Revenue Cycle Business Office

Core Qualifications:

Full Revenue cycle professional with over 20 years’ experience

Well organized and disciplined ability to manage multiple priorities and projects.

Exceptional interpersonal skills and managerial techniques/ Team building.

Expertise in Claims appeals/ Claims denial trending analysis, AR Days, cash to net revenue.

AI automation

Streamline workflows/ Create efficiencies.

KPI/SOP development

Proven Track record of increasing partner compensation

Current Procedural Terminology (CPT)/ DX coding specialist, EPIC Certified

Director of Business Office 6/2023- present

Ascension St Thomas Behavioral Health Hospital an Acadia Company

Nashville, TN

Reconciliation Daily of Status Reports, Payor Log Balancing, Proration Summary, Payor Exceptions

Perform Audit of financial classes and HSV Change Reports, patient transfers and all admissions

Work closely with UM department for insurance Authorization, concurrent concerns and missing documents.

Maintain Daily Revenue Usage Report, Final Census

Identify and Correct Bill Errors, identify payer trends, communicate payer issues to admissions

responsible for all Periodic Billing – inpatient and outpatient services

Monitor Unbilled Report/Recurring Outpatient List

Oversea Professional fee daily billing, all collections and all payments.

Cash Goal Monitoring, Bad debt allocations, Charity Log preparation, Upfront Collections activity

Review agency placement and account statuses

Maintain staff training, productivity, reviews and trainings. Keep team goal orientated and focused on the success of the business office.

Conduct Weekly AR review meetings and monthly denial Meetings

Conduct team audits, support outside resources during audits and state visits

Support Quality Council

Update Quarterly payer Matrix

Perform Month end close and reconciliation of accruals and reserves

Director of Revenue Cycle Operations

Regional Cancer Care Associates LLC

Hackensack, NJ (full time remote position as of 2019) 10/2017- 5/2023

One of the nation’s largest cancer physician networks, RCCA is in 3 states, NJ, MD, and CT with more than 30 office locations and 500 providers.

Evaluate work performance through timely performance and appraisals and identify strengths and weaknesses.

Oversite of the entire revenue cycle process Eligibility, Precertification through Collections.

Insures efficient cost-effective use of department resources

Maintains excellent working relationships with locations in all 3 states New Jersey, Maryland, and Connecticut.

Monitors and evaluates the changes in regulatory and reimbursement environment and develops strategic plans to deal with these changes

Strong executive presence, including communication skills that enable appreciation of others and the ability to offer compelling insights and recommendations.

Implements changes into operational procedures to ensure compliance.

Ensures the ongoing education of personnel to maintain a level of expertise and competency.

Excellent oral and written communication skills and able to communicate effectively with all levels of management.

Participates in denial avoidance solutions and works as a liaison with Accounts Receivable Departments to avoid lost reimbursement.

Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.

Increased the footprint of CBO by developing 3 new central billing departments, Precertification, Financial Advocacy, and Injectable Pharmacy.

Overseas PA/PAP, and payment posting teams for Oral RX, utilizing CPR+ and QS1 systems.

Maintains negotiations with payers for DIR fees

Negotiates with payers on contracts, carve outs, drug rebates, sequestration. Knowledge of the content, structure and maintenance of the Charge master and fee schedules.

Coordinates weekly, bi-weekly, and monthly calls with Practice Administrators and Oncologist to review charge lag, collections, year to date collections and monthly collections based on target.

Strong quantitative, analytic, and problem-solving skills to elevate all aspects of the problem or opportunity and draw valid conclusions to facilitate appropriate and timely decisions.

Development and implementation of Shared Service billing, OCM, TCM and CCM.OEM in 2023.

Established a training process for new hires at CBO and front desk staff at locations.

Business Office Manager 5/2017-10/2017

Care One Management, LLC New Milford, New Jersey

Care- One is a family owned and operated healthcare continuum with over 68 care centers located in 9 states. Care – One has over 15,000 employees and $1B in revenues. Care-One is New Jersey’s largest privately-owned healthcare company in the US. Care One in New Milford offers Post-Acute Rehabilitation, Long Term and Assisted Living, Respite Care and Memory Care. 236 bed facility at Woodcrest, New Milford.

• Ensures platform for growth, clinical excellence, and regulatory compliance, consistent with state survey regulations.

• Responsible for all billing for the facility. Ensuring implementation of procedures to achieve cash collection goals.

• Verify daily census, verifying contracts with insurances, ambulance vendors, and pharmacies.

• Medicare A & B Billing, Medicare, Managed Care, Private Pay claims, corrections, and follow-up.

• RUG score CPT, ICD code reporting on claims to ensure maximum reimbursement and timely processing

• Medicaid Application Assistance, Family, social work, state, and attorney meetings.

