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Revenue Cycle Leader Resume Example

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Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Summary
Dear Hiring Manager,
I came across this opportunity with Natera and would like to thank you for the opportunity for an interview.
 
As an accomplished professional with 8 years of experience in the Healthcare industry, including 6 years of a team leadership/management role; as well as management experience outside of Healthcare. I believe I would be the perfect fit for the position Manager, Reimbursement. My background includes extensive and intimate knowledge of multiple operating systems, and I am a quick study and eager to learn and incorporate new processes.
The following are just a few highlights of my professional skills and achievements that I bring to your company:
♦ Advanced proficiency in MS Excel and MS Word
♦ Extensive knowledge of EPIC Healthcare System
♦ Proficient knowledge Project Management
♦ Extensive knowledge in contracts
♦ Advanced knowledge in Management in multiple careers
♦ Proficient knowledge of ICD-10, CPT10, and HCPCS
♦ Advanced knowledge of medical terminology, medical insurance,
revenue, and payroll.
♦ Relationship and Team building techniques
♦ Currently in progress of obtaining Bachelor's Degree in
Healthcare Management and certification in IT related field

Skills
  • Advanced skills in creating tipsheets/workflows and training.
  • Experience in QA Audits
  • Oversee an intimate team of medical billing professionals tasked with collaborating with coding and medical records departments to ensure proper medical billing while increasing clean claim rate and expected reimbursements.
  • Regularly document and audit 1500 account pharmacy charge issues, resulting in reimbursement in excess of $800,000 within my department.
  • Create financial data reports for Chief Financial Officer showing clean claim rate, reimbursement, and adjustments per Ansi code reported by insurance payor.
  • Advanced proficiency in the EPIC Healthcare System, MS Excel, MS Word, and Medicaid Management Information Systems.
  • Demonstrate expert recruiting, suggested hiring, and training of new employees, while continuously strengthening team relationships through open communication and leading informative and constructive team meetings.
  • Advanced knowledge of Medical Terminology, Patient Confidentiality / HIPAA Standards, and ICD-10, CPT10, HCPCS
  • Exceptional communication skills in relation to both medical professionals and patients.
  • Created and implemented a process improvement plan for insurance follow up and denials resulting in more efficient process for my billing team.
  • Knowledge of various computer programs, including billing systems, document imaging system, and all Microsoft office product
  • Advanced knowledge of medical terminology, medical insurance, revenue, and payroll.
Education and Training
Ashworth College Norcross, GA Expected in 2018 Bachelor of Science : Healthcare Management - GPA : Healthcare Management
Penn Foster Scottsdale, AZ Expected in 2016 Certificate : Fitness and Nutrition - GPA : Completed
Laramie County Community College Cheyenne, WY Expected in 2008 GED : High School Diploma (Equiv) - GPA :
Completed
Experience
Cheyenne Regional Medical Center - Revenue Cycle Leader
City, STATE, 05/2011 - 06/2017
  • Manage a team that bills Medicare, Medicaid, and all commercial insurance billing.
  • Collaborate with multiple departments to interview, hire, and train candidates.
  • Audit departments processes within the organization, assist with workflows and improvements.
  • Review claims, records, charges in order to receive payment for rendered services.
  • Utilize Craneware and Chargemaster toolkit to audit claims for proper billing and locate any oversights in coding or charges, as well as the APC rates.
  • Process denial reports and appealed claims
  • Set up EDI billing procedures for payors.
  • Work with credentialing to collect correct documentation
  • Provide Assisstance to the Reimbursement Coordinator with preparing refund packets and review accounts for payor adjustments and disputes.
  • Research DRG audits, review documentation for provider reports meetings, provide correct information via reports and presentations for RAC auditor.
  • Create training manuals, tip sheets, and workflows for multiple departments.
  • Work alongside the Patient Access Manager and Director to correct multiple patient issues/concerns including but not limited to: Coverage corrections, Third party liability claims, Patient disputes, authorizations etc.
  • Assist Medical Records, Coding to review accounts processing and coding satisfaction.
  • Work with EPIC team to correct issues and updates needed for billing or charge purposes.
  • Oversee an intimate team of medical billing professionals tasked with collaborating with coding and medical records departments to ensure proper medical billing while increasing clean claim rate and expected reimbursements.
