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RCM Systems Support Services Manager Resume Example

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RCM SYSTEMS SUPPORT SERVICES MANAGER
Professional Summary

Forward thinking healthcare revenue cycle professional with more than 20 years of experience in customer and vendor engagements, possessing a fundamental passion for working collaboratively towards team and organizational successes, specializing in healthcare revenue cycle billing management within federal and multi-state regulatory and commercial insurance health plan spheres.
Proven strengths in effectively spearheading strategic initiatives resulting in electronic data interchange improvements which translate into significant organizational cost reductions.
Extensive experience and insight in managing diverse billing systems and software support solutions within numerous network and cloud-based electronic health record platforms, successfully supporting key client performance benchmarks while cultivating and maintaining long-term business partnerships.

Work History
Company Name - RCM Systems Support Services ManagerCity, State01/2017 - 05/2020

Oversight for all home health and hospice billing and cash department activities within EMR and clearinghouse environments including:

  • Managed team responsible for pre-billing review, tracking and monitoring of daily, weekly and month-end electronic claims for 31 clients representing portfolio of $81M in yearly revenue.
  • Spearheaded configuration, testing and ongoing maintenance of client financial and billing modules, charge master & rate files, payor plans, reimbursement methodologies and reimbursement rates ensuring compliance with regulatory and payer requirements, including implementation of major industry initiatives such as CMS' FY2020 Final Rule transition PPS to PDGM, within 12 different Electronic Health Record environments.
  • Key stakeholder in client billing assessments, new client on-boarding and implementations ensuring timely completion of milestones and go-live of revenue cycle services.
  • Subject Matter Expert and liaison among internal IT support teams, client leadership, and vendors, providing analysis and resolution of billing system (billed and unbilled claims) and payment posting issues.
  • Trained and mentored staff and accounts managers providing process improvement through improved system knowledge and proficiencies.
  • Contract analysis identifying term requirements and specifications for application within EHR billing and financial modules as delineated.
  • Comprehensive review and preparation of billing and charge rate recommendations at time of payor contract renewal negotiations.
  • Collaborated successfully with clients and vendors to achieve objectives by utilizing effective communication, interpersonal and people skills.
Company Name - RCM Systems Support & Billing ManagerCity, State06/2012 - 12/2016
  • Management and coordination of client account transition to company's proprietary claims management system successfully transitioning multiple clients and gaining significantly improved billing, collections, and cash posting claims management efficiencies.
  • Trained, coached and mentored billing and cash team staff in 12 different Electronic Health Record environments maximizing department efficiencies.
  • Driver of value-add unbilled revenue review services generating, analyzing and presenting unbilled revenue reports to client executive leadership, aiding internal process management, identifying revenue at risk of untimely filing, reducing bad debt write-offs and improving cash-flow.
  • Continuous quality assurance, monitoring, identifying and addressing trends to support monthly departmental goals and outcomes by meeting or exceeding industry benchmark standards, contributing to department achieving less than 3% of AR greater than 120 days for Medicare accounts and on average less than 12% for Commercial accounts.
  • Developed company forms, documented best-practice billing and cash process standards, prepared end-user guides, new- hire training documents, system maintenance documents and special project documentation.
  • Spearheaded analysis, identified, proposed and implemented key methods to optimize billing, medical records management and cash application tasks and time management, such as electronic data interchange (EDI) transactions and secure file transfer protocol (sFTP); successfully transitioning all paper billing to electronic billing formats.
  • Researched, compiled and presented executive leadership team with statistical data to support cost control and process improvement initiatives.
  • Assessed software platforms, identified additional cost reducing opportunity and implemented process automation and efficiency enhancement.
  • Developed, implemented and oversaw SmartSheet billing and cash tracking logs and reconciliation processes.
  • Developed and implemented EDI dashboard solutions for electronic billing and remittances, and denial management.
Company Name - RCM AR Team LeadCity, State01/2005 - 05/2012
  • Owned, managed and reconciled portfolio of $12M in Home Health, Hospice and Infusion client receivables from time of billing through validation of proper payment.
  • Resolved delinquent accounts successfully achieving collections goals and maintaining high customer satisfaction ratings in a fast-paced environment.
  • Trained, cross-trained, coached and mentored staff in billing and collections best practice techniques to ensure timely resolution of receivables.
  • Lead resource and subject matter expert for resolution of payer denials, recovery projects, appeals, contractual/rate differential adjustments, refunds.
  • Produced analyzed and presented monthly, quarterly and annual account receivable reports for client meetings.
  • Resolved 121+ problem accounts and established exceptional client relationships through accounts resolution.
Languages
  • English
  • Spanish
Skills
  • EDI Implementation Project Management, Explanation of Benefits Expert, Strong Analytical & Problem-Resolution Skills, Conflict Management, Process Improvement, Staff Development, Productivity Analysis, Performance Improvement, Medical Terminology, Anatomy, Certified Procedural Coding, 5010, ICD-9/ICD-10, Secure File Transfer Protocol, UB-04, CMS-1500 Forms Specialist, PPS, PDGM, HCPCS/CPT Coding, MS Office Suite, SmartSheet, Adobe Acrobat ProDC, Technical Support
  • EHR Billing Systems: Cerner, Maestro/Meditech, HCHB, Brightree, Delta-Crescendo, Careficient, Interlink, CareAnyware, Casamba-Healthwyse, Wellsky/Kinnser, McKesson, KanTime, Devero
  • New Client Billing Assessments, Onboarding, Implementation, Training
  • Revenue Cycle Systems: Waystar, Zirmed, Quadax Xpeditor, NaviNet, Availity, SSI, Emdeon, OfficeAlly, Quadax Xpeditor, MyAbility, eSolutions, Medicaid Portals, FISS
  • Revenue Cycle Management: 5010 Electronic Transactions, EDI Billing, EDI Cash Posting and Remittances, UB-04 and CMS-1500 Forms
  • Support Ticket System Management
Education
1998Sandhills Community CollegeCity, StateCertified Procedural Coding, Medical Terminology, Anatomy
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Resume Overview

School Attended

  • Sandhills Community College

Job Titles Held:

  • RCM Systems Support Services Manager
  • RCM Systems Support & Billing Manager
  • RCM AR Team Lead

Degrees

  • Certified Procedural Coding, Medical Terminology, Anatomy

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