Willie Ray

adkadh@r.postjobfree.com

314-***-****

SUMMARY OF QUALIFICATIONS

Results-oriented professional with 10+ years of experience in healthcare billing, collections management, and contract negotiations and compliance auditioning or Molina, as well as other Managed Care Plans. Strong leadership skills and a proven history of increasing revenue, streamlining operations, and improving employee performance. Strengths include auditing and monitoring regulatory compliance, charge master management, facilities management, project management, new business development, and educating employees to effectively perform a full range of billing activities. Experienced in managing overall operational direction with executive oversight for Revenue Cycle Billing and Collections by coordinating and making improvements in operations. Work closely with executive management in setting the tone of the department as a service organization and by continuous process improvement. Core Competencies

Revenue Integrity Management

Patient Access Management

Performance Management

Healthcare Compliance Management

Billing Management

Healthcare Delivery Systems

Charge Master Management

Credentialing Management

PROFESSIONAL EXPRIENCES

Springfield Hospital Springfield Vermont

Interim Revenue Cycle Director 2020—Present

Directly oversee Revenue Cycle Process for a 25 bed Critical Access Hospital a FQHC and multi-specialty clinics. Manages five departments, ten direct reports. Responsible for resolving complex issues and interface directly with high-level operations and stakeholders, Analyze insurance payer agreements, Evaluate current practice management software, Calculate and maintain payer tables and produce revenue accrual in direct alignment with payer contracts, Oversees all aspects of the Revenue Cycle system by providing strategy, decision support, organizational planning and operational leadership. Coordinates and works collaboratively with CCF and the RCM leadership team to ensure consistency with best practices. Oversee Labor Union Contracts, Provide guidance to support to Human Resources with Interpretation and Compliance of the Collective Bargaining Agreements. Accomplishments:

Implemented RYCAN Software (replaced the billing software for clearinghouse CPSI was using. This allowed us to have higher clean claim rates resulting in faster turnaround time of claims.

Improved Clean-claim rates from 0% rate to 85-90% where all claims were touched prior to submission. This allows for more efficiency and more time to follow up on past due claims.

AR days went from 60 days to 40 days for SH and SMCS have improved from 30 to 25.5 days.

Exceeded goals of collecting 85% of revenue billed within 60 days in the first year in the position.

After training and implementation processes brought outsourced follow up collections back in house.

Implemented new denial management software, which improved the denial management process for Hospital, and SMCS. Reduced the bottom line of accounts receivables.

Improved accuracy of billing information coming out of various departments to ensure less manual correction of CPT & Diagnosis codes, reducing billing & compliance issues

Implemented the HRSA COVID 19 uninsured billing process allowed the hospital and SMCS to collect cost of billing for the COVID 19 tests, resulting in additional 350,000 monthly revenue

Improved and recovered lost revenue in Lab requisitions due to poor work processes with no accountability, losing over $60k thousand each month. Increases Lab revenue by additional $400,000 in six months

Improved and implemented a better process for missing ER Department EKGs, lost of $48,800 monthly, improved revenue by $ 244,400 in the six months.

Establish a missing charge initiative for various specialty departments resulting in a reduction of 85+% in missing charges. Which Increase charges by $1m, resulting in $800k in additional revenue. Anderson Hospital Maryville Illinois

Revenue Cycle Audit & Compliance Consultant 2019 -- 2020

Develops monitors and directs the audit and compliance in coordination with the Integrity Program.

Ensure professional coding, audit, documentation and data quality complies with all regulatory Federal and state requirements.

Responsible for assuring the key elements of an effective revenue cycle compliance program is in place and operationalized as it relates to the Corporate Integrity Program (e.g., policies, education, risk assessments, profiling, work plan monitoring, audit, reporting and corrective/remedial actions and daily operations).

Provides guidance and education designed to promote regulatory compliance related to charge capture, documentation, coding and billing.

