Business-Minded Reimbursement Manager proudly offering over 15 Years' experience in Revenue Cycle Management with a strong background in developing and implementing policies and procedures that improve workflows, while providing leadership, strategic direction and supervision of reimbursement functions and activities, ensuring reimbursement objectives are met.
Skills
Leadership & Supervision
Proactive Problem Resolution
Team Assistance and Oversight
Billing and Collections Procedures
Reimbursement Management
Contract Negotiation
Team Management
Training & Development
Relationship Building
Planning & Organizing
Data Management
Microsoft Office
Vendor Relationship Management
Analytics Skills
Effective Customer Communication
Critical Thinking
Experience
11/2019 to Current
Manager of Reimbursement & CollectionsLehigh Valley Hospital & Health – Fogelsville, PA,
Recommended and implemented new financial and accounting software packages
Serve as a resource for forecasting and annual budget, prepare interim and annual cost reports
Prepare metrics for quarterly QMC meetings to ensure billing objectives are adherent to URAC and ACHC accreditation standards
Complete month-end and year-end closings, keeping records audit-ready and monitored timely recording of accounting transactions.
Developed workflow processes as they pertain to specialty pharmacy using EPIC/Willow Ambulatory retail software
Established policy and procedures for pharmacy operations as it pertains to Revenue Cycle functions
Maintain policies and procedures for revenue cycle operations that can be incorporated into actionable methods to increase productivity and efficiency.
Analyze and report on revenue cycle data to inform management.
Provided revenue cycle process support to all clinical personnel, including resolving procedure challenges.
Assist Pharmacy Director with completing documentation to be submitted for new out of state pharmacy licensure
Assist Pharmacy Director with state Medicaid applications
Oversee the management of insurance benefit investigations (Medicare/Medicaid, Medical, and PBM insurance), billing, payment reconciliation, and collections.
Monitor accounts receivables and assess payor account listings, checking for appropriate information processing.
Provide personnel development by holding weekly one on one meetings and team building activities.
Maintained regular performance appraisals for subordinates through verbal, written and on-going review programs.
Delegated work to staff, setting priorities and goals.
07/2016 to 11/2019
RCM Billing and Collections ManagerDoordash – Bensalem, PA,
Evaluate Revenue Cycle department processes and procedures, suggest and implement methods to minimize labor costs and improve operations.
Audit accounts to ensure account analysis is accurate and in compliance with established policies and procedures
Identify collection trends, reporting in support of the Revenue Cycle Director
Oversee the management of select revenue cycle personnel which includes training, evaluating performance, as well as disciplinary action (if needed) to assigned personnel
Assist with the growth and development of of the Revenue Cycle team; creating policies and procedures
Prepare and review month end revenue reports
Support the audit function and prepare necessary audit schedules
Utilize and understand revenue GL transactions
Approve and process all account adjustments, write offs, and refunds
Lead and cross train account receivable staff
Create and maintain positive working relationships with all internal and external customers
Meet with staff ina one on one setting quarterly to discuss progress and goals, and provide feedback on claims being worked
07/2015 to 07/2016
RCM Collections SupervisorWashington Hospital, Inc., Mary – Fredericksburg, VA,
Oversee the day to day operations of revenue cycle via remote location from our corporate team (11 employees)
Identify trends and issues with problem payers and communicate possible solutions to management
Utilize and understand GL transactions
Approved and processes account adjustments, write offs, and refunds up to a limited dollar amount
Work with Revenue Cycle Director and Revenue Cycle Manager to help direct, lead, and grow the Revenue Cycle team
Train new hires on Absolute AR, EPS dispensing software, and all other related billing systems
Assist Revenue Cycle Manager with the interview process
Work with Revenue Cycle Manager to determine what each employee's strengths are, and utilize the individual employee's strengths where it best serves the company
Meet with staff in a one on one setting to discuss progress and provide feedback on collection activity
Meet every two weeks with Revenue Cycle team to keep open communication
Conduct claims analysis and provide feedback and direction to the department Manager and Director
04/2015 to 07/2015
Denial SpecialistAvella Pharmacy – City, STATE,
Research accounts in depth to determine the best possible outcome
Determine if A/R is uncollectible and submit for internal adjustment
Submit appeals as needed for denied or underpaid claims per contract guidelines
Adhere to timely follow up on A/R collection activity
Identify denial trends and report findings to management team with resolution to decrease bad debt outcomes and further denials
04/2012 to 04/2015
Lead Collection AnalystAxium Healthcare Pharmacy – City, STATE,
Lead collector to 12 employees
Analyzed patient accounts for possible payment arrangements
Implemented billing strategies as needed per Medicaid web portals
Handled escalated phone calls
Reported productivity from excel reports and provide information to the Revenue Cycle Director
Maintained assigned Managed Care, PBM, Medicaid, Medicare, and patient assistance accounts
Trained new hires on CPR+ dispensing software
Assisted Supervisor in the interviewing process
Adjudicated primary and secondary PBM claims within the dispensing software
Resolved PBM rejections on claims that have already been dispensed
Followed up on all claims within 14 days
Assisted the Pharmacist in Charge with pharmacy claims audit reviews
Reviewed and signed off on all adjustment requests prior to being approved by Supervisor and/or Director
03/2010 to 04/2012
Collection AnalystAxium Healthcare Pharmacy – City, STATE,
Reviewed patient accounts for possible payment arrangements
Worked regularly assigned Managed Care accounts
Trained new hires on CPR+ software system
Adjudicated primary and secondary claims on dispensing software
Assisted with audit reviews
Maintained clean accounts receivables for claims over 90 days
06/2007 to 03/2010
Insurance Verification SpecialistAxium Healthcare Pharmacy – City, STATE,
Verified patient benefits for managed care, Medicare, Medicaid, and patient assistance programs
Assisted in obtaining and securing prior authorizations for patient's specialty medications
Explained patient benefits to patients and answer any questions and address any concerns the patient may have about their benefits
Train new hires on QS, Great Plains, and Pin2 software systems
Education and Training
Expected in to to
BBA: Interdisciplinary Studies Keiser University - Fort Lauderdale, FL GPA:
Additional Coursework in Business Management and Healthcare Management
3.5 GPA
Expected in to to
BBA: Healthcare Management Capella University - Minneapolis, MN GPA:
2010, 2011, 2012 - Dean's List
Biology AP Course
3.9 GPA
Additional Information
My most recent experience in specialty pharmacy, has been in a start up health-system specialty pharmacy, where my objective upon hire was to build revenue cycle department from ground zero.
I have been through ACHC and URAC accreditations.
All together, I have 25 years of experience in the pharmacy industry, having worked in several different pharmacy settings, including 7 years in retail, 3 years in long term care, and 15 years specialty.
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