Anaheim, CA *****

714-***-****

adhk5o@r.postjobfree.com

Romika Prasad

OBJECTIVE:

Highly motivated, self-starter, collaborating professionally with individuals of all levels & earning a trustworthy reputation of being a dedicated, progressive viewed, accomplished, efficient & result oriented leader in the diverse range of healthcare functions of full Revenue Cycle Management (RCM) including Operations Management. I develop and or review strategic initiatives for process improvements that has resulted in streamlined workflows for efficiency and goal attainment to meet benchmarks & dept. /client goals. I enjoy mentoring and developing a positive & safe work culture within the organization, I believe strongly with employee engagement and think it keeps the team motivated for continued best performance.

WORK EXPERIENCE:

University California Irvine, Orange CA

Revenue Cycle project & Billing manager, October 2019(interim July) to present

Manage, coordinate and champion multiple revenue cycle initiative across the organization to improve processes and support revenue cycle objectives. Improve performance by gathering and analyzing data, create reports and develop deliverables either in written form or in presentation. Discovering opportunities through reviewing KPIs, metrics and collaborating with key stakeholders. Using project management principles to develop create and implement processes. Collaborate with inter-departmental teams to effect change management by presenting the impact to their department and financials. Coming up with “best practice” for operational effectiveness and financial outcomes. Special payer related projects identified in trends. Provide leadership, positive work culture, staff development amongst additional functions as needed. Acquired the Reimbursement Audit Unit to revamp and develop additional enhanced processes for efficiencies and best practice to maximize from the MPV system with 5 direct hires that includes 4 collectors and 1 contracting analyst.

University California Irvine, Orange CA

Billing Manager, December 2014 to January 2020

Responsible for the day-to-day operation overseeing charge capture and reimbursement for professional billings. Manage and work with a team of 10-reimbursement representative, 3 coding abstractors, 1 Registration coordinator, 1 administrative assistant and a Billing supervisor. Review and analyze claim denial reports to implement additional processes or to create edits to aid in cleaner claims going out for a quick turn around on reimbursement. Assist my staff in collection escalation on aged accounts by reaching out to the payers contracting dept/network dept for a point contact to work with on the resolution. Train new hires or educate my existing staff on certain job functions as well as cross train them so I may utilize their skill for certain projects or for staff coverage. Identify and lead projects with payers on common denial that can affect other groups/managers on their claims. Review process workflows and streamline functions for effective and efficient use of staff time for operations. Collaborating with the groups (Dept. of Pediatrics including Neonatal/Perinatal, Dept. of Radiation Oncology and University Surgeons of Orange) CAOs and their Division Administrators to help them achieve their budget goals along with ways to maximize their charge capture and sharing billing trends or issues of payer reimbursement and finding prompt resolution as needed to bridge the reimbursement delays. Create Monthly detail reports of finances from Charges & Payments to Accounts Receivable for each subdivisions within the groups and meet with them to go over the details. Discuss billing trends or issues of payer reimbursement and finding prompt resolution as needed to bridge the reimbursement delays on the front end if possible. Communicating with attending providers and paraprofessionals with feedback pertaining to billing and coding or areas that affect their work RVUs. Address and review complex problems and search for solutions for the groups. Providing the highest quality of customer service and addressing my client needs are amongst a few of my work ethics I strive to achieve.

St. Joseph Home Health and Home Care Service, Orange, CA

Finance Supervisor, June 2013-September 2014

Manage the Billing and Collection team for Home Health, Home Care Services, Hospice and Private Duty. Also, oversee the Cash Application Department to post payments, adjustments and write off as well as refunds approved and reviewed by me. Assist the reimbursement staff on payer projects or to escalate issues in delay of claim payments. Assist to escalate system issue regarding billing and claim submission with billing system vendors or with payers through their EDI department. Have regular one on one with direct report to review areas of focus or improvement as needed, also to address their issues with payers or process and get feedback on workload to identify areas that may need help or come up with action plans to achieve goals and targets set for them. Assist the Finance Manager in the day-to-day operations and assist the Intake, Insurance Verification Department with the Authorization Department in the absence of the Finance Manager. I will step in as needed to verify insurance for patients if short hand on the Insurance Verification Department and forward patient and insurance information to authorization nurses if authorization is needed for the services. Help with month end closing; provide monthly reports to management of the health and status of the AR with breakdowns of the age of the accounts. Provide the cash trends on a monthly basis as well as show the run rate. Able to assist the team of issues concerning difficult payer claims processing. Work with contracting to try to resolve payer project issues on rate reimbursement. Still new duties and challenges arise daily but I am able to multitask and prioritize to accomplish what's needed for the business.

