CONTACT

*** – *** – ****

adyicd@r.postjobfree.com

ADDRESS

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

Pembroke Pines, FL 33026

PROFILE

Results- driven Business/ Billing Manager with extensive experience in revenue cycle management within the skilled nursing facility setting. Expertise in managing billing processes, reducing Accounts Receivables (AR) days, and maximizing collections. Adept at implementing efficient strategies to improve financial performance and achieve organizational goals.

EDUCATION

Bachelor Degree

Health Care Administration – 2023

(Magna Cum Laude)

Florida National University

Associate of Science

Medical Technologist – 2000

Associate of Science

Computer Programming – 1995

Florida National College

SKILLS

•Bilingual – English & Spanish

•20+ of experience in revenue cycle management, specifically within skilled nursing facilities

•Proven track record of optimizing billing processes, reducing denials, and increasing collections

•In-depth knowledge of Medicare, Medicaid, and third party payer reimbursement regulations

•Proficient in utilizing revenue cycle management software

•Strong analytical and problem- solving skills to identify and resolve revenue cycle issues

•Excellent communication and interpersonal skills for collaborating with multidisciplinary teams

•Detail- oriented and organized with the ability to meet deadlines and work in a fast-paced environment

•Billing & Collections Growth

•Excellent communication and interpersonal skills

•Strong leadership and supervisory skills

•Strong knowledge of medical terminology, insurance verification, and authorization processes

WENDY L. GARCIA

BUSINESS OFFICE- REVENUE CYCLE MANAGER

Life Care Center Inverrary 3/2020- Present

Business Office Manager /Medicaid Specialist

oManaged the full cycle of medical billing operations for 120 bed skilled nursing facility

oReduced AR days from negative DSO 44 to a positive 9

oResponsible for all private pay. Insurance, Medicaid, Hospice and Medicare billing and collections

oProven track record of optimizing billing processes, reducing denials, and increasing collections

oImplemented a comprehensive claims review process to identify and resolve billing errors promptly

oConducted regular staff training to reduce claim denials and rejections

oEnsure compliance with Medicare, Medicaid, private insurance reimbursement regulations

oKnowledge of ICD 10, CPT and HCPCS coding system

oUtilize billing software system to process payments, post adjustments, and generate reports

oConduct regular audits of billing records to ensure accuracy and compliance with regulatory requirements

oProficient in managing accounts receivables and payable, including processing refunds and write-offs to maintain and clean credit aging.

oImplemented strategies to reduce accounts receivables aging and improve cash flow

oExperienced in financial forecasting and planning, including creating an eight-week forecast due on a monthly basis

oOversaw month-end reporting and close processes, ensuring accurate and timely financial reporting

oOversee, distribute, and reconcile all residents’ Trust Accounts and Petty Cash.

oHandle bank account deposits and withdrawals, maintaining accurate records of transactions and reconciling bank statements on a regular basis.

oRespond to patient and family inquiries regarding billing and insurance coverage

oProcess payroll

oTrained and supervised a team of 5 office staff, providing ongoing coaching and performance evaluations

oSkilled in managing employees providing guidance and support to ensure high levels of performance

oAssist residents applying for benefits related to Social Security

oResponsible for all Medicaid applications including annual recertification

oKnowledge of professional (CMS 1500) and institutional (UB-04) claim types

Fountain Manor Nursing & Rehab 2/2010 – 3/2020

Business Office Manager/ Regional Medicaid Specialist

oOversaw all aspects of the facility’s business office, including financial operations, billing, and accounts receivables/ payable

oManaged the full cycle of medical billing operations for 146 bed skilled nursing facility

oReduced AR days from negative DSO 56 to a positive 7

oImplemented efficient systems for billing and collection, resulting in a major decrease in outstanding accounts within the first year

oStrengthened communication channels between billing office, clinical staff, and insurance companies to expedite claims processing

oResponsible for all private pay. Insurance, Medicaid, Hospice and Medicare billing and collections

oImplemented strategies to reduce denials and improve clean claim rates, resulting in increased revenue and improved cash flow

oDeveloped and maintained strong relationships with payers, negotiating contracts and resolving payment disputes

oExperience in billing reconciliation and payment posting

oOversaw month-end reporting and close processes, ensuring accurate and timely financial reporting

oOversee, distribute, and reconcile all residents’ Trust Accounts and Petty Cash.

oHandle bank account deposits and withdrawals, maintaining accurate records of transactions and reconciling bank statements on a regular basis.

oManage payroll functions, including timesheet verification and coordination with HR department

oKnowledgeable about healthcare regulations, compliance, and privacy laws (HIPPA)

oTrained and supervised a team of 6 office staff, providing ongoing coaching and performance evaluations

oResponsible for all Medicaid applications including annual recertification

oAssisted residents applying for benefits related to Social Security Administration

oCollaborated with other department heads to optimize operational efficiency and improve resident satisfaction

oMaintained positive relationships with residents and their families, addressing concerns and providing excellent customer service

