Ambitious Director of Operations Manager with more than 16 years of management experience in the Healthcare industry. Applies strong analytical and critical thinking skills to solve complex operational problems.
Skill Highlights
OB-GYN, Surgery, Gastro, Plastics, Derm and Radiation Oncology experience
Knowledge of HMOs, Medicare and Medi-Cal
Managed care contract knowledge
PPO & HMO Contract Negotiation/ Credentialing
Electronic Medical Record (EMR) software
Healthcare billing proficiency
Revenue Cycle
Operations
A/R Clinic & Facility
Collections
ICD-9 coding
Trained in ASC Coding
CPT and HCPCS coding
Appeal/Denial Letters
Posting & Adjusting of Insurance EOBās
Staff training and development
In-depth claims knowledge
Claims analysis and review specialist
Extensive EHR experience
Medical Assisting specialist
Hiring and retention
Human Resources Management
Compensation/payroll
Regulatory compliance
Personnel records maintenance
New hire orientation
OSHA inspections
Direct marketing campaigns
Cost reduction and containment
Multi-site operations
Systems implementation
Service contract review and recommendations
Ā Fiscal Management
Sales and Market Growth
Start-up Business Development
Education
University of PhoenixLos Angeles, CAExpected in 2012 ā āMBA:Healthcare Administration - GPA:
University of PhoenixLos Angeles, CAExpected in 2010 ā āBachelor of Science:Healthcare Administration - GPA:
Core Accomplishments
Staff Development:
Launched well-received program of professional development courses for all staff.
Mentored and coached employees resulting in a 12% increase in productivity.
Human Resources:
Spearheaded new Customer RetentionĀ program which increased profit by 25%.
Implementation
Assisted in implementation of new EHR system that resulted in improved patient care.
Professional Experience
Related Companies - Director of Operations Harbor City, CA, 2012 - 11/2015
Ā
Business Operations
Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.Ā Supervised and evaluated the activities of medical, nursing, technical, clerical, maintenance and other personnel. Jumped in to fill gaps for Medical Assistants, Surgery Schedulers and Front Office when necessary.Ā Diligently monitored the QA (Quality Assurance) program to improve performance and maintain high standards of care.Ā Minimized staff turnover through appropriate selection, orientation, training, staff education and development.Ā Established and maintained positive relationships with government regulators, other area health care providers, physicians and community at large.Ā Organized and led weekly personnel meetings with 25 team members. Developed and managed budget and revenue expectations while actively seeking ways to eliminate or reduce expenses.Ā Revised policies and procedures in accordance with changes in local, state and federal laws and regulations.Ā Established facility\'s annual budget and conducted monthly reviews to ensure finances were being properly allocated.Ā Monitored infection control procedures to ensure facility-wide health and safety.Ā Developed and arranged continuing education opportunities for all staff to increase knowledge and skills.
Ā Ā
Billing/Financial
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.Ā Accurately entered procedure codes, diagnosis codes and patient information into billing software.Ā Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Ā Thoroughly reviewed remittance codes from EOBS/AR\'s. Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature. Completed appeals and filed and submitted claims. Applied payments, adjustments and denials into system. Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables and clearing house. Meticulously tracked and resolved underpayments. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.Ā Handled cash and deposits using the proper accounting procedures and documentation.Ā Processed bank reconciliations and financial reports to verify practice of proper due diligence.
Ā
Human Resources
Recruited, trained, mentored and fired employees. Conducted new employee orientation to foster positive attitude toward organizational objectives. Designed training modules that implemented strategic business practices and organizational behavior training concepts. Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.Ā Processed payroll and employee pay adjustments.
Ā
Contracting / Credentialing
Prepared, reviewed
and process all credentialing and re-credentialing applications for all
providers employed by and/or contracted with associated with practice. Ā Maintained
current and obtain updated insurances agreements/contracts/ licenses and
certifications, etc, related to credentialing. Ensured all insurance
carriers are up today on all of changes and updates made to providers or groups.
