Finance
Resume:
Krystal L. Spencer, CCS
Beech Bluff, TN 38313
Email: ******************@*****.***
PROFILE
. Over 15 years of extensive accomplishments within Case Mix and
development, Cost per Case, EBITDA, effective cost containment,
contract management with all payers, as well as auditing
. Recently Added $9 million to the bottom line within 6 weeks of
employment with a National Dialysis Company by identifying a billing
format issue.
. Budget operations responsibilities
. Multi-Site Experience
. Over 15 billing and coding experience as well as auditing experience
* Directly responsible for compliance program design and implementation
* Extensive experience with governmental and managed care plans
* Ability to identify root causes of issues and resolution
* Consistently a high performer that has a track record of resolving
payer issues and adding cash to the bottom line while reducing AR
Days.
. Extensive knowledge of Tenncare, Medicare and all Commercial
Insurances
. Knowledgeable and skilled in fostering relationships with department
managers, physicians and administration and management
. Strong customer service skills - patient and physician relations
skills
. History of identifying and resolving opportunities to lower AR days
within the healthcare setting
. Strong background of handling all Human Resources Issues
. Dedicated work ethic that enables a strong leadership that is lead by
example
WORK EXPERIENCE
Frix/Jennings Clinic
Revenue Cycle Director
June 2012 - Present
Responsible for contracting, payer analysis, Case Mix, Cost per Case
analysis, coding and auditing records to ensure medical necessity with
payer guidelines.
Ampharm
Vice-President of Finance and Reimbursement
February 2011 -March 2012
. Established a business plan to adequately prepare for the 2012
compliance plan as set forth by the Federal Government as it applies
to pharmacies that supply nursing home medications. Directly
responsible for compliance as applied to accounting and revenue cycle.
. Responsible for reconciling 12.5 years of accounts receivable that has
never been reconciled. Developed and implemented daily and monthly
processes going forward. Assembled a team of professionals to carry
our appropriate processes within the accounts receivable department.
. Developed and implemented process to promptly identify overpayments
within the 60-day OIG reporting timeframe.
. Partnered with facility administrators to ensure compliance and
maximizing case mix and net revenue per case.
. Responsible for the management of the Balance Sheet, P&L Statement
Reporting and forecasting, cost accounting, proposal preparation,
vendor and insurance contract analysis.
. Reviewed general ledger journal entries and adjustments to determine
their validity and timeliness, and to ensure that any prior month's
journal entry reversal.
. Responsible for all accounts payable and receivable.
. Evaluated and adjusted indirect rate structure to satisfy business
requirements and maximize profitability.
. Responsible for maximizing contracts and reimbursements. Monitor and
evaluate reimbursement percentages. Developed and implemented
monitoring tools to enable staff to locate short paid claims.
. Directed all activities for a pharmaceutical business that supplies
medications to over 30 nursing homes in Tennessee and Alabama.
. Oversaw and directed all activities of accounts payable, assist with
the preparation of yearly budget as well as accountable for all budget
operations within the fiscal year.
. Attended monthly corporate meetings and report all financial
operations of the pharmacy.
. Developed measures to ensure capture of all revenue accurately as well
as identifying overpayments and seeking all underpayments for
immediate processing.
. Accountable for meeting benchmarks set by corporate office as well as
directing all financial operations for a multi-million dollar
business.
. Ensured compliance with all billing and accounts receivable.
. Responsible for establishing policies and procedures where there were
none, training all employees on 5 computer systems, develop training
manuals and classes for new staff members, restructured the accounts
receivable department from the ground floor.
. Oversaw the overall management and the day-to-day operations while
maintaining compliance with all applicable laws and regulations as
they apply to reimbursement.
. Responsible for hiring and supervising all employees, conducting
performance reviews to ensure adequate staffing and staff placement.
Hardin Medical Center
Director of Patient Financial Services
March 2010 - February 2011
. Responsible for directing all systems throughout the Revenue Cycle
Process. 3 supervisors and 27 indirect reports.