Responsible for further advancement of the Hospital mission of providing quality health care to all patients, while ensuring prevention of fraud, waste and abuse in the health care delivery system. Village of Washington Park Illinois Village of Washington Park, IL Municipality Administrative Clerk 2017 – Present

Managed the day-to-day functions of a team of eight employees in the business office.

Implement written policies and procedures that govern the accounting and business functions of the municipality.

Maintain and protect files, records and ordinances for the Village of Washington Park Municipality.

Record and Prepare Minutes for all meetings for the Village of Washington Park.

Create a standardize methods in which work should be accomplish.

Forward invoices to appropriate department personnel for approval for payment.

Communicate with supplier/vendors concerning errors or questions on invoices.

Maintain a file of copies of all charge slips, debits, credits, etc., of each transaction.

Monitor and collect accounts receivables.

Assist in preparing monthly financial statements to include preparing monthly balance sheet, income and expense reports, etc., as required.

Prepare and mail statements.

Make written and oral reports/recommendations to the Mayor concerning market trends.

Assist in reconciling bank statements as directed.

Assist in preparing trial balances as directed.

Assist in preparing financial and statistical reports as directed by the Mayor.

Manages the creation and distribution of monthly reports for Mayor and the Board of Trustees, and municipal customers where required by contract, on the effectiveness of contract and initiatives.

Manages the creation and distribution of Annual Reports for top municipal contracts in the business unit, which highlight key metrics, contributions and services delivered during the year to the municipality.

Coordinates and assists in the creation of all communications, programs, outreach, marketing materials and reports that are directly relates to the assign programs.

Oversees community outreach and public education events, as required per contract.

Plans programs that promote good will and fosters relationships with community leaders in city where the Village of Washington Park currently conducts business. Salem Township Hospital Salem, IL

Revenue Cycle Director 2016 – 2018

Assigned for Critical Access Hospital, Rural Hospital Clinic, and a Stand-Alone Family Healthcare Clinic management oversight for the development of high quality, cost effective, and integrated Revenue Cycle, including billing, collections, patient/resident accounting, information management, utilization review, patient access/registration, and charge master management for the hospital and clinics.

Exercised management responsibility by ensuring that efficient services designed to meet needs of patients, providers, public, and staff. Directed and managed billing department team of 12 employees and supervised a total of two Registration departments of 14 employees and Data Management departments.

Served Facility Manager of Clinic and Pod Rentals to outside providers, maintained and updated budget and contracts monthly. Demonstrated ability for providing assistance in the development of annual cost reports, while reviewing and providing management of all third party payor contracts.

Managed complex Revenue Cycle projects, working with key stakeholders across Salem Township Hospital. Coordinated and implemented revenue cycle initiatives, including: identifying and assembling resources.

Monitored operational performance to anticipate and met the needs of leadership. Maintained revenue cycle KPI’s within established industry and/or Salem Township standards, and instilled accountability.

Reviewed/verified billing/collection operations for compliance with established policies and standards.

Led in the development of annual cost reports. Reviewed/provided management third party payor contracts.

Leveraged a career of revenue cycle management within hospitals – leading organizations and individuals toward results, setting high performance standards, and providing revenue cycle management. Revenue Cycle Integrity Manager

Ensured that organizational integrity and regulatory standards were maintained in all Revenue Cycle policies, procedures, and processes. Ensured that all team members knew and understood their role. Facilitated compliance with administrative and legal requirements and governmental regulations.

Continuously identified opportunities for process improvement, and implemented them by engaging stakeholders throughout the entire organization. Understood interrelationships among systems, and processed across functional areas to redesign process, improve efficiency, and ensure optimal results.

Managed and maintained system-wide Revenue Cycle policies, standards, processes, and procedures. Provided appropriate education, training, and monitoring of these policies. Formulated and made recommendations to leadership on policies and practices relating to revenue cycle improvements Centene Corporation St. Louis, MO

Billing Compliance Analyst

2013 – 2015

Monitored risk management strategies to ensure regulatory compliance with timely and detailed reports.