Medical Accounts Receivables Solutions, Garden Grove CA

Financial Manager, October 2012-June 2013

Manage a Team of 15 Account Managers on multiple client projects. Assist Director of Operations and the Company President of day-to-day Management activity including special client reporting of Cash Month to Date, Productivity etc. Also responsible for making sure the AR assigned is worked efficiently and proactively with fast and best results for the company and the client. Addressing any payer issues Account Managers face. Audit and review work performance. Developed strategies to sustain the efficiency and the accuracy of claims processing and collections. Analyzed accounts and initiated reimbursement process. Responsible for communicating with insurance companies (Nationwide Payers) for the resolution and payment of claims. Mainly focused on aged and hard to collect account over 365 days or special projects. Analysis of Accounts Receivables to identify uncollectible accounts (bad debt) (over 180 days report). Creating adjustment and attaching supporting documents to validate all avenues exhausted. Train new hires of the company and go over the company policy and procedures along with work description listed below under Account Manager. Represent the company at the NHIA Conference each year held in different State & City doing Sales & Marketing for the company for more business.

Medical Accounts Receivables Solutions, Garden Grove CA

Account Manager, September 2009-October 2012

Responsible for processing and supporting claims by analyzing data such as provider member and health plan information. Developed strategies to sustain the efficiency and the accuracy of claims processing and collections. Reviewed status of accounts and initiated collection actions by contacting each account. Maintaining record of monthly cash flow on a collection to date of AR. Responsible for communicating with insurance companies (Nationwide Payers) for the payment of claims. Updated patient history with written comments. Mainly focused on aged and hard to collect accounts over 365 days, or as clients need and or special projects. Analysis of Accounts Receivables to identify uncollectible accounts (bad debt) (over 180 days report). Creating adjustment and attaching supporting documents to validate all avenues exhausted. Helping train new hires of company policy and procedures as well as assisting to train interns from Accredited Colleges. Also helped screen possible new hires and set up interviews. Creating and maintaining patient charts as open account is worked. Archiving closed account securely and HIPAA compliant. Accounts Receivables clean up while collecting on collectible outstanding claims and receivables. Represent the company at the NHIA Conference held in different State & City each year doing Sales & Marketing.

Vengroff Williams and Associates, Garden Grove CA

Medical Biller/Collector, April 2007 – September 2009

Responsible for processing and supporting claims by analyzing data such as provider, member and health plan data. Developed strategies to sustain the efficiency and the accuracy of claims processing. Reviewed status of accounts and initiated collection actions by contacting each accounts. Maintaining record of monthly cash flow to monitor cost of estimation project. Responsible for communicating with the insurance companies for the payment of the claims. Updated customer history with written comments. Answer the patient's queries, problems, complaints, and identifying solutions.

Saddleback Memorial Care Hospital, Laguna Hills CA

Senior Patient Care Service Representative, August 2006- April 2007

Greeted and interviewed incoming patients, obtained patients' demographic and collected patient and insurance information and explained hospital policy to patients and visitors. Provided all administrative services related to admission and pre-testing of patients of all ages. Collected co-payments and billing balances from patients. Training new hires, monitoring performance, and auditing. Properly filed daily and monthly cash collection transactions.

Ambry Genetics Laboratory, Aliso Viejo CA

Accounts Receivable Specialist, May 2005-August 2006

Position involved ensuring control of remittance and EOB is received, proper posting to accounts, preparation, and input of invoices into our computer system. Properly coding invoices, checking of prices, extensions and quantities, check preparation and distribution. Running aging reports and reconciling after reviewing accounts from past notes. Communicated with healthcare providers verifying patient coverage and benefits. Resolving difficult problems and discrepancies with insurance companies and patients regarding they are accounts. Responsible for day-to-day cash management and preparation of required reporting.

SUMMARY OF QUALIFICATIONS:

Full Revenue Cycle Management experience & knowledge including Leadership/Team Management

Financial Reporting, Data Analysis with complex problems and finding solutions and fixes

Business and Strategic Planning, Day to day operations management

Process Improvement and streamlining for efficient time and effective work

14+ years’ experience in the Health Field

Professional written and verbal communication

Tenacious Reimbursement knowledge and creative, detail appeal and grievance filing

Strong knowledge of the following software programs (Microsoft Office; Word, Excel and PowerPoint) Knowledge of reporting and pivoting data. Medical Billing systems: EPIC,GE, TRAC, Precision BI, CPR+, All Scripts, SCS, E-premise, I-Emphysis, Emdeon, Charts Online,Zirmed, Advantage, MDP, Xifin, EzClaim, QuickBooks, Lab Director

Knowledge of Medical Terminology and Abbreviations, the different coding methodologies used in medical billing, including CPT-4, ICD-9/10.CM and HCPCS.

Strong Training & Presentation Skills

Ability to perform all assigned job duties within an acceptable metric of performance as determined by management

Professional Media: www.linkedin.com Romika Prasad

PROFESSIONAL AND PERSONAL REFERENCE: Can be provided upon request.

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