I have the background, team leadership to reach successful outcomes

Dorothy M Roberts

**** ******** **.

Trenton, MI 48183

Cell: 313-***-****

Home: 734-***-****

******@*******.***

QUALIFICATIONS

· Seasoned management experience of health care operations within facility, and professional environments - revenue cycle management; Front-end, call center, billing, claims processing and customer service.

· Managed staffs as large as 40 FTEs and smaller staffs, multiple locations.

· Time Management experienced, with the ability to manage multiple tasks with competing deadlines.

· Healthcare Liaison, interacted with physician groups, rehab facilities and hospital departments in-servicing on new or existing business lines along with third party benefit guidelines and criteria.

· Responsible for client retention through positive customer service.

· Provider Relations experience resolving benefit and claims issues for Medicare Advantage and TPA’s Provider Network and plan members

· Comfortable interacting with and presenting to staff, physicians and executive leadership.

· Excellent team building and written and verbal communication skills.

· Experience with management of external third party relations including hospitals, billing companies and third party payers.

· Experience with human resources, payroll and accounts payable for facility with 155 employees

· Competent with MS Office products, KREDO, SIGNITURE, HAMMS, INVISION, PAPERS, MBS, Rh-positive and FACETS.

STRATEGIC ACHIEVEMENTS

Revenue Cycle Management

· Decreased DSO’s by 5 days in 12 months through implementation of aggressive front-end follow-up program.

· Decreased non-billed services by 45% by instituting enhanced front-end process, verification of benefits and implementing authorization department. Maintained at decreased level through ongoing monitoring.

· Implemented front end central intake department within the DME, home care, home infusion environment, trained front end staff and RNs and LPNs on clean, profitable referrals and benefit verification

· Implemented call center department within the collections – physician billing, and home care environments, trained staff on call center P&P. Directly responsible for decreasing hold times by 60%

· Initiated and tracked enrollee letter campaign, related to erroneous disenrollment by Medicare from advantage special needs program which reversed the revenue lose of $1,000,000.

Information Technology

· Researched, and selected new billing system for skilled nursing home environment.

· Assisted project manager for design and implementation of authorization and claims tracking and payment software including management of encounters for health plan.

Business Development

· Developed and designed marketing materials including brochure, initiated friendly patient information form and rolled out positive customer service plan for Durable Medical Equipment Company, Home Care, and Home Infusion Services.

· Developed follow-up and collection processes on aged claims to ensure revenue collection and decreasing bad debt exposure.

Dorothy M. Roberts

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· Trained new staff on processes and procedures related to Medicare advantage transmission reporting and reconciliation of the reporting.

· Initiated and developed strategic relationships with provider groups to grow and retain provider network within SE and Mid Michigan.

· Developed and Implemented communications with third party payors to assure quick turn around for claim submissions.

· Assisted in developing relationship with HELP LOAN program developers for outstanding physician services accounts.

Human Resources

· Hired, trained and developed new staff members for customer service, billing, claims and front end processing

· Integral team member for consolidation of two home care agencies. Revised Policy and Procedures to encompass the best practices of both agencies.

· Followed human resources P/P for staff process improvements, corrective action plans and terminations

PROFESSIONAL EXPERIENCE

· St Joseph’s Healthcare and Rehabilitation Facility, Business Manager, August 2008-Present

· Midwest HealthPlan of MI, Business Services Manager, March 2008-June 2008

· Fidelis SecureCare of MI, Member Enrollment and Retention Analyst - Operations Liaison,

April 2005-February 2008

· Oakwood Skilled Nursing Facilities Dearborn – Trenton Oakwood Health Promotions, Manager Billing A/R, February 2001-February 2005.

· Oakwood Satellite Accounting / Oakwood HealthCare System, Supervisor Collection/Customer, Service, July 2000-February 2001

· Northwood, Inc. TPA, Program Manager, HealthPlus of Michigan, October 1998-July 2000

· Oakwood Home Care Services / Oakwood Infusion Services, Reimbursement Manager, July 1994-September 1998

· Oakwood Home Medical Equipment, Business Manager/Sales Manager, November 1987-July 1994

EDUCATION

· Camp School of Soft Good Fitting - Certified Orthotic soft good fitter,

· Victor Business Management School

· Various Management Seminars through Hospital System’s Continued Educational Classes

· Various billing seminars held through Medicare, Medicaid, and other third party payors

· Seminars held through claims processing software company

FAMILIAR WITH JCAHO, CHAPPS, NCQA, HIPPA

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