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director of billing and claims resume example with 12+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Professional Summary

Goal-oriented manager with distinguished experience in HealthCare industries and proven leadership abilities. Expert in increasing productivity and customer satisfaction while driving revenue and sales. Committed to streamlining procedures while optimizing employee talent.

Skills
  • Budgeting and Forecasting
  • Account Management
  • Account Growth
  • Consultative Sales Approach
  • Problem Resolution
  • Regional Campaign Management
  • Acquire New Business
  • Promote Products
  • Solution Delivery
  • Growth Portfolios
  • Client Satisfaction
  • Supply Chain Cost Management
  • Healthcare Management
  • Account Planning and Management
Work History
Director of Billing and Claims, 05/2021 to Current
Aria Care Partners, , Anchorage, AK
  • Managed daily operations of all revenue cycle functions, including but not limited to billing, follow-up and collections, cash posting, denial management, and credit balance reviews.
  • Monitored A/R effectively and ensure aging categories are within established goals and national benchmarks and verifies collection processes are being followed.
  • Assessed collection of medical services payments and reimbursements from patients, insurance carriers, financial aid and guarantors.
  • Collaborated with operations, reviews and enhances insurance verification, coding review, billing, collections, payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow.
  • Trained and mentored department staff on policies and procedures to establish strong foundation for client development and service activities.
  • Developed high-level knowledge of client business goals, policies and procedures to establish foundation for targeted problem solutions.
  • Monitored daily productions of billing, denials, and appeals.
  • Participated in billing and collections operations to facilitate client payment of overdue invoices.
  • Reviewed feedback/disputes from caregiver after audit findings are shared with caregiver and/or operational leadership.
  • Established and re-evaluated performance metrics (productivity, accuracy and inter-rater) for Specialists (L1) and Supervisors (L2) on monthly basis. Seeks ways to improve processes or training to achieve optimal performance with high degree of accuracy.
  • Identified, and reported statistics, trends, and analysis to management; analyses data, prepares and presents project reports for management, clients or others.
  • Reviewed, monitored and recommended updates to medical practices' fee schedule to maintain fees at levels that maximize reimbursement.
  • Ensured all training materials are up to date and current.
  • Supported Program Supervisors with training and staff oversight when necessary.
  • Developed strategic plans for day-to-day financial operations.
  • Completed audit papers by thoroughly documenting audit tests and findings.
  • Identified management control weaknesses and provided value added suggestions for remediation.
  • Developed, redesigned and monitored KPIs including payer mix, A/R collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
  • Diminished outstanding debts by analyzing accounts for issues.
  • Cooperated with senior leaders to create operating budgets and initiate financial planning.
  • Assisted in refining QA program development (job aids, SOPs, trainings); facilitates development of random samples of claims to be included in audit reports (L1 and L2) along with dashboard statistics for both QA Team and caregiver performance metrics.
  • Exceeded goals through effective task prioritization and great work ethic.
  • Identified opportunities to improve business process flows and overall departmental productivity.
  • Established performance goals for department and provided methods for reaching milestones.
  • Increased company growth through collaboration with sales and marketing departments.
  • Attended trade shows and client meetings, promoting company brand and building rapport with prospects and partners.
  • Spearheaded cross-functional initiatives across departments to achieve business goals for bottom-line profits.
  • Facilitated over $[Amount] in annual business for [Number]+ years.
Director of Revenue Cycle Management. , 01/2015 to 12/2019
Lee Enterprises, Incorporated, , Alexandria, LA
  • Supported clinical team members with revenue cycle procedures and addressed issues.
  • Monitored and guided revenue cycle operations.
  • Identified discrepancies between budgetary targets and actual revenue and expenses.
  • Assessed current revenue cycle procedures and implemented improvements to foster efficiency.
  • Completed financial reporting and analysis for billing revenue cycle.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Collected payments and applied to patient accounts.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Interacted with physicians and other healthcare staff to ask questions regarding patient services.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Verified signatures and checked medical charts for accuracy and completion.
  • Accurately selected proper descriptive code when more than one anatomical location was indicated.
  • Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
  • Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
  • Initiated, performed and documented quarterly coding audits for physicians.
  • Coded Observations and Inpatient Professional Services at average rate of 40-60 per hour.
  • Implemented new coding procedures that reduced mistakes by 75% and simplified processes.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Quickly and accurately answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction 100%
  • Cross-trained and provided back up for customer service managers..
  • Increased efficiency and team productivity by promoting operational best practices.
  • Delivered excellent customer service, resulting in consistent 95% customer satisfaction rating.
  • Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
  • Ensured compliance with relevant federal, state and payor-specific billing requirements.
Assistant District Manager , 08/2010 to 12/2014
Jackson Hewitt Tax Service, , Anchorage, AK
  • Managed 10+ multi-unit retail locations in assigned district and worked in tandem with District Manager to strategically manage district operations
  • Drove operations at each location to maximize efficiency of Tax preparer's work and increase revenue and profitability
  • Lead recruiting efforts and managed interviewing of seasonal employees for assigned areas Managed leads from Jackson Hewitt Networks and outside sources
  • Worked directly on job-fairs, hiring initiatives, processes and training of all preparer's to execute jobs
  • Assisted tax education process and flow of teams, including transition to hire
  • Monitored associate performances to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems
  • Ensured all assigned locations met company standards including but not limited to : office set up, build-outs and breakdown, technology set up, telecommunications, office supplies and facilities maintenance.
  • Resolved client complaints or answered client questions regarding policies and procedures
  • Provided employees guidance in handling difficult or complex problems while resolving escalated complaints or disputes
  • Conducted internal audits of all assigned offices to ensure all employees are in compliance with company policies and procedures
  • Monitored GL & P&L performance and holds/voids/rejects, discount reports and productivity reports for assigned store group
  • Met all assigned district goals including 10% increase in client growth while managing cash control of 1.2 million dollars and tax return count
  • Educated and supported clients with marketing strategies including but not limited to internal office branding, client segmentation and external marketing strategies.
  • Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags.
  • Followed through with client requests to resolve problems.
  • Exceeded team goals and collaborated with staff members to implement customer service initiatives.
  • Resolved concerns with products or services to help with retention and drive sales.
  • Completed special projects by using effective decision making, critical thinking and time management skills.
  • Determined direction for strategic accounts by researching competitive landscape, market insights and communication across stakeholders.
  • Maintained comprehensive industry knowledge and studied consumer behavior to identify and present innovative solutions.
  • Built relationships with customers and community to promote long term business growth.
  • Fostered lasting relationships with customers through effective communication and quick response, resulting in long-term loyalty and expanded client base.
  • Developed loyal and highly satisfied customer base through proactive management of team customer service strategies
  • Assisted in organizing and overseeing assignments to drive operational excellence
  • Created employee schedules to align coverage with forecasted demands
  • Strengthened merchandising and promotional strategies to drive customer engagement and boost sales
Education
Master of Arts: Health Administration, Expected in 12/2023 to University of Alaska Anchorage - Anchorage, AK
GPA:
Bachelor of Arts: Communications, Expected in 2004 to University of Alaska Anchorage - Anchorage, AK
GPA:

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Resume Overview

School Attended

  • University of Alaska Anchorage
  • University of Alaska Anchorage

Job Titles Held:

  • Director of Billing and Claims
  • Director of Revenue Cycle Management.
  • Assistant District Manager

Degrees

  • Master of Arts
  • Bachelor of Arts

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