Manager Medical

Sue Kumar

**** ******** *****

Troy, MI *****

Cell-248-***-****

adiczt@r.postjobfree.com

Career Objective: To pursue a challenging career and be a part of a progressive organization that gives scope to enhance my knowledge, skills and to reach the pinnacle in the accounting field with sheer determination, dedication and hard work.

Summary of Qualifications

* Over 18 years of work experience with over 13+ years of Leadership experience of PFS in Facility and Professional billing, coding, customer service etc.

* Strong oral and written communication skills

* Excellent managing, reporting and analytical skills

* Successful track record of problem solving and taking initiatives to enhance AR Solutions, Goals and customer satisfaction.

Professional Experience

REVENUE CYCLE MANAGER-McLaren Health Care-July’18-Current- Responsible for managing the Insurance Billing Office across a multi-facility integrated healthcare delivery system; which includes all billing associated with 10 hospitals of McLaren Healthcare, outpatient clinics and employed physicians. Shares knowledge, motivation and engages the Insurance Billing Office team to provide high quality services, which meet or exceed customer expectations. Collaborates with members of the team, identifies departmental and business unit priorities, establishes goals and implements strategies designed to maximize reimbursement, reduction in DNFB, Prebills and Credits for the Health System and fosters a culture of innovation, employee engagement, and exceptional business performance. Maintains Accounts Receivable activity including preparation of weekly aging along with daily function through both direct supervision of staff, as well as managing Supervisors who have responsibility for many aspects of daily operations with Governmental and non-governmental Payers. Implemented compliance auditing for 340B drugs programs, Credit balances etc. Maintains quality services through consistent application of policies, procedures and Identifies problems related to the functioning of the Billing, recommends solutions, and takes corrective action to resolve them. Creates and maintains a work environment conducive to effective communication, team building and professionalism responsible for setting and tracking metrics for quality and productivity. Responds promptly, professionally and courteously to all PFS needs. Cooperates and communicates and collaborates effectively with all McLaren Health Care and outside team members. Contributes to continuous quality improvement efforts.

REVENUE CYCLE MANAGER- McKesson Corporations- Oct’14-June’18- Supervising and managing variety of duties for daily operations of Revenue Cycle. Establishing, Interacting, supporting clients, Process Directors, AR Directors and interact with radiology clients for Physicians Billing. Create, reconcile, monitor and analyze various reports on daily, weekly, and monthly basis. Responsible for overseeing various health care functions such as preregistration, insurance verification, point-of-service cash collections, financial counseling, registration, coding, medical records, billing, account follow-up and collections, customer service and cash posting along with building and maintaining a data model to efficiently produce reports to meet revenue reporting needs. Expertise in utilizing internal and external data, creating automated reporting processes and procedures, writing analytical reports, and making recommendations for meeting goals. Worked as matter expert in Risk Adjustment and its role in managing CMS revenue.

BILLING Manager - Unity point Health Methodist/Proctor-Peoria, IL-July'12-Oct’14-Direct management responsibility of daily operation or revenue cycle team of 25 members. Managing, coaching, interviewing, hiring, evaluating, budgeting variety of duties, including establishing policies and procedures for daily operation of Patient accounts Dept. Supervising customer service, Billing, Insurance Follow up, Cash posting, account receivable and payable. Supervised various task groups and committees. Provides effective input into hiring, termination, discipline, assignment, and evaluation of work for employees. Participated in orientation of new employees, quality improvement, and research, educational and other related activities. Maintains knowledge of current trends and developments in the field by reading appropriate literature. Coaches staff to develop stronger decision-making skills, improve productivity and quality of work.

ADJUNCT FACULTY - Elmira Business Institute-Vestal, NY -Oct'10-June'12 Teaching Health Information Management, Medical Transcription, Medical Coding, Medical Law and Ethics, Medical Billing & Reimbursement and Medical Terminology.

BUSINESS OFFICE Sup.- Our Lady of Lourdes Memorial Hospital, Binghamton, NY-Nov'10-June'12- Worked Closely with Patient, Insurance companies, Clinics, Labs and other Medical offices to resolve all kind of Patient issues with billing and coding of Facility and Physicians sides. Worked as a Patient advocate. Pre-screened patients for financial assistance and charities. Known for strong training, mentoring and leadership skills. Service excellence Champion for 2012.

BILLING ANALYST - Cooley Dickinson Hospital, Northampton, MA - Nov'09- Oct'10 Analyzed and conducted appropriate follow-up activity with third party payer to ensure timely disposition of aged accounts. Handled patients call to resolve billing and eligibility issues. Accomplished projects of setting up secondary electronic billing system and billed over 1400 accounts in a very short period of time to state of MA and closed accounts after receiving the payments. Trained employees on electronic secondary billing, obtaining electronic EOBs, eligibility verification and other patient accounting areas. Responsible for overseeing billing and follow up of Consolidated billing including individual nursing homes, VNA and Hospice billing and reconciliation. Excellent knowledge of Quadra-med, Affinity, SSI, MMIS, Medicare FISS system.

SYSTEM CO-ORDINATOR- Henry Ford Health System, Troy, MI, Mar 05 -Oct'09 Worked specifically with PFS Directors, PFS Managers and Revenue Team Managers to interpret third party billing and reimbursement regulations concentrating on their overall impact on the Patient Financial Services operation. Initiated communication with Patient Financial Services staff in order to monitor and resolve third party billing, coding and compliance issues. Performed special projects while taking an active role as a departmental liaison in the implementation of policies and procedures that affect PFS and external clients. Maintained a variety of different hospital and professional billing system master files with an emphasis on their base parameters and tables which controlled user-defined components of the system. Supported and maintained application systems installed for PFS billing acting as a liaison between technical support, McKesson and end users. Prepared and analyzed system-generated departmental reports in order to track trends and notify appropriate management of inconsistencies as discovered. Researched, developed and tested methodologies relative to special projects initiated by financial administration. Extended knowledge and experience of PC software such as Excel, Word, Bi-Query, PC Anywhere, Laser Arc, and TSO File Aid, Charge Masters and Code sets.

EDUCATION

MASTERS (English) Patna University, India

BACHELOR (Education) Patna University, India

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