropractic
Practice Manager Nashville/Murfreesboro, TN/ Jan 2007 - Nov 2011
Consult with (patients)
Revenue Cycle Management (front end/back end) patient intake, claims submission, remittance based
Provider Credentialing and Contract Negotiation- 5 years
Vendor Relations Management- 5 years
Direct and manage staff
Performed Insurance billing, patient scheduling, collection
Reviewed procedures/diagnosis codes
Performed credentialing for two providers and negotiation of fee schedules for maximum reimbursement
Carried out AP/AR reconciled all patient accounts including all claim denials, pended or requirements of additional information needed for payment of claim
Communicated with patients, in regards to denials and found solutions that were satisfactory to both provider and patient’
Responsible for system training for new employees
Maintained inventory, daily reports and recommended process changes as needed
Performed EDI interface and troubleshooting/maintaining all inner office applications
Star Physical Therapy
A/R Analyst- Workers’ Compensation Claims Cool Springs, TN 2005-2006
AP/AR- claim based analytics
Responsible for Data management
Maintain a good rapport with all workers’ comp payers/vendors to ensure timely payment of patient accounts
Managed and resolved all old unpaid accounts
CIGNA Healthcare Sherman, TX /1998-2005
Client Satisfaction Coordinator/Consultant Sherman, TX 1998-2005
Revenue Cycle Operations
Provider Relations
Direct and manage staff, responsible for educational training and service excellence of 150+employees in all operations systems
Act as Consultant for high end clients, Project Manager/Analyst to track trend and provide feedback for improvement opportunities within the organization to account management teams in order to reduce rework and increase overall results and service
ducation / training of 150+employees in all operations systems (medical and dental). Directed and manage staff
Headed several projects, including multiple claims issues, investigation of underpayment and over payment adjustment projects for client accounts
Conducted client presentations to review site operations and answer service questions regarding hiring, training of staff roles and responsibilities of all functional areas
Processing of Inpatient/Outpatient claims as needed
Managed relationships with key stakeholders and decision maker
Development of a medical necessity document for providers and facilities to utilize when appealing claims
AWARDS/RECOGNITIONS
CIGNA COE (Circle of Excellence)
CIGNA Star
CIGNA Champion and Matrix Partner of the Month
Star Physical Therapy Partner of the Month
HHC/CAM Employee of the Year
CIGNA Healthspring-Consultant of the Month Feb-2016