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Manager at Revenue Cycle Management Division Resume Example

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MANAGER AT REVENUE CYCLE MANAGEMENT DIVISION
Executive Profile
An ambitious manager of human and material resources, who creates strategic alliances with organization leaders to effectively align with and support key business initiatives. Builds and retains high performance teams by hiring, developing and motivating skilled professionals. A very hardworking, highly motivated and innovative person willing to always improve on the status quo. With a unique skill set that combines business, healthcare and technological know-how in approaching operational challenges at all level.
Skill Highlights
  • Staffing management ability
  • Proven patience and self-discipline
  • Conflict resolution
  • Patient-oriented
  • Personal and professional integrity
  • Financial aptitude
  • Relationship and team building
  • Sound decision making
  • Staff training and development
  • Critical thinking proficiency
  • Cultural awareness and sensitivity
  • Maintains strict confidentiality




  • Exercises good judgment
  • Good written communication
  • Deadline-driven
  • Team player with positive attitude
  • Strong work ethic
  • Patient-focused care
  • Strong planning skills
  • HIPAA compliance
  • CPT and HCPCS coding
  • ICD-9 & 10 coding
  • Electronic Medical Record (EMR) software - EPIC, NEXTGEN
  • Knowledge of HMOs, Medicare and Medi-Cal
Core Accomplishments
  • Manages the authorization processes at Patient Financial Clearance department to ensure access of care for patients seeking treatment at SHC
  • Manages the clinical documentation/referrals, denials and Peer to Peer for Cancer Center (GI Oncology & Sarcoma clinics now to expand to all the clinics soon after our pilot period) at SHC.
  • Oversees and coordinate all the vendor management activities of the Patient Financial Clearance department in the Revenue Cycle Division including over 50 staffs i.e. RFP decision making, advising the department and division on selection of a vendor and vendor quality reviews
  • Developed a compliant tracker used in Patient Financial Clearance department of the Revenue Cycle Division to track and address complaints by staffs, other departments and even third party agencies across Stanford Healthcare
  • Developed the Patient Financial Clearance communication center to a fully functional center with standard workflow and improved daily metrics i.e. average of 0-2% call abandon rate, improve speed to answer at 98 %, improve team call volume, regulate transferred calls to only when necessary
  • Collaborate with other colleagues to ensure reduced denial rate and write-offs by about 30%
  • Coordinated a new dress code for the over 130 staffs at the Patient Financial Clearance department
  • Educated physicians and other healthcare providers' on healthcare policies, clinical and financial implications of incomplete chart documentation resulting from providers clinical practice and from analysis of internal and external sources of healthcare policy documents in accordance with CMS guidelines and compliance.
Professional Experience
01/2016 - Current
Stanford Healthcare ,Patient Financial Clearance － Newark, CAManager at Revenue Cycle Management Division
  • Manage the authorization processes at Patient Financial Clearance department to ensure access of care for patients seeking treatment at SHC
  • Oversees and coordinate all the vendor management activities of the Patient Financial Clearance department in the Revenue Cycle Division including over 50 staffs i.e. RFP decision making, advising the department and division on selection of a vendor
  • Manage vendor's performance and quality review
  • Developed a compliant tracker used in Patient Financial Clearance department of the Revenue Cycle Division to track and address complaints by staffs, other departments and even third party agencies.
  • Manages the clinical documentation/referrals, denials and Peer to Peer for Cancer Center (GI Oncology & Sarcoma clinics now to expand to all the clinics soon after our pilot period).
  • Oversees and manages the denial process and Peer to peer review between all Stanford clinics and insurance plans.
  • Collaborate with other colleagues to ensure reduced denial rate and write-offs
  • Planning a streamline workflow for all clinics at SHC for authorization process of Botox, oral medication and injectable to ensure efficient services for patients and staffs
  • Developed the Patient Financial Clearance communication center to a fully functional center with standard workflow and improved daily metrics i.e. average of 0-2% call abandon rate, improve speed to answer at 98 %, improve team call volume, regulate transferred calls to only when necessary
  • Rebranded the communication center and renamed it with improved and efficient services now offered to serve patients
  • Leading, planning and directing overall clearance functions which includes pre-registration, payer authorization (outpatient and hospital), insurance verification
  • Initiated bi-weekly managers meeting the Patient Financial Clearance department and introduced new initiatives to improve operational functions in the department
  • Coordinated a new dress code for the over 150 staffs at the Patient Financial Clearance department
  • Contributed to reduction in denials and write-offs to improve the revenue of the Patient Financial Clearance department and the Revenue Cycle Enterprise division as a whole.
01/2015 - 01/2016
Stanford Healthcare － Palo Alto, CAClinical Documentation Improvement Specialist/Revenue Cycle/HIM
