Management position where my experience, analytical, problem solving and training skills could help execute projects on time and within budget
01/2013 to Current
Revenue Cycle AdministratorAlbert Einstein College of Medicine
To ensure the integrity of the entire revenue cycle of the Rose F.
Kennedy Center CERC including: Patient Accounts, Claims Management, Billing and Collections, Patient Insurance, and Data Processing.
Develops, implements, and maintains the Practice's revenue cycle standard operating procedures.
Responsible for the overall coordination of front office duties to include scheduling, check-in, and co-pay/co-insurance collection Management oversight of all business related functions of the patient visit from point of entry to accurate adjudication of the patients' accounts Analyzes claims, utilization, and medical cost data Resolves escalated reimbursement issues with over a dozen payors Monitors aged accounts, verifies appropriate collections procedures are being followed and works with a collection agency as needed Manages projects at the practice level, such as audits and budgets Develops, monitors, and assesses business metrics in order to refine processes and improve efficiencies Establishes internal goals and identifies external benchmarks Responsible for maximizing the collection of medical services payments and reimbursements from patients, Medicaid/Medicare and third-party insurance carriers Provide hands on administrative supervision of ~ ten 1199 Clerical workers at the front line of patient care in four different locations, including 3 Reimbursement Data Specialists, and a number of Clerks.
Responsible for interviewing candidates for the billing and registration staff Monitor administrative functions and integrity of information per HIPAA guidelines Provide training relative to revenue cycle, analytics, and all other revenue cycle management activities Develop and implement systems to improve services, efficiencies, and staff productivity Establish and enforce work standards Independently handle disciplinary proceedings Ensure critical staff coverage for all billing and registration areas Track daily attendance Approve and process time off requests Perform monthly one-on-one meetings with each employee and sets goals and establish performance reviews; gives timely, specific feedback and helpful coaching Cascades Center goals down to staff's annual objectives Holds monthly team meetings to update staff on changes, new policies, etc.
Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed CERC's objectives.
Keeps abreast of all regulatory changes affecting provider reimbursement Develops training materials and facilitates staff training of standard operating procedures, systems and Government regulations Enforces adherence to CERC's Billing and Revenue policies Ability to identify areas in need of billing policy changes, through the use of concrete examples and data collection, and in response to current or new NY State Article 28 or Article 16 regulations, federal law, or Einstein requirements.
Acts as primary liaison to the MillinPro implementation team, requiring 125+ hours of preparation time: Coordinate all data transfers from a 26 year old practice management system Patient account information Clinician demographics Participate in the planning and design of all custom features Act as one of the primary 'super users' and subsequent trainers for the RFK CERC staff Assist in the on-going implementation and management of Ambulatory Patient Groups (APGs) required by the NYS DOH in coordination with the Assistant Director, Administrator, and CERC budget analyst.
Acts as the Center's lead administrator responsible for the implementation of the upcoming ICD-10 transition, Responsible for insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and accounts receivable management, denial management, reporting of results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight Handles patient/family calls regarding complaints and/or account inquiries and records complaints per Article 28 regulations Regularly provides upper management with revenue cycle status including reports, metrics, and presentations Works hand in hand with the CERC budget analyst to produce all relevant reporting materials Travels as needed to attend pertinent industry conferences and meetings Acts as the Administrator on Duty during times when the CERC Administrator and Assistant Director are out of the office.
01/1991 to 01/2013
Systems ManagerAlbert Einstein College of Medicine
Manage, maintain and monitor system resources for Sun Enterprise 250 Design, test and produce reports for research studies, productivity management and outpatient follow-up Research and purchase all computer equipment and software for CERC at five sites Install all PC workstations and networks for entire CERC staff Proven ability to analyze system requirements and advise users on the most appropriate hardware/software Troubleshooting skills to diagnose system/ programming bugs Excellence in providing user support and user training Developed and tested new operational procedures for the Global Health System(GHIS) system to cope with legislated changes in health care delivery, such as Managed care, Medicaid utilization thresholds and special contracts, thereby sustaining CERC's revenue under changing structures Worked with Associate Director, Billing Supervisor and Billing Staff; developed system which helped bring Medicaid revenues from 85% to 97% of billings on annuals basis; generated a quarter million dollars per year on "old" denied claims Set in motion the system for billing and collection(through collection agencies of unpaid debts, supervised weekly submission of paid activity reports and posting of pay.
01/1989 to 01/1991
Programmer/Facilities ManagerGlobal Health Systems – Rockville New York City, MD
Developed and program reports needed by Global sites Participated in weekly systems development meetings Provided training and assistance to users on the system Troubleshoot any hardware problems that surface Installed computer equipment needed by Global sites Managed, maintained and monitored system resources among users at all for sites Report user's requests and problems to main office in Rockville, Maryland Debug and test new software.
BS: Computer Information Systems BusinessMercy College - Dobbs Ferry, New York Computer Information Systems Business
accounts receivable, administrative, analyst, agency, auditing, Billing, billings, budgets, budget, Clerical, coaching, hardware, conferences, contracts, data collection, Data Processing, delivery, DOH, features, front office, Government, Insurance, law, Director, materials, meetings, office, 97, Works, Monitors, Enterprise, networks, performance reviews, policies, Portuguese, presentations, processes, coding, programming, reporting, Research, scheduling, software
Troubleshooting, Spanish, staff training, Sun, Supervisor, supervision, systems development, user support, user training, training materials, Troubleshoot