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Patient Representative III (Lead) Resume Example

Resume Score: 90%

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PATIENT REPRESENTATIVE III (LEAD)
Professional Summary
Certified Project Manager with over 10 years of diverse and progressive healthcare industry experience. Dedicated to continuous process improvement in face of rapidly evolving and changing markets. Extremely results-oriented and proactive in finding cost-effective solutions to company-wide problems.
Skills
  • Complex problem solving
  • Analytical reasoning
  • Results-oriented
  • Microsoft Office Suite Expert
  • GE Centricity, IDX, EPIC, EMR, Optum
  • Change Management theory
  • Process Improvement
  • Project Management
  • Contract Management
  • Trained in Six Sigma,TQM methodologies
Accomplishments

Position: Patient Representative III (Lead)

  • Ranked a top performer on the revenue cycle team.
  • Consistently receives 100% quality and productivity on monthly performance measures.
  • Consistently receives "exceed expectation" results on annual performance measures.
  • Contributed to the development and implementation of AR 2.0(Denial Centralization), an innovative process improvement initiative that improves revenue cycle management and ranked revenue team 3rd in the nation.
  • Collaborates with multiple departments on the development of revenue generating initiative.                                         

Position: Medical Billing Lead

  • Dramatically increased revenue by 70% within 3 months of employment through aggressive revenue cycle management. Maintained or exceeded revenue target by 30% monthly.
  • Process Improvement- Achieved revenue objective by implementing cost-cutting measure.
  • Improved operational efficiency by implementing processes to streamline workflow. Negotiated manage care contracts that were mutually beneficial for stakeholders.
  • Lead 7 member team to achieve business strategic goals.
Work History
Patient Representative III (Lead)01/2013 to Current
Company Name – City, State
  • Work with clinic specialties to enhance revenue performance within charge capture and accounts receivable.
  • Analyze and compose effective reports daily to streamline workflows.
  • Performs qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
  • Meticulously identify and rectify inconsistencies, deficiencies and discrepancies in medical documentation.
  • Research CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Facilitate successful internal and external audits through sound and thorough documentation.
  • Collaborate with the Medical Staff to ensure compliance with the health system contracts in place with all managed care payers.
  • Demonstrate fiscal responsibility and contributes to departmental achievement of financial goals.
  • Collaborate with various stakeholder on process automation to encourage continuous improvement.
  • Effectively collaborate with appropriate physicians, management, and staff to obtain, document and validate information related to assigned projects.                                                                                                                  

Position: Patient Account Representative II                

  • Assisted with multiple projects aimed to increase revenue generation and improve process efficiencies. Helped develop KPIs and dashboard to track project's progress.
  • Developed and helped implement TAVR correct coding and claim resolution processes to decrease payment lag. 
  • Identified revenue opportunities within Clinical billing processes and developed SOPs to ensure timely charge capture and provide the opportunity for charge reconciliation.
  • Identified $350,000 in critical care denials and worked with the Clinical management to develop a plan to correct the coding errors and appeal for reimbursement. Implemented edits to decrease errors.
  • Analyzed Internal Medicine's accounts receivables and identified $400,000 in potential reimbursement and developed project plans to resolve each project with implementation led by section leaders.
Medical Billing Lead01/2009 to 11/2012
Company Name – City, State
  • Served as primary resource for internal and external stakeholders within the Billing department.
  • Supervised multiple clinics Billing team daily activities and delegated tasks according to business needs.
  • Performed employee evaluation, Coached undeveloped employees, and developed performance improvement plan.
  • Developed quality and service metrics to assess the overall success of improvement efforts.  Developed training modules and supporting instructional materials that enhance the learning objectives.
  • Evaluated and implemented new initiatives that assisted in the achievement of business goals.
  • Maximized operational efficiency by coaching staff on new initiatives. 
  • Initiated, performed and documented quarterly coding audits for physicians.
  • Managed physicians contracts and credentialed new physicians.
  • Managed CDM database and performed regular updates of charges and/or fee schedules to adhere to federal, state regulatory guidelines, and billing compliance.
  • Collaborated with owners in negotiating new and renewal manage care contracts terms and fee schedules.
  • Analyzed and compiled reports to update owners on revenue cycle trends and provided recommendation for improvement.
  • Evaluated processes, generated alternatives and made recommendations to reduce waste, increase utilization, reduce costs, improve Patient satisfaction and produce improved financial outcomes. Effectively communicated team recommendations.
Office Coordinator09/2006 to 12/2009
Company Name – City, State
  • General Office duties 
Education
Bachelor of Science: Business ManagementJuly 2015Western Governor University - City, State
Associate of Science: Business AdministrationDecember 2011Georgia Perimeter College - City, State
Associate of Applied Science: Medical Billing and CodingJanuary 2008Javelin Technical Institute - City, State
Professional Development

Six Sigma and Lean Sigma training, Western Governors University, 2014.

Change Theory Methodologies, Western Governors University, 2014.
Certifications

ComTIA project+, CompTIA, 2015.

CPC, AAPC, 2015.

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Resume Overview

School Attended

  • Western Governor University
  • Georgia Perimeter College
  • Javelin Technical Institute

Job Titles Held:

  • Patient Representative III (Lead)
  • Medical Billing Lead
  • Office Coordinator

Degrees

  • Bachelor of Science : Business Management July 2015
    Associate of Science : Business Administration December 2011
    Associate of Applied Science : Medical Billing and Coding January 2008

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