• Payment processing, Reconciliation and Reporting.

• Accounts receivable and Month End Closing

• Refund and bank Account transactions.

• Management, Control and Reconciliation of Resident Needs Account

• Weekly Utilization Review Meeting and Monthly reporting of metrics on Revenue

• Daily Department Head Stand up, participation in community outreach activities.

Area Business Office Manager 2/2014-03/2017

Amedisys Home Health / Hospice Hackensack, New Jersey

Amedisys is a Fortune 1000 company with one of the largest market caps in the industry. The largest Home Health and the 4th largest Hospice in the country. Awarded 2015 Elite Home Care Agency

• Area Business Office Manager for largest branch of Amedisys home health care division and one of the largest Hospice offices in New Jersey servicing Bergen, Hudson, Passaic, and Essex Counties. Average daily patient census of 1200 for Home Health and 175 censuses for Hospice

• Ensured platform for growth, clinical excellence, regulatory compliance, and strategic excellence

• Liaison to the corporate office in Baton Rouge LA to ensure that all operations meet all regulatory requirements through several federal and state government agencies

• Successfully brought outstanding receivable from 1.6 million totals to under 400k in 1 years’ time for Home Health. Successfully brought Hospice outstanding unbilled from a longstanding $1.2 million dollars to $600 in less than 6 months.

• Achieved outstanding FTF to under 1% which is below the market standard from 124% percent outstanding over 1 year ago for Home Health

• Brought Hospice Care Center within state compliance guidelines, survey window ready.

• Organize compliance fire drills for care center.

• Hospice Care Center has received Veterans Status as of 12/2016.

• Successfully organized/prepared PAG (Professional Advisory Group) meeting for Home Health and Hospice. Amedisys is accredited by the Accreditation Commission for Health Care (ACHC).

• Performance evaluations and training of office staff which included 14 direct reports Business Office Specialists as well as the all-field personnel which is about 180 clinicians.

Director of Business and Finance 11/2011-2/2014

Teaneck Surgical Center, LLC Teaneck, New Jersey

Ambulatory Surgery Center -, same day procedures, anesthesia, orthopedics, Pain management, podiatry

• Skillfully developed billing goals, objectives, and standards of performance, policies, and procedures.

• Organized the department in accordance with administrative guidelines to meet CMS and all insurance guidelines for successful transmission of claims for payment.

• Established and implementation of an effective case cost analysis to ensure proposals received from insurance companies improved the net profit per case.

• Oversaw private and MCR billing, payment posting, and AR and verified that proper procedures established.

• Achieved monthly financial goals.

• Nominated and achieved having Center nominated as one of the top 100 ASCs to work for in Becker’s 2013.

• Routinely collaborated with coding company to correct problems.

• Monitoring billed charges at physician level ensuring the consistency between the provider and the ASC.

• Investigated, provided, and submitted information to Quality Department about special incidents, events and complaints.

• Effectively oversaw attorney firm Delgado Halcovich, workers compensation, DMV and insurance arbitrations.

• Monitored Implant log to ensure nursing has accounted for all implants and billable items on each case.

• Implemented QI reporting to Medicare to ensure successful claims processing and reporting of all

Medicare claims

• Liaison with Collection Agencies BAC and Berks’.

•Implemented EFT transfers directed to lock box for efficiency. Completed month end closing reports and reconcile Vision Month end close reports to bank statement.

Education

Bergen Community College, Paramus, NJ Medical Billing and Coding Certification Completed 5/2006

Cross Country Education, Maywood, NJ ICD10-CM Certified Medical Coding Completed 2/2014

AAPC-Assoc of Community Cancer Centers Certified Financial Counselor Completed 1/2021

Epic System Trained/Certified Completed 4/23

Additional Education/Training:

Fazzi Oasis ICD-10

ONCO- EMR

Centricity/G4 Unlimited

Assist Point/SAMBACARE/Glide/Rxlightening

MISys Tiger Software

Home Care Home Base

IDX

MEDHOST

CHANGE HEALTHCARE

SSI

IDS/GETIX

Volunteer/Outreach Organizations:

White House Ladies Charity Squad Volunteer White House, TN

Martha’s Song Contributor Nashville, TN

Hope Center for Batter Women Contributor White House, TN

COA- Community Oncology Alliance- Advocate for Cancer Patients Washington DC

Light the Night- Leukemia & Lymphoma Society Long Branch, NJ

Q1 Productions Oncology- Dedicated to Quality First Philadelphia, PA

Avon Walk for Breast Cancer New York, NY

Spokesperson for Englewood Hospital Breast Center Englewood, NJ

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