Goal-oriented executive offering 10 years of experience overseeing top-level operations in practice management healthcare consulting company. Decisive and hardworking leader with in-depth understanding of complex business issues, policy development and process updates. Demonstrated success in operations, team building and expertise in business planning, and revenue development. Offers entrepreneurial, forward-thinking mindset and experience managing and driving change to promote continuous operational improvement. Employed multi-prong strategy to streamline internal systems, enhance revenue and extend profits, demonstrating a track record of achievement with success facilitating an average of 200% growth across medical practice organizations with over $20 million in annual revenue for clients. Boosted customer satisfaction and market penetration with strategic approaches and proactive oversight of tactical leadership. Imaginative problem solver with sophisticated approaches to diverse challenges.
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- Established start-up healthcare consulting company, overseeing strategic planning, market analysis, policy development and regulatory compliance.
- Led organization, established business direction and actualized operational plans to meet goals.
- Supervised office managers and patient care coordinators to effectively direct and enhance billing operational areas.
- Managed digital marketing strategy.
- Devised strategic improvements to resolve issues and spearhead necessary operational updates.
- Improved internal processes and stimulated overall organizational efficiency by implementing software, project management for unpaid insurance A/R and Set up participation and enrollment for providers with government and commercial insurance payors
- Engaged operations team to assess current operations and contribute to strategic revitalization for expansion of insurance payment percentages against patient self pay
- Analyzed and determined courses of action to align operations and revenue performance with clients organizational goals.
- Oversaw strategic business decision-making to develop, enhance and enforce business mission.
- Developed long-range plans for business growth, resulting in an average of 150% increase in revenue for clients within 8 months of client contract start date
- Enabled organization to scale through rapid growth by identifying and eliminating bottlenecks, risks and other constraints.
- Cultivated successful business culture focused on performance optimization and goal attainment.
- Complied with healthcare standard regulatory bodies to meet business requirements.
- Monitored business trend forecasts, adjusting budgets and operational plans to maximize growth and opportunities.
- Reviewed daily financial reports and reconciled accounts to keep information current and accurate.
- Promoted company public profile by delivering speeches, writing articles and presenting at industry conferences as public face of organization.
- Expertly assigned charges and payments for medical procedures.
- Reviewed medical records to meet insurance company requirements.
- Assessed medical codes on patient records for accuracy.
- Recorded, stored and reported medical coding information to create statistics of healthcare encounters.
- Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
- Reviewed all claims for accurateness and appropriateness.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Addressed and responded to staff and client inquiries regarding CPT and diagnosis codes.
- Completed and submitted appeals.
- Performed routine quality assurance audits to promote data integrity.
- Oversaw day-to-day operations of billing department, including medical coding, charge entry, claims and payment posting.
- Organized information for accounts more than 90 days past due and transferred to collection agency.
- Added modifiers, coded narrative diagnosis and verified diagnoses.
- Utilized electronic charge capture systems to consolidate and streamline billing processes.
- Assigned CPT procedure and evaluation and management (E&M) codes for services to assure appropriate billing and reimbursement.
- Managed benefit contract pricing, processing, policies and procedures.
- Maintained knowledge of new or revised codes and industry regulations to complete accurate coding services, including local coverage determinations.
- Maintained accurate and timely charge submissions utilizing electronic charge capture practices, including billing and account receivables (BAR) system and medical billing clearinghouse accounts.
- Investigated denials and collaborated with internal team members and third-party representatives to identify solutions.
- Reviewed medical records to meet insurance company requirements.
- Reviewed all claims for accurateness and appropriateness.
- Filed and submitted insurance claims.
- Reviewed received payments for accuracy and applied to intended patient accounts.
- Compiled and maintained logs, and statistical or research records to locate requested health data.
- Flagged return claims and dealt with insufficient payments.
- Applied HIPAA Privacy and Security Regulations while handling patient information.
- Completed and submitted appeals.
- Maintained 99% accuracy rate on daily production of 100 to 600 claim reviews per day.
Completed professional development in Entrepreneurship and Financial management (2 Years)
Completed continuing education in the following online courses:
- Finance
- Team Leadership
- Facebook Ads and Facebook Marketing
- Google ads training
- Digital Marketing
- Management
- Microsoft Office
- Google Apps
- Adobe
- Blockchain
- Amazon Web Services
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Resume Overview
School Attended
- Reed City High School
- Davenport University
- Udemy.com Lynda.com
Job Titles Held:
- Chief Executive Officer
- Medical Biller, Accounts Receivable
- Medical Billing Clerk
Degrees
- High School Diploma
- Some College (No Degree)
- Course Completion
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