Revenue Cycle Front End

Andre M. Copeland

760-***-**** Gilbert, AZ

*******@*****.*** – https://www.linkedin.com/in/andre-copeland-a8b22b29

Sr. Director of RCM/ RCM Consultant

Self-motivated, creative, analytical, and highly organized Revenue Cycle Manager with more than 30 years’ experience in revenue growth analyzing AR reports, minimizing denials management, identifying trends, identifying, and applying front end edits, and process improvements within the AR workflow process. Champion of empowerment and goal setting that bolsters the AR process and inspires employee engagement. Tenacious attention to detail with strong communication and listening skills that seeks to fully understand the complexities of an issue before offering a positive solution. Agile leader who radiates charm and improves relations with even the most demanding clients.

Revenue Cycle research and forecasting Create /deliver training resources

Billing and Collections efficiency management Employee coach/mentor

Patient escalation management Clearinghouse edits

Align departmental practices with emerging company strategies

Professional Experience:

RI International INC, Phoenix, CA July 2023 – Sept 2024

Sr. Director of Revenue Cycle Management

Oversee day-to-day corporate administrative functions related to the Revenue Cycle Management (RCM) function which includes Coding, Credentialing, and Contracts departments.

Leads the development and implementation of revenue cycle strategies, processes, and improvement initiatives to continuously improve the RCM process to maximize various billings and collections. Drives the design, execution, monitoring, and assessment of reporting departments performance metrics to refine processes and improve efficiencies and productivity to reduce overall costs.

Consistently monitor RCM, Credentialing, Coding and Contracts functions to proactively identify efficiency issues and propose solutions.

Maintain a working knowledge of all phases of RCM departments.

Establishes payer and industry relationships, remaining current with all relevant payer criteria and industry trends.

Leads and manages large revenue cycle projects such as audits, budgets, and technology enhancements.

Collaborate with clinical team to ensure that clinical documentation in the electronic health record meets the requirements for billing. Hire, train, and supervise direct reports and provide overall guidance for the team direction and vision, including, but not limited to, managing staff performance by providing regular feedback, performance reviews, and one-on-one meetings.

Negotiates single case agreements with payers for out of network services.

Assist Credentialing supervisor to ensure clinicians/providers are fully contracted with all payers.

Set guidelines and KPI’s and workflow for the Coding team.

Knowledge and experience in data management functions including organization, claims submission, billing, follow-up, cash management, vendor relations, regulatory and compliance findings, payment variance, denial management, payer relations and clinical audit functions.

Ensure payer Contracts are fully executed in a timely manner by working with the Contracts supervisor.

Participate in the financial development processes as requested and maintain a high level of fiscal responsibility.

Provides regular performance updates to the senior leadership team.

Ensures billing is carried out in compliance with federal, state, and regulatory laws, rules, and regulations.

Performs other related duties as assigned.

Conduct annual performance reviews for all RCM departments

RI International INC, Phoenix, AZ October 2023 - January 2024

Associate Director of Revenue Cycle Management

Managing client services billing functions to assure billing is prepared, submitted, and reconciled in a timely manner.

Monitored the DOS and Aging reports to ensure that the claims turn around was timely

Meet with the RCM Manager to ensure the d denials by state, by payer, by CARC codes were quantified to identify and correct trends.

Responsible for ensuring the managers were working with staff to ensure clean claims are submitted to the clearinghouse.

Develop the new coding team, Hiring, Training, developing SOP’S and training resources. Provide expectations, resources and tools needed to be successful within the new department.

Provided a meeting schedule with the different sites, clinicians, and MDs to discuss coding issues and trends.

Ensure that the credentialing manager and the team were on boarding new physicians and clinicians in a timely manner by partnering with HR as new hires came on board.

Met monthly with the credentialing committee to present credentialing and certification denials for follow up.

Meet with the contracting Manager weekly to ensure all contracts have been completed with the different MCO’s PPO’S, Medicare, and Medicaid for all states.

Followed up with credentialing manager to ensure RI rosters are updated with the payers as peer the contracts

Managed the RCM IT team to ensure the charge master was consistently being updated by state by payer.

Conducting client interviews and meetings to understand current state billing/EHR systems, operational processes, and workflows.

Supporting in the evaluation of the design and effectiveness of current revenue cycle operations including analysis of client data for trends and issues.

Assisting in development and/or implementation of recommendations for optimizing revenue cycle operations.

Coordinating activities involving developing deliverables, process review work papers, and other supporting. process documentation.

Developed departmental SOP’s and workflow processes.

