Manager Office
Resume:
Shanyse DeJesus
**********@*****.***
Relevant Work Experience:
Weill Cornell Medical College
Revenue Cycle Manager Anesthesia/ Pain Management Department 1/2018-Present
Develops and implements billing guidelines and policies.
Reviews, updates and maintains fee schedules and procedure code dictionaries.
Develops, writes and distributes changes to WCM’s coding rules when needed.
As needed, assists with the development and implementation of revenue cycle strategies and workflows that will enhance cash collections, expedite account resolution and streamline billing processes.
Attends workshops, seminars and/or conferences to keep abreast of standards and best practices within the field. Disseminates information to colleagues and/or staff as appropriate.
Establishes operational benchmarks, metrics and productivity standards to streamline workflows and identify improvement opportunities.
Utilizes financial reports to develop action plans aimed at maintaining or improving financial and/or operational performance.
Analyzes data to enhance revenue opportunities.
Develops, implements and manages quality control and audit procedures to monitor the timeliness and effectiveness of revenue cycle activities.
Acting as Operations Practice Manager ( temporary September 2019-Prresent)
Revenue Cycle Supervisor 12/2014-1/2018
• Supervise day to day operations of the Managed Care Unit.
• Responsible for providing direct supervision to a staff of 36 employees within the Managed Care Unit and for the account receivables for 27 specialty groups.
• Maintain data integrity when manipulating data files for purposes of analysis to ensure data does not become corrupted through conscientious use of tools and a system of checks and balances.
• Manage all back-end operations to ensure all claims are paid at full reimbursement rate.
• Responsible for coordinating daily work assignments to be completed within a specified time period.
• Coordinate staff training for the policies and procedures and EPIC Practice Management system related to the Managed Care unit.
• Liaison between department administrators and Business office
Mount Sinai Medical Center Central Billing Office
Billing Supervisor 9/2012-12/2014
• Managed work of non-supervisory employees engaged in processing claims, maintaining related files and logs, and checking patient eligibility for. Proactively identifies problems and assists in solving payment and other business office issues.
• Monitored processing of claims for reimbursement and ensures all necessary documentation and attachment are included with claims. Interacts with physicians and administrators to coordinate communication of billable services to patients.
• Oriented and trained employees in department policies and procedures and assists staff in carrying out their work by responding to more complex questions and problems.
• Assisted in the resolution of patient complains and concerns and resolves.
• Assisted in interviewing of new staff and recommend hiring and participate in performance valuations of employees’
• Gathered and exchanged information necessary to ensure timely processing and reimbursement of claims and to promote maximum payments and reduce outstanding days in accounts receivable.
Center for Women’s Reproductive Care at Columbia University (CWRC) 9/2002- 9/2012
Billing Practice Manager
• Managed large billing department in a high volume infertility clinic; evaluated employees on an ongoing basis.
• Trained all new billing staff to ensure cohesiveness within department.
• Implemented plans for improving the overall operations of billing; worked closely with Network Director to maintain high standards.
• Worked closely with a multi-disciplinary staff including Physicians, Nurses, Administrators, Social Workers, etc. to maximize effectiveness of CWRC Billing Dept.
• Worked closely with Patient Services and Patient Relations to resolve patient issues with all billing concerns in a congenial manner.
• Ensured authorization and pre certification was done for infertility treatments for all patients.
• Ensured all insurance verifications for infertility treatments are correct and relayed to patients in a timely manner for effective treatment at the facility
• Advised patients of the financial aspects of infertility treatment process.
• Managed Billing Call Center and all TOS payments collected for self-pay patients
• Ensured TOS payments and billing charges were posted daily
• Advised staff of new schedule changes and protocols for managed care.
• Prepared monthly collection and billing activity reports.
• Worked in tandem with Business Office Manager with management of billing staff and operations.
Experience with: Epic Practice Management System, Cognos Reporting system, All Scripts, Cerner, Compurecords, Informatics reporting system, Experian, GE/Centricity Enterprise Task Manager Module [ETM], PCS, IDX/BAR, DBMS, Eagle, Receivables Edge, Claims Logic, Strong Microsoft Office Skills, Medical Terminology and Strong knowledge of ICD10/ CPT billing and compliance guidelines.
Education
University of Scranton - Master’s in Health Administration
References Available Upon Request
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