Revenue Cycle Consultant highly-motivated, organized, and competent with over 10+ years of experience in managing medical claims, handling disputes, and dealing with medicaid and commercial insurance companies. Experienced in supervising and training staff to ensure appropriate billing and payment collection procedures are followed in order to maximize reimbursement, minimize bad debt and ensure positive financial experiences.
Skills
Leadership and Strategy
Complex claim resolution
Project Management
Customer Billing
Medicaid/Commercial Insurance
Collections expertise
Process and procedure development
Hospice and palliative care
Claims denial process
Account Reconciliation
Work History
Revenue Cycle Consultant, 04/2019 to Current Community Health Network – Fortville, IN,
Review and process outstanding Client accounts receivable to facilitate subsequent payment and claims adjudication on timely basis working on average 40 to 50 accounts daily
Performed electronic and paper claim preparation and submission for various governmental and private insurance carrier
Interact with other department managers to improve processes/procedures from both operational and billing perspective with primary objectives of accurate billing, reimbursement maximization, and increasing cash flow
Remains current in Billing Compliance and state and federal collection regulations
Identify and provide solutions to breakdowns in revenue cycle which results in overall financial and quality improvement
Ensures that departmental policy and procedures are followed
Maintain relationships with major payers to establish mutually acceptable procedures to resolve reimbursement issues
Create, compile, analyze and present A/R performance metrics to Director of Patient Accounts
Identify opportunities for process improvements and or automation and implement new procedures
Responsible for special projects and all other duties as assigned
Strengthened team relationships and effectiveness with hands-on and motivational approach
Monitored department KPIs and employee performance and adjusted plans to meet daily and monthly goals
Revenue Cycle Account Manager, 09/2011 to 11/2018 Vitera Healthcare Solutions – Oklahoma City, OK,
Trained team of medical coders and collectors
Responsible for over 1.2 million in outstanding AR past 120 days resulting in collecting over 75% before adjusting to bad debt
Created incentive program for Revenue Cycle team
Managed revenue cycle to ensure proficient care of all patient account receivables
Worked with project managers to implement more efficient billing and collections procedures
Attended meetings with commercial Provider Reps to ensure proper billing, authorizations, and collections were handled timely and properly
Assisting and supervising daily functions of the billing department, and streamlining payment collection process
Responsible for all reports needed for month end process and identified any issues that prevented claims to be paid in a timely manner and corrected the problem
Handling billing financial standards by providing annual billing budget information, monitoring expenditure, identifying variances, and implementing corrective actions
Scheduling financial counseling for patients with large medical bills, and organizing monthly meetings with insurance company
Ensuring new contractors are fully trained prior to accepting their duties for working directly with patients, physicians, and insurance companies
Reviewing disputed medical bills, and resolving them by suggesting solutions
Reported monthly cash flow to Physician group
Physician Office Representative, 01/2009 to 09/2011 Neurovascular Association Of Texas – City, STATE,
Responsible for patient registration, scheduled, confirmed patient appointments
Verified insurance benefits, obtained referral when needed, entered patient demographics in database
Assisted office with transition from using EPIC software to using Centricity
Received and entered payments for Physician/Clinic Services according to insurance
Posted daily payments, billed charges for over 75 patients weekly in database utilizing appropriate codes
Assisted accounts section to perform verification calls with insurance companies
Reviewed patients' charts for determining detected diagnosis, and kept precise records of treatments provided to create appropriate discharge bills
Collaborated with accounts team to solve discrepancies in hospital bills for medical services offered
Interacted with various physicians, nursing staff, and other medical professionals to collect detailed information about clinical facilities provided to patients during treatment
Understood aspects of insurance coverage, completed paperwork, and kept accurate track of patient data over multiple visits for treatment
Education
: Psychology, Expected in Southwestern Assemblies of God University - Waxahachie, TX, GPA:
GED: , Expected in 2017 Navarro College - Corsicana, TX GPA:
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