Maintenance Manager Quality Assurance
Resume:
Danny Heredia
Lake Elsinore, Ca 92532
Cell Phone: 909-***-****
Email: admk1f@r.postjobfree.com
OBJECTIVE: Seeking a challenging position where my extensive background and knowledge in Healthcare Business Office operations will be used effectively. I hope to expand my career by gaining a better understanding of the fiscal and patient care challenges facing Healthcare providers today.
QUALIFICATIONS
Over 30 years’ experience in Revenue Cycle Operations within the Healthcare Sector. Diverse background and experience in Business Office functions, computer software, applications, intimate knowledge of the inner workings and infrastructure.
Project Management and leadership: Pre/post Testing of Systems Implementations for newly acquired hospitals and lines of business. Process Improvement, Denial and Resource management, training, auditing and creating Quality Assurance procedures to minimize errors and maximize qualitative and quantitative results and performance.
Strong organizational skills, contract language and interpretation, Excellent writing and communication skills
Well abled in Personnel and Customer Conflict Resolution
Over 20 Years Billing and Collections
9 Years Support Services Management: Electronic payments, Contract Management, Document Imaging, Cash applications and Reconciliation, Customer service, Vendor Management, Specialty billing (Kidney Transplants, Capitation, Global Billing & Transportation. Credit Balance-Refunds, Electronic Posting, On demand reporting and analysis.)
Team Leadership and Development
.
EMPLOYMENT HISTORY
Monrovia Memorial Hospital – Monrovia Ca
Jan 5, 2015 to present
Director of Patient Financial Services
As Director of Patient Financial services in a Long-Term Care Hospital, I oversee Admitting Department and Accounts Receivable Business Office functions for a 48 bed Long Term Care Hospital and Surgery Center, including management of 8 FTEs.
Manage daily Census to ensure appropriate classification of accounts based on Medicare, payer guidelines and reimbursement methodology.
From a reimbursement stand point there are 3 lines of business: Medicare, Personal Injury and Workers Comp, Medicare accounts are billed within 5-8 business days and are paid in 11-14 business days with exceptions, Personal Injury and Workers Comp accounts are billed 30-45 days from discharge date and are generally paid within 30 days unless they are disputed injuries or are in litigation, in which case liens are filed and cases are monitored internally. We have successfully maintained these guidelines during my tenure.
Intimate knowledge in Medicare billing including direct data entry, part B billing and related billing processes.
Review Processes and work flows to ensure efficiency and identify opportunities for Improvement.
Implemented process and procedures to increase secondary billing recoveries
Collected over $40,000 interest for payer delayed secondary billing accounts
Maintain less than 3% Registration error ratio, said errors are identified during QA process and corrected
Review eligibility verifications for accuracy prior to admit and report any coverage restrictions and limitations to Senior Management as necessary.
Track and trend critical operation indicators to ensure proper coding, charge integrity and internal billing protocols.
Work closely with CFO in managing Charge Master to ensure appropriate usage, reviewing new charge requests to determine appropriateness and pricing.
Implemented cross training in critical areas to ensure coverage
Daily analysis of charge entry, daily routines and interrelated functions.
Auditing and special projects
Work closely with CFO in preparing Cost Report, other critical requests and required reporting from internal and outside entities.
DRG and Reimbursement Validation
Resource Management-Ensure assembly line flow and transparency in a very lean driven environment.
Denial Management: Work closely with team members to ensure all payer denials are addressed timely, proper and maximum utilization of payer dispute mechanisms resulting in less than 1% in unresolved denials
06-12-13 to 12-31-2014
Consultant/ Account Maintenance Manager
Saint Joseph Hospital of Orange
11000 W. Stewart Drive
Orange, CA 92868
Retained by subject employer to oversee efforts and action accordingly in following areas:
Train and direct team of 3 Revenue Management Analysts in multiple projects and on demand tasks
Aging Analysis
On Demand Reporting & Data mining
Identify payer trends, systemic issues, training needs and process breaks
Quality control
Denial Management-identified payer issues and worked with plans for resolution as well as internal process discrepancies and work flow breaks that were resulting in lost revenue.
Aged account resolution
Audit Support
Customer Service Issues/Risk Management-Satisfactory resolution of Patient and customer concerns and complaints and employee disputes.
Reconciliation: Posting/Transaction errors, GL discrepancies (one sided entries, interest, incorrect transaction codes, etc.)