Conduct annual performance reviews for all RCM departments

RI International INC, Phoenix, AZ July 2023 – October 2023

Sr. RCM Manager

Managed RCM team client services billing functions to ensure billing is prepared, submitted, rejections and errors were worked and reconciled in a timely manner.

Ensure all billing submissions to the clearing house and funder portals achieves a 95%claim claim submission

Attend monthly JOC meetings to follow up with payer opportunities for overall provider improvement, special projects, contracts review, and rate increasements.

Participate in monthly credentialing committee meetings to present credentialing and certification denials for follow up.

Managed the RCM IT team to ensure the charge master was consistently being updated by state by payer.

Conducting client interviews and meetings to understand current state billing/EHR systems, operational processes, and workflows.

Analyze actionable claims data, including rates per funder, revenue, and volume, by state, procedure code, and diagnosis codes for claims reimbursement and to identify any trends

Ensured all ERAs were posted in a timely manner with CARC codes. All zero paid claims posted and forwarded to the proper RCM specials to follow up on non-paid claims

Monitored incoming correspondence to identify payer trends with the RCM managers

Impact Advisors, Naperville, IL March 2020- June 2023

Revenue Cycle Consultant (Remote Contract Position)

Redesigned billing specialist roles and incentive compensation plans tied to claims reviewed and billed, attendance, and accounts worked. The team performed above expectations with 15% monthly growth via new strategies that emphasized team performance over the individual.

Designed and implemented weekly quality assurance audits on AR team metrics to measure quantity verses quality.

Maintain reports as assigned to monitor Patient Billing Metrics including but not limited to: Quality metrics,

Enforce corporate policies regarding account adjustments and write-offs which resulted in decreasing DOS by 13 days.

Create and implemented KPI’s of 80% adherence of 60 outstanding accounts worked daily per RCM rep with 85% completion rate resulting in revenue from different payer.

Created and analysis payer reports resulted in identifying internal payer audit implementation which produced 92% clean claims and 48% decrease in payer denials.

Participating in patient financial services assessments for clients to evaluate patient registration, billing and collections processes, systems functionality, and accounts receivable metrics.

Conducting client interviews and meetings to understand current state billing/EHR systems, operational processes, and workflows.

Supporting in the evaluation of the design and effectiveness of current revenue cycle operations including analysis of client data for trends and issues.

Assisting in development and/or implementation of recommendations for optimizing revenue cycle operations.

Coordinating activities involving developing deliverables, process review work papers, and other supporting process documentation.

Dexcom, Mesa, AZ May 2018 – August 2019

Patient Billing/Collections Manager

Decreased DSO by 6 days, increased collections by 52%, decreased unbilled report by 72%. Train/develop billers and collections specialist by developing representatives on processing, denials, appeals, and follow up on unpaid claims in a timely manner.

Managed 49 collections specialist, 46 billing specialists, 22 customer service specialists in two locations Mesa and Manila, Philippines

Supervise workflow of Medicare Quality Control and Call-Center functions to ensure appropriate coverage within the department according to daily variants.

Spearheaded changes to the process of completing denials and rejections which increased collections by 42% each quarter.

Serve as escalation resource to satisfy urgent or problematic patient calls which decreased complaints by 32%

Create and implemented KPI’s of 80% adherence-6.0 calls per hour,5.45 talk time, 3 % abandon rate within the customer service team.

Redesigned billing specialist roles and incentive compensation plans tied to claims reviewed and billed, attendance, and accounts worked. The team performed above expectations with 15% monthly growth via new strategies that emphasized team performance over the individual.

Maintain reports as assigned to monitor Patient Billing Metrics including but not limited to: Quality metrics,

Responsible for overseeing training of new employees and providing ongoing education of Patient Billing and organization processes and procedures

Enforce corporate policies regarding account adjustments and write-offs which resulted in decreasing DOS by 6 days

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Oasis Hospital, Phoenix, AZ March 2017 – May 2018

Billing Manager

Assisted the Revenue Cycle director with building a new AR team which included collectors, cash poster, and billing specialist for the hospital. Train/ develop all teams. Created training manual, departmental policies, and procedures.

Managed 4 billers, 6 collectors, 1 insurance poster

Streamlined and implemented front end billing edits which decreased rejected claims by 49 %

Review and create billing edits through the clearing house which enabled us to have a 92% clean claim rate

Implement a new process to ensure the AR team would get the daily census, and Purchase orders from the hospital OR staff in a timely manner to ensure claims were able to bill within 48 hours.