  • Performs concurrent medical documentation reviews of complicated clinical cases
  • Oversees optimal clinical documentation to enhance quality measurement by the CMS
  • Develops and present physicians and other healthcare providers' education resulting from the analysis of clinical and financial information from internal and external sources for accurate documentation
  • Utilizes the knowledge of MS-DRGs and the Inpatient Prospective Payment System (IPPS), including new CMS guideline of key elements including clinical documentation of what constitutes an inpatient admission and Patient Safety Indicators (PSI)
  • Utilizes ICD-9 & ICD-10 hospital coding policies and procedures, Federal and State coding reimbursement guideline
  • Coordinate abnormal test findings and ambiguous clinical documentation by physicians when they occur and query physicians on current basis
  • Partner with other departments like HIM, Coding, Quality and Revenue departments to ensure accurate clinical documentation and reimbursement
  • Clinical documentation review and coding for Inpatient services.
12/2012 - 01/2015
Prime Healthcare Inc － Victorville, CAClinical Documentation Specialist/Health Information Management
  • Implemented improvement in clinical documentation/health record to reflect quality outcomes and increased reimbursement by 25%.
  • Practical knowledge and understanding of official physician E & M guidelines and documentation requirements in support of proper E & M assignment, establishment of medical necessity and CPT/HCPCS coding for reimbursement
  • Conducted system analysis requirements and ensure completeness of clinical documentation, clinical data management and research using the Electronic Health Record (EHR)
  • Developed and interacting tool for use by physicians, healthcare providers and health information management personnel to ensure accurate coding using the DRG, Hierarchical Coding Category (HCC) and Risk Adjustment Scores for Outpatient services.
  • Contributed to raising concurrent appropriate queries which improved complete documentation, patient health management, proper reimbursement and reduced denials significantly
  • Educate physicians and other providers on ICD 9 & 10 coding guidelines and usage
  • Train physicians and other providers including health information management staffs on proper use of EHR and compliance regulations by CMS to improve reimbursement to the hospital.
12/2010 - 12/2012
MD Anderson Cancer Center － Houston, TXGraduate Research Associate
  • Research aim: Determine "Predictors of Lymph node positive disease in Renal cell carcinoma (RCC)".
  • Determine non-Renal cell carcinoma combined data set for manuscript.
  • Data analysis and evaluation of 1500 patients determining lymph node positive disease in RCC.
  • Data collection, analysis and interpretation using STATA for publication of study's findings.
08/2009 - 12/2009
United Nations Millennium Development Goal － Lagos & Kaduna, NigeriaLead Consultant
  • Implemented the health base MDG's in 2 states (Lagos & Kaduna) with a total budget of over $20 million which led to refurbishment and setting up of new primary health centers in all the 20 local government areas of Lagos state.
  • Coordinated as the lead consultant the unveiling of building new public sanitation infrastructure and solar electricity in all the 23 local government areas of Kaduna state.
  • Conducted research on under-five and infant mortality rates in the 2 states prior to kick starting the project.
  • Achieved improvement in electricity through the use of solar panels in Kaduna state rural communities by about 15% after the project was completed base on our team's oversight.
06/2009 - 08/2009
United States Agency for International Development USAID MSH － Abuja, NigeriaConsultant
  • Coordinated HIV/AIDS counseling, prevention of mother to child, preventing stigmatization and management of infected patients through use of Anti-retroviral medication and diet.
  • Conducted Health education outreaches to prison inmates in Abuja and Nasarawa state on HIV/AIDS.
11/2008
World Health Organization － Abuja, NigeriaConsultant
  • Supervised and monitored the integrated measles campaign in Abuja, Nigeria.
  • Initiated a census program to ensure all households were immunized at about 35% improvement rate compared to previous year in a population of about 800,000.
09/2008 - 08/2010
Federal Capital Territory Health & Human services － Abuja , NigeriaMedical Doctor
  • Performed surgeries and participated in patient recovery to improve overall health outcome
  • Consultations in in-patients and out-patient clinics
  • Conducted research as part of the team that worked on a UNAIDS grants to reduce transmission of HIV from mother to child in a population of about 800,000
  • Developed a clinical tool used in our clinics to reduce patient waiting time from an average of 45 minutes to 17 minutes and that of the emergency department reduced from about 24 minutes to about 6 minutes averagely over a period of 2 years
  • Increases hospital visitation by 32% through regular health outreach and education of the rural communities around the FCT by gaining the support of the local chief to challenge their strong belief that only local herbal preparation can cure all ailments.
07/2008 - 09/2008
Kolstaf Medical Center － Abuja, NigeriaMedical Doctor
  • Performed surgeries and attended to medical emergencies.
  • Managed day to day running of the hospital including the clinical aspect to ensure optimal service delivery and efficient operational workflow.
  • Improved patient's health outcomes and reduced wait time from 17 minutes to 5 minute.