Berkshire Manor 1/2004 – 2/2010

Business Office Manager/ Medicaid Specialist

oManaged the complete revenue cycle process, including charge entry, claims submission, payment posting and accounts receivable follow-up for 245 bed skilled nursing facility

oResponsible for all private pay. Insurance, Medicaid, Hospice and Medicare billing and collections

oReduced AR days from negative DSO 66 to a positive 13

oProven track record of optimizing billing processes, reducing denials, and increasing collections

oEnsure compliance with Medicare, Medicaid, private insurance reimbursement regulations

oKnowledge of ICD 10, CPT and HCPCS coding system

oOversaw month-end reporting and close processes, ensuring accurate and timely financial reporting

oUtilize billing software system to process payments, post adjustments, and generate reports

oCollaborated with clinical staff, physicians, and billing team to identify and resolve coding and documentation issues impacting reimbursement

oProficient in managing accounts receivables and payable, including processing refunds and write-offs to maintain and clean credit aging.

oImplemented strategies to reduce accounts receivables aging and improve cash flow

oExperienced in financial forecasting and planning, including creating an eight-week forecast due on a monthly basis

oOversee, distribute, and reconcile all residents’ Trust Accounts and Petty Cash.

oHandle bank account deposits and withdrawals, maintaining accurate records of transactions and reconciling bank statements on a regular basis.

oRespond to patient and family inquiries regarding billing and insurance coverage

oProcess payroll

oTrained and supervised a team of 5 office staff, providing ongoing coaching and performance evaluations

oSkilled in managing employees providing guidance and support to ensure high levels of performance

oAssist residents applying for benefits related to Social Security

oResponsible for all Medicaid applications including annual recertification

oKnowledge of professional (CMS 1500) and institutional (UB-04) claim types

Pediatric Cardiology- 4/2000 – 1/2004

Office Manager Physician’s Assistant

oSupervise front desk staff, oversee daily operations, and manage patient schedules

oFoster positive relationships with patients, ensuring high levels of satisfaction and loyalty

oDevelop and implement new procedures and protocols to improve office efficiency and patient satisfaction

oCoordinated patient appointments and ensured appropriate scheduling of diagnostic testing

oOversee billing and insurance processes, ensuring accurate and timely submission of claims and maintaining up to date knowledge of medical billing codes and regulations.

oAssist Doctor in day to day business processes, conducting EKGs and educating families when placing 24 Hour Holters on patients

oAnalyze, process, research and adjust claims with the use of accurate/revenue and ICD-9 codes

oWork on all claim appeals if any denials received.

oDeveloped and implemented staff training and development programs, including performance evaluations, disciplinary actions, and rewards programs.

oExcellent interpersonal and communication skills with the ability to effectively interact with patients, healthcare professionals, and staff

Oceanside Extended Care Center – 3/1997 – 4/2000

Business Office Manager / Medicaid Specialist

oManaged the full cycle of medical billing operations for 196 bed skilled nursing facility

o20+ years of experience in revenue cycle management, specifically within skilled nursing facilities

oResponsible for all private pay. Insurance, Medicaid, Hospice and Medicare billing and collections

oProven track record of optimizing billing processes, reducing denials, and increasing collections

oEnsure compliance with Medicare, Medicaid, private insurance reimbursement regulations

oKnowledge of ICD 10, CPT and HCPCS coding system

oUtilize billing software system to process payments, post adjustments, and generate reports

oConduct regular audits of billing records to ensure accuracy and compliance with regulatory requirements

oProficient in managing accounts receivables and payable, including processing refunds and write-offs to maintain and clean credit aging.

oImplemented strategies to reduce accounts receivables aging and improve cash flow

oExperienced in financial forecasting and planning, including creating an eight-week forecast due on a monthly basis

oOversaw month-end reporting and close processes, ensuring accurate and timely financial reporting

oOversee, distribute, and reconcile all residents’ Trust Accounts and Petty Cash.

oHandle bank account deposits and withdrawals, maintaining accurate records of transactions and reconciling bank statements on a regular basis.

oRespond to patient and family inquiries regarding billing and insurance coverage

oProcess payroll

oTrained and supervised a team of 5 office staff, providing ongoing coaching and performance evaluations

oSkilled in managing employees providing guidance and support to ensure high levels of performance

oAssist residents applying for benefits related to Social Security

oResponsible for all Medicaid applications including annual recertification

oKnowledge of professional (CMS 1500) and institutional (UB-04) claim types

Humana Healthcare 2/1995 – 3/1997

Appointment Desk & Referral Department Supervisor

Managed the appointment desk department, overseeing the scheduling and coordination of appointments for 17 doctors, ensuring optimal patient flow and efficient use of providers’ time

Implemented and maintained an electronic scheduling system, optimizing efficiency and reducing errors

Developed and enforced appointment scheduling policies and procedures to enhance patient satisfaction and reduce wait times

Conducted insurance verification and obtained prior authorization for procedures, ensuring appropriate coverage and minimizing claim denials

Managed 6 referral coordinators to facilitate timely and accurate patient referrals, coordinating necessary appointments and sharing relevant medical information

Monitored and tracked referral status, ensuring all necessary documentation and authorization were obtained

Collaborated with billing and coding teams to ensure accurate coding and billing for services rendered

Acted as liaison between patients, providers, and insurance companies, addressing inquiries and resolving issues related to appointments and referrals

Trained and supervised appointments desk staff, ensuring consistent deliver of high- quality customer service

Contact this candidate