Related Companies - Director of Operations Irving, TX, 01/2008 - 05/2011
Ā
Business Operations
Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.Ā Monitored scheduling, registration, verifying insurance, insurance authorizations, coordination of required medical and financial information. Medical Records management, and scheduling of office staff.Ā Supervised and evaluated the activities of medical, nursing, technical, clerical, service, maintenance and other personnel.Ā Jumped in to fill gaps for Medical Assistants, surgery schedulers and Front Office when necessary.Ā
Ā
Operations of Ambulatory Surgery Center
Planned, directed and monitored regulatory operations.Ā Involvement of the entire process of
opening a AAASF Ambulatory Surgery Center (from build out to AAAASF
accreditation)
Managed the departments of nursing,
central supplies, medical records, and housekeeping, and
supervised the contracted services of
Biohazard, pharmaceuticals, laundry, and biomedical
engineering etc.
Directed, planned, coordinated, and monitored all operational and
financial aspects of the Surgery
Center, in conjunction with providing effective leadership to
staff and overseeing the delivery
of quality, cost-effective patient care
Directed
and coordinated clinical, regulatory, administrative, and distribution
activities of the surgery center
Maintained
Ambulatory Surgery Center certification through conducting quarterly Quality
Assurance meetings regarding Surgery Center regulations
Administered the infection control program
and medical staff review of the quality improvement
program
Collaborated with the Medical Director in
the review and revision of the Medical Staff Bylaws, Rules, and Regulations on
a biannual basis. Negotiated and controlled all external contracts, ancillary
services and purchasing agreements.
Ā
Billing / Financial
Using coded data to produce and submit claims electronically
to insurance companies. Worked directly with the insurance company, healthcare
provider, and patient to get a claim processed and paid. Reviewed and appealed
unpaid and denied claims. Handled collections on unpaid accounts. Managed and
monitored the facilityās Account Receivable reports. Answered patientsā billing
questions.
Intermountain Healthcare - Ambulatory Surgery Center Administrator Tooele, UT, 03/2003 - 01/2008
Ā
Operations of Ambulatory Surgery Center
Directed, coordinated, and controlled all aspects of the operating functions, processes, and staff of the ambulatory surgical center.Ā Served, as a liaison between the professional standards committee, medical staff, and all departments of the center.Ā Maintained and update Business Office Policies and Procedures. Conducted departmental meetings. Assured quality customer service to physicians, physician office schedulers and managers, surgery center staff, patients and their families. Attended Medical Advisory Meetings, Board Meetings and Committee Meetings as requested. Maintained accurate minutes for all meetings as requested. Maintained Peer Review, Nursing Audit and Infection Control files. Participated in preparation of budget that will allow for adequate personnel, supplies and equipment. Maintained surgery center supplies. Participated in Quality Improvement Activities; assists in developing quality reports. Oversaw IT Support and maintenance of office equipment. Credentialing all new providers and maintained up-to-date files. Maintained company website. Updated activity report in excel weekly.Ā
Ā
Accounts Receivable
Collected up-front patient co-pays. Timely posting of payments. Posted and deposit of daily receipts.
Ā
Staffing, Training and Supervision
Interviewed and hired personnel as needed due to staff changes. Monitored and covered staffing for all surgical cases. Provided proper orientation, trained and ongoing education to new staff. CounseledĀ and disciplinedĀ employees when necessary. Evaluated and communicated employee job performance through observation of individual productivity, punctuality, efficiency, accuracy and adherence to policies and procedures. Conducted personnel evaluations for employees supervised.
Ā
Scheduling and Registration
Maintained surgical schedule; worked closely with Clinical Director for efficient and accurate scheduling. Timely pre-verification of patient insurance coverage. Chart preparation. Developed relationships with physician schedulers and office managers. Ensured efficient patient registration.
Ā
Medical Records/HIPAA
Maintained complete and accurate records. Complied with state and federal guidelines. Insured proper medical record storage and retrieval. Processed medical record requests/disclosures in accordance with federal privacy laws. Oversaw and managed dictation. Maintained strict confidentiality in regards to patient account status.
Ā
Billing
Surgery Center billing and coding. Evaluation of billing and collection activities. Monitored patient accounts. Worked with
payers through claim processing to ensure accurate reimbursement. Ensured
collections are accurate and up to date. Payment posting. Worked appeals and
claim adjudication. Analyzed financials of practice.
Ā
Accounts Payable
Reconciled all front-office invoices (supported by purchase order)
Ā
Human Resources
Submitted payroll information for each pay period. Maintained complete and accurate personnel records for employees and medical staff.
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