Manage the revenue cycle department to increase cash collections by 68 %, A/R velocity, and decrease write offs/adjustments

Monitor and measure departmental outcomes to identify problems and solutions

Regularly review and analyze collections data, A/R information, workflows, and billing processes and proactively identify issues that may affect reimbursement or overall performance

Communicate with team members to provide routine feedback regarding performance,

Create and implemented KPI’s of 73% adherence- by the team

EPIC Medical Solutions, Chandler, AZ February 2016 – March 2017

Revenue Cycle Manager

Decreased DSO by 10 days, increased collections by 62%, decreased unbilled claims reports by 48%. Train/develop billers and collections specialist by developing representatives on processing, denials, appeals, and follow up on unpaid claims in a timely manner.

Managed 37 collections specialists, 28 billing specialists, 6 AR supervisors, 8 payment posters, 10 customer service specialists in the mesa and Houston Texas offices.

Spearheaded changes to the process of completing denials and rejections which increased collections by 52% each quarter.

Serve as escalation resource to satisfy urgent or problematic patient calls which decreased complaints by 21%

Create and implemented KPI’s of 75% adherence-6.0 calls per hour,5.27 talk time, 2.3 % abandon rate within the customer service team.

Redesigned billing specialist roles and incentive compensation plans tied to claims reviewed and billed, attendance, and accounts worked. The team performed above expectations with 35% monthly growth via new strategies that emphasized team performance over the individual.

Maintain reports as assigned to monitor Patient Billing Metrics including but not limited to: Quality metrics,

Responsible for overseeing training of new employees and providing ongoing education of Patient Billing and organization processes and procedures

Enforce corporate policies regarding account adjustments and write-offs which resulted in decreasing DOS by 6 days

Imprimis Pharmaceuticals, San Diego, CA July 2015 - December 2015

Revenue Cycle Manager

Spearheaded building a new AR team which included collectors, billing specialists and a customer service team. Train/ develop all teams. Created training manual, departmental policies and procedures, and SOP’s.

Managed 8 billers, 4 collectors, 10 customer service specialists

Supervise workflow of Medicare Quality Control and Call-Center functions to ensure appropriate coverage within the department according to daily variants.

Implement a new process to ensure the AR team and the PBM were working together to ensure patients prescriptions were being approved and paid in a timely manner.

Reviewed and approved all PBM contracts

Monitor and measure departmental outcomes to identify problems and solutions

Communicate with team members to provide routine feedback regarding performance,

Create and implemented KPI’s of 70% adherence- by the team

Responsible for the financial, customer service and productivity performance of the department

Develop the department operational policies, procedures standards, expectations, and departmental goals

Develop and monitor staff performance standards for productivity and quality by completing quality control audited bi- weekly.

Arch Health Partners, Poway, CA December 2012- July 2015

Revenue Cycle Manager

Mentor and developed the AR team which included coders, collectors, billing specialist and a customer service team. Created training manual, departmental policies and procedures, and SOP’s.

Managed 15 collections specialists, 1 credentialing specialist, 4 payment posters, 10 billing specialists, 8 customer service reps.

Decreased DOS by 8 days, increased collections by 1 million, decreased denials by 35 %

Perform full range of supervisory actions for billing, collections, data entry, and payment posting staff

Setting departmental expectations, goals, and standards

Monitor clearing house reports, oversee EDI claims submissions errors are resolved

Expedite, review provider contracts and amendments

Audit incoming ERA’s and denials to identify trends

Monitor and train staff to ensure staff is adhering to payer regulations

Compile and maintain department policies, procedures, and training programs. Ensures policies are communicated and administered consistently

Ensure that all charges are captured and submitted to insurance payers in a timely manner

Implement systems to audit billing s and posting of payments to ensure accuracy

Audit employees work weekly to identify training needs

Support and Mentor staff to improve job knowledge

Millennium Laboratories, San Diego, CA March 2012-December 2012

Billing and Revenue Cycle Corporate Trainer

Organized a revenue cycle training program for the entire AR team which included access to online Q&A through the company intranet, onsite weekly training courses by department, Billing rules and regulations for the sales team.

Support and coach a total of 80 AR staff to improve job knowledge

Oversees, evaluates, and monitors on-the-job performance of staff responsible for billing and collections

Perform weekly audits of employees’ work to identify training needs and provide feedback to the department managers and AR director.

Deliver training resources/guides to each AR department

Assist in standardizing workflow methods

Develops and implements new procedures to improve the quality and quantity of work processed

Ensures policies are communicated and administered consistently

Set individual goals upon completion of training and met with the employee every 30 days for re-cap and updates.

Compile training webinars for each department

Provide and maintain online FAQ for the staff

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