. Developed and implement quality initiative in the admissions area
resulting in a 55% error reduction rate. Decreased AR Days from 73 to
a 55-year record low of 52.75 within 4 months.
. Established a record setting cash flow.
. Evaluated existing contracts with payers to locate revenue
opportunities.
. Assist CFO with evaluations of case mix, case analysis and lost
revenue opportunities.
. Lead a team with steady hands on leadership while driving increased
cash collections.
. Responsible for admissions, ED admissions and business office
functions within the hospital setting.
. Coding ED charts as well as conducting audits reviews when non covered
services were provided to ensure accurate reimbursment
Interim Practice Administrator, Dr Jeff McCartney
August 2009 - March 2010
Assisting Dr. Jeff McCartney with the transition to CHS. Transition has
been completed as of this date. Assisting with
. Computer conversion
. Coding and billing all visits associated with practice as well as
sleep lab
. HR issues
. Contract negotiations
. Practice flow and analysis
. Collections
. Accounts payable
. Contracting and reimbursement issues
. Computer system conversion
. Trained staff with new systems and processes
Collections Director, DSI, (Oct 2008 - August 2009)
. Added 9 million dollars to the bottom line within 2 months of
employment that is still realized monthly
. Responsible for monthly collections of over $30 million dollars.
. Direct and oversee up to 20 employees within the collections
department
. Responsible for all collections functions for over 120 dialysis
facilities
. Hire, train and terminate up to 20 employees
. Accountable for all payers and the DSO's related to all payers for
every state in the United States
. Billing and coding reviews
Oversaw a Centralized collections office for over 120 dialysis facilities
nationwide. Responsible for all collections activity and cash flow as it
relates to a multi-state healthcare business. Accountable for all functions
and employees within the Centralized Collections office. Responsible for
the appeals processes with all insurance payers.
* Within the first month of employment collections department obtained a
record setting high collections month enabling employees to receive bonus
for the quarter in the first time of the history of the company.
* Restructured Collections Department to enable focus on high dollar
outstanding accounts
* Developed and implemented a program to address patient's receiving
insurance checks
* Reason for leaving: Unable to establish employment for spouse and/or
being unable to sell home in Jackson, Tn.
Regional Business Office Director, Symbion, Nashville, TN (April 2008 -Oct
2008)
Responsible for oversight of seven (7) regional business office teams.
Including but not limited to:
*Responsible for reporting variances of monthly P and L reports as it
related to collections and accounts receivable
* Case Costing by provider by payer
* Assisted in closing of Denver Surgery Center by reconciliation of
Accounts Receivable. Researched and located a law that enabled center
to keep over $400,000 previously thought to be refunded to commercial
payers.
*Assisted in training all Business Office Managers and served as a support
for Administrators
*Responsible for billing and ensuring capture of all billable codes
*Credit and collections review of all accounts before turning to outside
collections
*Responsible for and assisted with accounts payable functions
*Assisted centers in Human Resources functions
*Assist centers in policy and procedure issues
*Assisted with Inventory control and case costing
*All operational functions as related to an ambulatory surgery center
business
Responsible for billing and coding audit review to ensure policy and
procedures are being adhered to. Responsible and accountable for all day-to-
day operations and provide hands on leadership to Business Office Managers
and Administrators of seven ASC facilities within the Mid- West Region.
Ensure the company is receiving maximum reimbursement for services
performed while adhering to insurance regulatory guidelines. Make
recommendations to administrators re: improvements to Business Office
functions to ensure accuracy and timeliness of billing procedures. Train
Business Office managers, Staff and Administrators to ensure maximum
efficiency within the business office. Address any problems or issues
regarding reimbursement, human resources, inventory control and any other
operational challenges within the facility. Monitor the center's accounting
for Governmental and Insurance accounting for adherence to the contracts
and company's policies. Review Monthly Operational Reports and answer for
variances within the business office functions. Responsible for reducing
DSO's and ensuring accurate reimbursements from insurance and governmental
agencies.