Address Contract Management System discrepancies
ER Charge entry and coding
07-24-09 to 12-31-2012 / Account Maintenance Manager
Saint Joseph Hospital of Orange
11000 W. Stewart Drive
Orange, CA 92868
As Manager in Account Maintenance Department for a nonprofit 463 bed hospital, I supervise a team of 8 Analysts and support staff performing a diverse line of functions, including Cash Applications, Capitation Data Encounter processing, Specialty billing i.e. Global-Physician Billing and collections, Kidney Transplant billing and collections
Daily, weekly and monthly reporting, routines & data analysis.
Vendor communications / Documentation- transaction file management and support
Contract Management-Proration and auditing.
Additional Support: Incoming Document Management and processing
Cash Applications and reconciliation, ERA-835 file processing and management including payer set up and research of logistical and connectivity issues.
Troubleshooting systemic and process breaks / create work flows
System Access Management
Project Planning and implementation
Work closely with Finance Department on daily, weekly and monthly reconciliation, GL entries, usage and or management.
Successfully migrated Processes, Routines and functions from stand-alone operation for Saint Joseph Hospital to the Central Business Operations Office.
05-23-05 to 06-19-09 / Support Manager
AHMC Healthcare Central Business Office
1000 S. Fremont Ave. Bldg A9 East 6th Floor
Alhambra, Ca 91803
Support Manager for AHMC CBO, I was responsible for maintaining and monitoring productivity for a staff of 21 employees, make recommendations for improvement, implement new process and procedures in the following areas for a For Profit Startup Health System comprised of 5 major hospitals.
Instrumental in resource management relative to Software & process improvement implementations, i.e. AR System Implementations, transition of banking institutions, Medicare enrollment requirements, purchase of new hospitals prompting registration of bank account numbers, address changes, applicable TIN and NPI numbers, EFT and ERA set up, submission of applicable forms, license and permits, notification to payers of subject changes and related matters
Responsible for assisting with various reporting and provide assistance with month end process, up to but not limited to running monthly receipts reports, credit balances, Resolved over $1,000,000 in GL irregularities
and bank deposit discrepancies.
Implemented new process and procedures for 4 facilities
Cash Applications: Oversee posting of all incoming cash, adjustments, refunds, vendor transaction files to appropriate patient accounts and General ledgers, maintain appropriate financial records.
Reimbursement Analysis: Review of all patient account receivables by performing meticulous review of explanation of benefits in conjunction with contract matrix and account data variables to ensure optimal reimbursement.
Customer Service: Call Center inquiries
Credit Balance Analysis: Oversee and manage review of all credit balances, identify over booked contractuals, systemic failures or contract load errors, communicate and track according to policy and procedure then devise appropriate action plan and process all true patient and Insurance credits accordingly.
Document Management: Review and direction of all incoming correspondence to appropriate departments and outgoing mail management and processing.
Reception Desk: Oversee PBX position to ensure screening and transferring of all incoming calls is handled appropriately while providing preliminary assistance to callers with basic questions and concerns. Provides clerical assistance to other departments and provides assistance with special projects.
Banking and Reconciliation
Reconciliation of account receivables for all facilities, account activity, including lockbox deposits, electronic funds transfers, over the counter deposits, etc.
2002 thru May 17, 2005: Collection Dept Lead
Health Plus Corp.
Memorial Hospital of Gardena/ELA Doctors Hospital
1145 W. Redondo Beach Blvd.
Gardena, CA 90247
Directed daily collection efforts in Commercial and Managed Care lines of business.
Implemented new processes and procedures
Project Management and research
Identified payer trends and addressed mass denial Issues
Training & Development
Vendor Management.
Diverse Billing and Collection Background at the following Healthcare providers
and business associates.
1989-2002
Tenet Healthcare Extended Managed Care Unit
Midway Hospital
West Hills Medical Center / Columbia Healthcare
Verdugo Hills Hospital
Coastal Communities Hospital / Tenet Healthcare
Security Collection Bureau
TECHNICAL SKILLS
WORD
EXCEL
AR HOST SYSTEMS: P-BAR, AS400, ACE, INVISION CPSI, MEDITECH, CUBS
& SPHERE-NEXTGEN
MED ASSETS CONTRACT MANAGEMENT SYSTEM
MEDITECH CONTRACT MANAGEMENT MODULE
CHART MAXX IMAGING SYSTEM
PASSPORT MULTIPURPOSE SYSTEM (Eligibility, authorization, skip tracing, payments)
E-PREMIS BILLING SYSTEM
MEDI-ANALYTICS REPORTING SYSTEM
WINTASK SCRIPTING TOOL
EDUCATION
Garfield High School
Rio Hondo College
BILINGUAL: Spanish (speak, read and write)
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