Assisted director, manager, and coordinator of billing compliance in organizing and implementing compliance initiatives related to hospital and physician billing in accordance with rules, regulations, laws, and payer contractual requirements. Finalized reimbursements based upon audit findings.

Accepted and rejected clinical coding recommendations based on provider documentation details, administrative policies, regulatory codes, legislative directives, precedent, or other guidelines to perform analysis of provider billing against Current Procedural Terminology (CPT) coding logic and rules. SSM St. Joseph’s Hospital Highland, IL 2013

Revenue Cycle Supervisor

Led and supervise all revenue cycle activities related to billing in three departments, Central billing office staff 10 employees, Customer service staff of four employees, admissions and registration staff of 12 employees.

Facilitated timely patient follow up with third parties and ensured standards are maintain.

Audited productivity and quality, which led to an ATB report, which identified over $1 million in written- off and unbilled claims, and offered a time- sensitive strategy to secure payment for such claims.

Employed information technology to improve work processes to electronic submission of claims. Understood and managed all the denial processes.

Worked with other members of Revenue Cycle Management team in cultivating and managing strong relationships both internally and externally

Maintained employee management (time and attendance, disciplinary actions, etc.)

Ensure adherence to and compliance of payer, government and internal system regulatory policies

Created, maintain, update and provided training on policies and procedures

Identify potential process improvements

Carried out supervising responsibilities in accordance with the organizations policies Sanford Brown College St. Louis, MO

Lead Adjunct Instructor 2009 – 2012

Started teaching 12 hours per moved week up to 30.5 hours week.

Mentor new instructors teaching techniques and effective classroom management skills.

Developed curriculum and employed assessment methods for following classes: Business Management, Organizational Management, Operational Management, Health Information Data Management, Human Biological Systems, Ethics and Regulatory Compliance, Medical Billing & ICD 10 Coding, and ICD-9 Coding.

Design courses to meet learning outcomes, and promote students’ active participation in their own learning.

Create an effective learning environment that fosters students’ intellectual curiosity and helps students to problem solve using discipline-specific thinking strategies for classroom as large as 60 students.

Employ a variety of formative and summative assessments to ensure that classroom instruction leads to student learning and the attainment of the student learning outcomes for the course.

Help students reach their academic, personal and career goals and foster a safe environment that respects the diversity of people and ideas by modeling respect for all students and conveying confidence in every student’s ability to learn.

Reliant Care Management Company, LLC St. Louis, MO Billing and Account Receivables Supervisor 2004 – 2010 Directed billing department operations for four facilities a total 20 employees. Managed, coached, and motivated staff. Achieved high levels of team performance, met budgeted goals and demonstrated consistency in current A/R.

Monitored 30-60 days collection history, ensured appropriate billing of ancillary therapy, Medicare, Medicaid, room and board, pharmacy, lab, and X-rays resulting in consistent revenue generation.

Skillfully managed operations and achieved a 30% increase in budget profit for three consecutive years.

Responsible for tracking denials, resolution of denials and appeals

Continually monitors KPIs AR over 90 days, Reviewing Collections, Days in AR, Trending Cash Flow

Assists with extracting daily reports and analyzing data to maximize efficiency and direct focus to appropriate areas of concern

Provides training for new A/R billers for developing better skills in inexperienced or underperforming employees

Ensures adequate staffing levels are in place

Acts as a resource for all A/R representatives and supervisors for questions regarding billing policies, state guidelines, reimbursement analysis and assists with resolution of difficult/problem accounts and claims

Maintains a detailed knowledge of state and federal regulations, documentation and billing requirements

Supervise and evaluate A/R policies and procedures and make revisions and updates. EDUCATION

Webster University – Master of Business Administration St. Louis, MO

Webster University – B.A. in Healthcare Administration St. Louis, MO COMPUTER SKILLS

Epic, Athena Health, CSPI Trubridge, RCM Rycan, Allscript, NEBO, and NextGen, Meditech, Expanse, Cerner and Medical Management Software

Contact this candidate