Revenue Cycle Home Health
Resume:
Jillian DuBose
San Antonio, TX *****
*****************@*****.***
Professional Summary
• Claims/billing/ Revenue cycleCollection Management Effective/ billing collection strategies are vital to ensuring timely payments and a healthy revenue stream.
• Implemented new collection management techniques that improved cash flow and reduced the number of uncollected accounts.
• Denial Management Being able to effectively handle and resolve claim denials is essential for optimizing revenue.
• Extensive knowledge in Dme, hospice, home health, personal care.
• Wellsky, Genesis, DDE, Medicaid, Medicare, VA.
• Functions and reporting are well-understood. The ability to learn new concepts quickly is also present.
• Can be effectively overseen and managed, and solid suggestions can be made about how to allocate resources for future planning.
• Practices can be analyzed to identify trends that improve resource use and save money.
• Important trends found through analysis can be communicated clearly using various reports. Work Experience
Revenue Manager
BROOK ARMY MEDICAL CENTER-San Antonio, TX
February 2025 to Present
• Monitor insurance claims and patient accounts in work queues to ensure proper billing and follow-up according to BAMC guidelines.
• Manage assigned queues to process claims accurately, including clearinghouse claims.
• Research and correct claims to resolve errors preventing submission to insurance companies.
• Generate industry-standard healthcare claim forms for various services, including outpatient, inpatient, observation, and ambulatory procedures.
• Investigate and appeal denied claims to maximize reimbursement.
• Review Explanation of Benefits (EOBs) and payer correspondences to identify denials for appeal and work to reduce controllable rejections.
• Billing and Collections:
• Handle communication with insurance companies, Medicare regions, Medicaid offices, and families regarding insurance payments.
• Process insurance claims and verify patient insurance coverage.
• Maintain up-to-date knowledge of billing regulations and compliance standards.
• Perform accounts receivable follow-up to address outstanding balances.
• Contact insurance companies to determine reasons for claim denials and take appropriate action.
• Prepare and submit documentation to support appeals or claim adjustments.
• Data Management and Analysis:
• Extract, collate, and refine data from multiple sources for reporting and analysis.
• Prepare financial reports related to revenue cycle performance.
• Analyze revenue cycle metrics, identifying trends and opportunities for improvement.
• Identify opportunities for process improvements to enhance revenue cycle efficiency.
• Collaboration and Compliance:
• Collaborate with internal teams, such as the coding department, to ensure accurate billing.
• Maintain the highest level of confidentiality when handling sensitive financial information.
• Ensure compliance with applicable HIPAA, billing compliance, and safety policies and guidelines. Corporate Director Revenue Cycle/Operations
Focused healthcare management
March 2020 to Present
Corporate Billing Director / Credentialing, Contracting holds a crucial leadership role in healthcare organizations, overseeing the revenue cycle management (RCM) process and ensuring accurate and timely reimbursement for services rendered. This position combines responsibilities related to both billing and credentialing/contracting, demanding expertise in various areas of healthcare administration. Key Responsibilities:
• Overseeing billing operations: Ensuring accurate and timely submission of claims, managing accounts receivable, and resolving billing issues and discrepancies.
• Managing provider credentialing and contracting: Coordinating and maintaining the credentialing and re-credentialing process for healthcare providers with various payers and governmental entities.
• Negotiating and managing contracts:Negotiating payer contracts and rates, tracking renewals, and ensuring compliance with contract terms.
• Ensuring compliance: Maintaining compliance with all health plan requirements related to provider certification and credentialing, and adhering to federal and state regulations, including HIPAA and Medicare/Medicaid guidelines.
• Collaborating with stakeholders: Working closely with internal departments such as Revenue Cycle Management, Clinical Leadership, and Human Resources to ensure smooth onboarding and billing readiness.
• Improving efficiency and streamlining processes: Identifying root causes of credentialing-related denials and revenue-impacting gaps, implementing corrective actions, and developing standardized processes.
Skills and Qualifications:
• Experience: Relevant experience in managed care enrollment, billing, and/or medical staff service setting, with progressively more related experience in complex, multi-state health settings strongly preferred.
• Knowledge of credentialing and contracting:Strong knowledge of payer credentialing requirements, fee schedules, contract structures, and healthcare regulations.
• Technical skills: Proficiency in Microsoft Office Suite, particularly Excel, and familiarity with credentialing software platforms like CAQH, PECOS, and NPPES.
• Analytical and problem-solving skills: Ability to analyze data, identify issues, perform root-cause analysis, and develop effective solutions.
• Communication and interpersonal skills:Excellent verbal and written communication skills to interact effectively with internal and external stakeholders, including payers, providers, and staff.
• Organizational and time-management skills:Ability to manage multiple priorities, meet deadlines, and work independently with minimal supervision.
• Compliance expertise: Thorough understanding of regulatory requirements, accreditation standards, and applicable laws related to healthcare billing and credentialing. Establishing and maintaining standards for conscientious, supportive end-of-life care. Recruiting, hiring and overseeing hospice personnel. Collecting and reviewing daily or weekly reports regarding hospice operations. Setting and monitoring budgets.
Overseeing Mission Home health and MIssion Homecare. Corporate Account Manager Medical Claims DME Billing Medtronic-San Antonio, TX
December 2018 to March 2020
Corporate Clinical Professional II DME Medical Claims/Billing KCI - Acelity-San Antonio, TX
July 2009 to October 2018
• Conduct assessments to determine needs, strengths, and challenges.
• Develop and implement individualized case plans.
• Coordinate with service providers.
• Monitor client progress and adjust plans as needed.
• Advocate for clients' needs and rights.
• Maintain accurate case records and documentation. UnitedHealth Group-San Antonio, TX
February 2006 to November 2008
Responsibilities:
· Report directly to the CFO and CEO, handling tasks such as reviewing reports, discussing appeals, payments, and actions for non-payment payers. Medical claims, medical billing,DME.
· Alert management team members regarding late or missing documents required for billing.
· Develop and implement strategies for team building and organizational structure.
· Foster a collaborative and inclusive team environment.
· Identify and address team development needs through training and mentorship programs. Education
Associate's degree in Bioscience
San Antonio College-San Antonio, TX
January 2021 to May 2025
Associate in Medical Billing & Coding
Career Point College-San Antonio, TX
January 2003 to January 2004
Associate in Medical Assistant
Career Point College-San Antonio, TX
January 2003 to January 2004
High School Diploma
Smithson Valley High School-San Antonio, TX
August 1995 to May 1998
Skills
• Passionate, motivated, and fiscally responsible healthcare executive with 25 years of experience managing operations to achieve organizational objectives.
• Over 5 years of progressive network management experience, including hospital contracting and network administration in a healthcare company.
Links
www.linkedin.com/in/jillian-dubose-4830a2196
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