Highlights at Symbion
* Number one region in the Company
* Due to contract language our region was able to recoup monies originally
thought to be needed to refund to the payers (approximately $400K)
* 3 of 6 of my regional locations experienced record setting daily deposits
during my
Direction of Regional Business Office Director
Reported to Jim Ray
Chief Operating Officer, Back Care Institute, Jackson, TN. (June 2003 -
April 2008)
Responsible for developing and implementing all compliance activities
including new employee orientation, ongoing training and maintaining
current on OIG work plans as well as OIG updates. Developed a plan and
department to manage audit processes re: claims.
Developed and implemented all policies and procedures for the startup of
clinic in June 2003. Oversee all functions of a multi-site healthcare
facility. Assume full responsibility for strategic planning, Credit and
Collections, Accounts Receivable, Invoicing, Credit
Evaluations of prospective patients, approve all write offs, ensure
reimbursement rates are in accordance with contracted amounts, responsible
for final approval for all patients that receive financing, Oversee monthly
invoicing of all patients including but not limited to collections letters
and lawsuit processes, Responsible for monthly reduction of DSO's,
development and implementation of QI projects,
Operations, employee evaluations, sales, marketing, patient services, human
resources, and P & L performance. Direct day-to-day operational activities,
and provide stable hands-on leadership. Responsible for interfacing with
Physicians and Clinicians pertaining to patient care and insurance
reimbursement regulations.
Developed all policies and procedures for the Credit and Collections
department as well as the billing department. Responsible for managing and
lowering DSO's to a current level of 47 DSO's. Responsible for all
sales/patient target amounts as set forth by president of company.
. Lowered DSO'S from 172 to the current level of 47
. Increased revenues 700% from 2005-2006
. Coded and Billed visits as well as conducted audit reviews
. Serve as Manager for all clinical programs and development of QI
Programs
. Continue to meet and exceed all collection and billing goals as set
forth by the President
. Serve as Human Resources Director
. Performed all performance reviews
. Developed and published Policy and Procedure Manual
. Established all processes and procedures for the accounts receivable
and collections departments
Office Manager, Dr. David A Magee, Henderson, TN. (1998 - 2003)
Business Office Manager, West Tennessee Healthcare, Bolivar, TN. (1997 -
1998)
Managed accounts receivable, Credit and Collections, Invoicing, Initial and
Secondary billing to Medicare, Medicaid, Tenncare and Commercial Insurance,
inpatient, outpatient, emergency room and physician billing and
collections. Responsible for the registration department as well as the
accuracy of the input of patient demographics. Provided budgeting and cost
report assistance. Supervised and scheduled up to 15 employees. Understand
the healthcare processes from point of patient check in to resolution of
claims.
. Responsible for all Credit and Collections functions and procedures
within the Business Office
. Responsible for timely billing of all claims
. Responsible for all invoicing on a monthly basis
. Member of the Quality Improvement Management Team
. Initiated new follow-up process with all insurance companies, which
enhanced relations with carriers and patients and resulted in the
reduction of DSO's from 235 to 140 in one year
. Identified and resolved the issue of Medicare insured's mammograms not
being paid for two years.
. Complied and maintained records for Joint Commission Inspection within
six weeks of my employment. As a result the Business Office passed
with no deficiencies.
. Implemented new billing process to ensure timely billing of primary
and secondary claims
. Identified, developed and implemented processes for all billing
processes in the Business Office
. Developed and Implemented streamlined procedures and trained employees
on the processes.
. Re-trained all admissions staff to enable correct billing
Medicare Supervisor, Apria Healthcare, Jackson, TN. (1994 - 1997)
Patient Services Representative, Jackson Clinic, Jackson, TN(1992 - 1994)
Federal Express, Billing and Collections, (1986 - 1988)
EDUCATION
Bachelor in Healthcare Administration - Suffield University, 2003, Twin
Falls, Idaho
M.B.A - Suffield University, 2005, Twin Falls, Idaho
PROFESSIONAL ORGANIZATIONS
Member of MGMA
Certified Professional Compliance Officer
CCS
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