Revenue Cycle Professional

LINN ROCHE – Revenue Cycle Leader

Location: Holmen, WI ■ Phone: 312-***-**** ■ Email: linn,*********@*****.***■

PROFILE

Result-driven, dedicated professional with experience in medical billing, revenue cycle management, enrollment, front office and back office. Extensive knowledge within accounting, customer service, credentialing, call center management, as well as implementation and oversight of projects. Ample management experience in multiple-location health care facilities. Vast experience with Medicare, Medicaid, Tricare, Commercial, HMO, Self-Pay and workman compensation carriers.

CORE SKILLS

Management

Problem Solving

Team focused

Interpersonal Communication Skill

Enrollment

Credentialing

Collections

Broad Insurance background

PROFESSIONAL EXPERIENCE

Scenic Bluffs Health Center

Revenue Cycle Manager 12/2023 to Current

Provide Leadership and training to the Front Desk and Billing Teams

Audit and complete/correct all credentialing

Audit and ensure correct and complete setup of EMR

Complete the review of all policies associated with Billing and Front Desk Teams for presentation to the Board of Directors

Participate and provide all documents required for the annual FQHC audit

Set KPI’s and monitor progress with each Team

Bay Street Orthopedics and Spine

Director of Revenue Cycle 9/2022 to 12/2023

Responsible for seventeen providers; seven physicians and ten mid-levels.

Delegate tasks to guarantee responsible financial management of the company. Reduced the days in A/R by 32. Retrained all staff on patient information, allowing for 56% more clean claims. This includes, but is not limited to negotiations with vendors and insurance contracts.

Communicate effectively throughout the company’s 102 employees as well as the six locations in Northern Michigan, including three fast-paced Urgent Care Centers.

Develop and integrate new and positive strategies to aid the company in its operation and growth in underserved communities in Northern Michigan.

Complete day to day operations and provide ample support to all staff to ensure patient satisfaction and excellence in health care.

Huff Senior House Calls

Director of Operations and Revenue 8/2017 to 8/2022

Responsible for the setup and implementation of a new practice. Practice has two doctors and four Nurse Practitioners

Setup EMR, Labs, Mobile X-Ray, New Patient Paperwork, Home Health Portals, Billing System, Phone and Fax Systems.

Credentialed all providers with Medicare, Medicaid, UHC, Optum, Blue Cross, Aetna, Cigna and companies popular in the area of the practice.

Oversaw the hiring of support staff, training of all staff, establishment of workflows and the development of all Policies and Procedures.

Managed all revenue cycle activities, patient verification, entry into various systems, EMR, billing Home Health Portals. Performed all billing, collection work and all follow up.

Responsible for all providers scheduling.

Concerto Renal Services

Director of Reimbursement and Operations 3/2016 to 8/2017

Responsible for the management of three teams; Admissions, Billing/Collections, and Crown Web for 31 clinics.

Credentialed and contracted each new facility we serviced with Medicare, Medicaid and all commercial carriers in two states.

Project Manager of a new billing system with QMS implementation.

Reduced A/R days from 122 to 32 days by initiating new workflow for follow up.

Introduced a new procedure for authorizations, reducing denials by 47%.

Converted the Admission process from a paper system to electronic.

Developed training and education on insurance documentation to ensure the highest reimbursement.

Corporate contact for all non-clinical operations.

Gundersen Health System

Prior Authorization Specialist 1/2015 to 2/2016

Initiated and tracked authorizations for three departments, ensuring prompt timely payment and reducing denials

One of three prior authorization specialists chosen to head up a training team for providers and access personal

Examine and work any denials

Mercy Hospital and Medical Center

Director of Physician Revenue 1/2013 to 1/2015

Responsible for all revenue activities for 250 Physician Providers, 60 Residents and 32 Nurse Practitioners.

Managed numerous departments, Billing, Collections, Credentialing and Patient Access. During this time the State Medicaid program went to managed care and all staff had to be trained on the new insurances and obtaining authorizations.

Oversight of all revenue activities for FQHC, Hospital Activities, Hospice and 11 satellite locations.

Ensured all providers were credentialed at all facilities, reducing denials by 54%.

Revised and improved provider onboarding process, ensuring timely credentialing.

Brought billing in-house and purchased new software to develop workflow for in-house revenue cycle.

Hired and trained all staff in the Billing, Credentialing and Patient Access departments.

Established Charge Sheets for all provider specialties.

Devised audits to ensure all billable charges were being captured.

Developed and instituted education for all patient access teams, regarding the new insurance market and outsourcing of the Medicaid program.

Fresenius Medical Care

Manager of Billing and Front-End Operations 8/2010 to 12/2012

Responsible for Insurance Verification, Document Control, and Billing teams who provided front end revenue cycle services for 132 dialysis clinics.

Revamped workflow to ensure the correct revenue source was captured timely, reducing the overstatement of revenue by 63%.

Established a monthly call, where challenges and successes were discussed, to improve communications with field operations.

Project Managed with the Director of Financial Counselors, new processes to ensure consistent and timely streamlined workflow between all departments.

Selected to serve on two Six Sigma committees that were tasked with accomplishing a complete overhaul of all front-end processes in the billing office and the clinics.

Da Vita Village Health

Revenue Cycle Manager 5/2008 to 6/2010

Manager oversight of Enrollment, Provider Services, Call Center, Reimbursement, and Part C Replacement Demonstration Plan as well as Disease Management Program.

Oversaw the process of bringing claims payment from an outside BPO to an in-house payment group.

Led a team responsible for the payment of all claims for all members, in 6 states and the District of Columbia, enrolled in our plan.

Trained all staff in the payment of all types of claims, physician (all specialties) facility, home health, hospice and drug claim.

Tracked and addressed all grievances and appeals according to CMS guidelines.

Implemented audit procedures to ensure timely and accurate payment of all claim types in accordance with Medicare guidelines.

Responsible for all RAPS, LICA, RX and MMR monthly reporting and reconciliations.

Managed the on-site staff, in the central business office as well as teams in the field which included disease management nurses.

Operationally supported remote nursing staff that were providing disease management services to patients with CKD or ESRD.

EDUCATION

BA, Business Management and Communications, Alverno College, Milwaukee, WI

REFERENCES

Character and Professional references available by request

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