09/2007 - 06/2008
National Directorate for Employment staff clinic － Abuja, NigeriaMedical Doctor
  • Performed minor surgeries and medical consultation.
  • Managed day to day running of the hospital including the clinical aspect to ensure optimal service delivery and efficient operational workflow.
03/2007 - 02/2008
National Assembly Clinic － Abuja, NigeriaMedical Doctor
  • Developed a clinical tool that reduced patients wait time from 27 minutes to about 4 minutes.
  • Performed minor surgeries and attended to medical emergencies.
  • Managed day to day running of the hospital including the clinical aspect to ensure optimal service delivery and efficient operational workflow.
  • Initiated a rolling program on quarterly health education outreach by staffs of the clinic to rural areas of the state.
03/2006 - 02/2007
University of Abuja Teaching Hospital － Abuja, NigeriaMedical Doctor
  • Conducted research as part of a team that developed a white paper on proper utilization of primary healthcare center in all the local government council in Abuja sponsored by the FCT health and human services.
  • Rotated through the major departments namely Medicine, Surgery, Pediatrics and OB&GYN.
Education & Certifications
2016
California State UniversitySan BernardinoMBA: ManagementManagement
2016
California State UniversitySan BernardinoMBA: Business Intelligence & Info. TechBusiness Intelligence & Info. Tech
2012
University of TexasHoustonMPH: Healthcare ManagementHealthcare Management
2008
Nigerian Institute of ManagementDiploma: ManagementManagement
2005
University of Ibadan MDM.D.
Dec 2012
University of TexasMD Anderson Cancer Center Postdoctoral Association certification on Publication Practices and Responsible Authorship
Dec 2012
American Board of Surgical AssistantsMD Anderson Cancer Center Postdoctoral Association certification on Ethical Issues on Biomedical Research
May 2008
Nigerian Institute of Management (Chartered)
2013
Harvard UniversityHealth in Numbers: Quantitative methods in Clinical & Public Health Research
2014
American Health Information Management AssociationCertified Documentation Improvement Practitioner (CDIP)
2013
NextGenCertified Professional- Enterprise Practice Management (NCP-EPM)
2013
NextGen Certified Professional- Electronic Health Record (NCP-EHR)
2013
American Health Information Management AssociationCertified Coding Specialist (CCS)
Publications
Preoperative Predictors of Pathologic lymph Nodes Metastasis in Patient with Renal Cell Carcinoma undergoing RPLND (Published Oct, 2014) Wahab Adelani, Sanchez C, Wood C Jnr, Sprague T, Gerber J, Fang J, Golla V, Babaian K, Christopher Wood, Karam
Skills
 CMS, Clinical care , consultant,  counseling, CPT, Data analysis, Data collection, data management, decision making,  directing, documentation, Financial, functional, grants,  Health education, ICD-10, ICD-9, insurance, interpretation,  Enterprise, Patient Safety Index, peer review, personnel, policies, processes, Coding, Public Health, Publication, Quality, Research, RFP, STATA, Surgery, system analysis, transmission, vendor management, workflow, Team Leadership, Strategic Planning,Interpersonal Skills,Team Player, Staff Development, Staff Motivation, Staff Training, Change Implementation, Communication Skills, Community Outreach, Performance Analysis, Performance Evaluations, Problem Resolution, Leader, Leadership
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Resume Overview

Companies Worked For:

  • Stanford Healthcare ,Patient Financial Clearance
  • Stanford Healthcare
  • Prime Healthcare Inc
  • MD Anderson Cancer Center
  • United Nations Millennium Development Goal
  • United States Agency for International Development USAID MSH
  • World Health Organization
  • Federal Capital Territory Health & Human services
  • Kolstaf Medical Center
  • National Directorate for Employment staff clinic
  • National Assembly Clinic
  • University of Abuja Teaching Hospital

School Attended

  • California State University
  • University of Texas
  • Nigerian Institute of Management
  • University of Ibadan MD
  • American Board of Surgical Assistants
  • Nigerian Institute of Management (Chartered)
  • Harvard University
  • American Health Information Management Association
  • NextGen

Job Titles Held:

  • Manager at Revenue Cycle Management Division
  • Clinical Documentation Improvement Specialist/Revenue Cycle/HIM
  • Clinical Documentation Specialist/Health Information Management
  • Graduate Research Associate
  • Lead Consultant
  • Consultant
  • Medical Doctor

Degrees

  • MBA : Management
    MBA : Business Intelligence & Info. Tech
    MPH : Healthcare Management
    Diploma : Management
    M.D.
    MD Anderson Cancer Center Postdoctoral Association certification on Publication Practices and Responsible Authorship
    MD Anderson Cancer Center Postdoctoral Association certification on Ethical Issues on Biomedical Research
    Health in Numbers: Quantitative methods in Clinical & Public Health Research
    Certified Documentation Improvement Practitioner (CDIP)
    Certified Professional- Enterprise Practice Management (NCP-EPM)
    Certified Coding Specialist (CCS)

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