  • Developed and maintained professional relationships with Directors, Staff, Physicians, Clinics, Key administrators, and Managers to provide support as requested.
  • Provide Leadership to the team by communicating project objectives, contract, scope, terms, and schedules.
  • Create and build meetings as needed including meeting minutes or go to meetings
Cheyenne Regional Medical Center - HIM Tech/ Receptionist/ MA Assistant/ Back-up Insurance Coordinator
City, STATE, 11/2009 - 05/2011
  • Managed front office, and trained staff Answer phones, scheduled appointments, prepared patient charts
  • Worked as MA - took patient vitals and roomed and assisted patients with any questions
  • Worked closely with insurance companies to ensure patient coverage was correct
  • Kept close contact with physicians and psychologist to keep charts prepared
  • Functioned as the back-up Insurance Coordinator duties included: explaining nutrition and dietary changes as directed by Physician, Contacting payors for insurance coverage, surgical costs, and creating LOMN (letter of medical necessity).
  • Scan items in a timely and efficient manner daily.
  • Prep, assemble all documents in outlined order for chart prep policy
  • Review, discuss, collect patient financial at the appropriate time in the admission process
  • Obtained necessary signatures of consent for services and mandatory Medicare documents.
  • Communicate with third parties to coordinate authorized hospital services
  • Registered patients and/or responsible party in a timely and efficient manner using multiple methods of communications.
  • Promote accurate billing information and dissuades fraudulent use of insurance Execute the pre-registration and pre-authorization
  • Locate, organize, review, scan medical records backlogs, index, and file medical records.
  • Assisted in the delivery and pick up of patient charts
  • Support and enforce the HIPAA policies and procedures.
  • Perform qualitative and quantitative analysis of all records for incomplete or missing items and record those promptly on analysis worksheet
DT Stucco & Plastering - Cheyenne - Assistant Manager / Payroll Clerk
City, STATE, 01/2007 - 04/2009
  • Answered phones, set appointments/meetings
  • Maintained and controlled contracts
  • Assisted with contract bids and assisting owner with inputting data for business
  • Processed applications, analyzed and interviewed employees for hire Ordered products and materials from contracted companies
  • Utilized Intuit program for processing payroll accounts and managing internal funds.
Skills
Construction Management, Case Management, Healthcare Management, Administrative work/Assistant, Customer service/Management, Clinical Research, Team Building, EPIC EMR/EHR systems, Analytical thinker, Project Management, Medical billing system, Recruiting, Insurance, Leadership, Medical Assistant(MA), Microsoft products such as Access, MS Excel, office, MS Word, Health Information Management Systems, payroll, HIPAA policies, QA Project management/process improvement, Training, IT Related studies
References
  • Alex Chacon, Cheyenne, WY 82001 307-633-3048 (CRMC Contact Prev. employment) Operations Management Business Reference (Letter of Rec. available)​
  • ​Beth Hallingbye CRMC Cheyenne , WY 82001 307-633-7605 Executive Assistant; Business Reference (Letter of Rec. available)​
  • Bonnie Raner CRMC Cheyenne, WY 82001 307-432-6482​ Patient Access Director; Business Reference (Letter of Rec. available)​
  • Nathan Robillard CRMC Cheyenne, WY 82001 307-432-3633 IT PC Tech Lead; Business Reference (Letter of Rec. available)​
  • Tara Mueller CRMC Cheyenne, WY 82001 307-633-7619​ LPN; Business Reference (Letter of Rec. available)​
  • Rebecca Grant CRMC Cheyenne, WY 82001 307-633-6114​ Supervisor Bariatrics/Clinic; Business Reference (Letter of Rec. available)​
  • Catina Todd, Cheyenne, WY 82001 307-275-0757 DT Stucco & Plastering Owner (Business/Personal Reference)​​
  • Patty Hocker, Cheyenne, WY 82001 307-220-1033 Personal Reference​
Accomplishments
Cybrary Degree Name: CEU's
Field Of Study: CompTIA Linux+
Grade 10 CEU/CPE and 5.5 hour training course
Cybrary Degree Name: CEU's
Field Of Study: CompTIA Cloud+
Grade 4 CEU/CPE and 2.5 hour training course
Cybrary Degree Name: CEU's
Field Of Study: Micro Certification CEU's - IT Governance and Management
5 CPE/CEU Credit Hours
Cybrary Degree Name: CEU's
Field of Study: CompTIA A+ 45 CEU/CPE and 43 Hour Training course.

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Resume Overview

School Attended
  • Ashworth College
  • Penn Foster
  • Laramie County Community College
Job Titles Held:
  • Revenue Cycle Leader
  • HIM Tech/ Receptionist/ MA Assistant/ Back-up Insurance Coordinator
  • Assistant Manager / Payroll Clerk
Degrees
  • Bachelor of Science
  • Certificate
  • GED