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revenue cycle claims manager resume example with 17+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Professional Summary

Detail oriented quality focused professional in Revenue Cycle Management. Successful track record handling complicated assignments. Highly experienced in reconciling insurance and patient payments and resolving account disputes. Proficient in a variety of practice management software applications. Dedicated to maintaining strict patient confidentiality.

Skills
  • ICD-9, CPT-10, & Medical Terminology Charge and Payment Posting
  • Medical Insurance Billing Records Organization & Management
  • Accounts Receivable Follow-up HIPAA Compliance
  • Denials Management Download 835 & 837 via payor portals
  • EOB Interpretation Excellent Interpersonal Skills
  • Various Practice Management Systems use Proficient in Ms Office Suite: Word, Excel, PowerPoint
  • Vision
Work History
Revenue Cycle Claims Manager, 12/2014 to 02/2022
'Ike GroupHonolulu, HI,
  • Managed a staff of 15; including hiring, training, performance reviews and disciplinary action
  • Responsible for the accounts receivable of 17 different clients totaling $5 million in charges each month, including credentialing, denial management and third party follow up
  • Analyzed the top denials for each client and identified solutions to increase cash and A/R days
  • Reduced average days in A/R from 79 to 60 in a 3 month time period
  • Increased net collections from 65% to 80%
  • Built collector work-queues and monitored the performance of the staff
  • Worked with the clearinghouse and the payers to ensure all claims were processed and received by the insurance companies in a timely manner
  • Reduced clearinghouse denials from 39% "bomb" rate to 15% in a 6 month period of time
  • Maintained a strong relationship with all clients and presented trends to them on a monthly basis
  • Wrote policies and procedures for billing, collection, and posting
  • Assist with Month-End Close
  • Provide support and backup assistance to other areas as needed
Revenue Cycle Analyst, 06/2020 to 08/2021
'Ike GroupHonolulu, HI,
  • Collaborated with other business analysts to streamline tasks and duties in effort to improve overall efficiency.
  • Analyzed financial and statistical data related to revenue cycle, creating in-depth reports to show KPIs.
  • Identified and resolved payment issues between patients and providers.
  • Balanced and reconciled accounts A/R against payer remittance advice and patient credit card payments.
  • Reviewed / worked / resolved escalated claims within my assigned work-queue.
  • Respond to insurance requests for records/reports
  • reviewed charge, scheduling and other financial reports along with billing practices to ensure physician and office reimbursement is appropriate.
  • Ensured timely submission, reimbursement, and claim follow-up of professional and hospital claims.
  • Prepare, key, and review claims prior to reconciliation
  • Processed claim corrections captured on the clearinghouse claims rejections report.
  • Audit payer payments in accordance to contract to ensure proper claims adjudication and reimbursement.
  • Participated in special projects related to payer under-payments.
  • Reviewed accounts with balances to identify next steps, including balances needing to be set as "collections" for balance due patient.
Revenue Cycle Analyst, 10/2005 to 02/2014
Axonics, Inc.Irvine, CA,
  • Managed six direct reports, seven indirect reports, including financial operations team
  • Directed the full lifecycle of revenue cycle operations
  • Established and implemented new departmental revenue cycle processes
  • Advised clinical personnel on all revenue cycle procedures and resolved coding issues for clinical and financial staff
  • Managed Oncology's
  • Chargemaster (CDM) and IDX Dictionary updates
  • Served as liaison between the practice and all other associated internal departments
  • Recognized for distinguished project execution on transition to new system
  • Overhauled policies and procedures to eliminate gaps and standardize processes
  • Reduced time to learn new software applications with development of instructional training manuals
  • Reduced waiting time for insurance reimbursement having conducted a need gap analysis, developed and implemented Maintained quality levels by conducting random charge/coding audits and working with personnel to resolve problems
  • Trained physicians and lead in-service presentations to ensure compliance on correct coding and Reviewed encounter claims in preparation for billing, cleared pre-billing edits, transmitted electronic and paper claims submission
  • Post and reconcile insurance and patient payments
  • Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts Set up new patient accounts in the Practice Management EMR System Assign ICD-9/10 to physicians diagnosis and insure correct level of service and various other CPT codes Set-up practice management EMR system for submission of electronic claims to clearinghouse
  • Work with clearinghouse to resolve file compatibility issues Retrieve Electronic Remittance Advice (ERA's) Submitted secondary claims upon processing of primary insurance
  • Monthly processing of Patient statements
  • Answer and resolve patient billing inquires Follow up on Insurance and patient aging
  • Re-submit insurance claims as necessary
  • Knowledgeable in timely filing restrictions
  • Insure office practices are in compliance with HIPAA regulations
Accounts Receivable Specialist, 06/2003 to 09/2005
GMS Revenue Cycle Consulting GroupCity, STATE,
  • Charge entry, and electronic billing, and paper claims to payors who require reporting with submission of claims
  • Responded to claim denial mail and resubmitted claims with necessary corrections and/or medical reports when required
  • Responsible for researching and posting all payments to outstanding patient accounts
  • Identified over-payments on accounts and initiate a refund on overpaid accounts
  • Contact banking institution about any missing deposits or deposit errors immediately
  • Insure Front office patient co-pay accuracy by balancing clinical totals daily as well
  • Cash report reconciliation per Physician, as well as per facility and reconciling complete practice daily totals
  • Ran claims for secondary payors, copied EOB's for submission of claims to patient secondary insurance carrier
  • Complete month-end reports and reconciled directly with Practice Manager's
  • Analyze inpatient and outpatient records for deficiencies Establish and maintain medical records Coordinate timely retrieval of any required medical records information Maintain patient confidence by keeping patient records information confidential
Education
High School Diploma: , Expected in to All American Sr. High School - Miami, FL
GPA:

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Resume Overview

School Attended

  • All American Sr. High School

Job Titles Held:

  • Revenue Cycle Claims Manager
  • Revenue Cycle Analyst
  • Revenue Cycle Analyst
  • Accounts Receivable Specialist

Degrees

  • High School Diploma

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