Revenue Cycle Management Supervisor Resume Example Accredo An Express Scripts Company

REVENUE CYCLE MANAGEMENT SUPERVISOR

Professional Summary

Analytical and patient focused health care professional with many years experience in revenue cycle management. Strong proficiency in financial strategies including on-boarding, verification, process improvement and departmental leadership focused on positive customer outcomes. Take a moment to review my profile on Linkedin (https://www.linkedin.com/pub/jan-breeden-lee/83/724/388 )

Core Qualifications

Accomplished leadership
Independent judgment and decision making
Effective mentor and coach
Excellent Presentation skills
Customer focused

Quality improvement
HIPAA compliance
Medicare/ Medicaid statutes and regulations
Attention to detail
Root case analysis

Experience

07/2001 to 11/2013

Revenue Cycle Management SupervisorAccredo - An Express Scripts Company － Memphis, TN

HR functions: staff of 25 ; performance, disciplinary, payroll and career planning management.
Departmental Liaison for the Taleo on boarding team. Expert understanding of Kronos payroll system.
Utilized monthly team and individual meetings to build moral, solicit feedback and communicate new directives.
Communication, collaboration and Customer Service functions: communicate, clarify and train organizational changes and updates.
Work with Managed care team,providers, vendors and patients to resolve complex insurance reimbursement issues.
Routinely reviewed and updated departmental policies, procedures and programs.
Designated departmental subject matter expert. Member of Accredo Presidential Committee of Excellence.
Project leader assigned to train the reimbursement team to assist with pharmacy scheduling of Medco specialty patients.
Department Liaison to IT and UAT team for reimbursement system updates.
Work stream functions: Work with peers and other departments to improve efficiency; develop processes to improve quality and customer service.
As designated department SME worked with Directors, training department and QA to review, update and implement SOP changes as needed.
Member of project team assigned to align SOP of 3 divisions, assisted with training and on-boarding of back office team.
Finance functions: Analyzed multi million dollar AR, recommended and implemented strategies to meet or exceed departmental goals.
Member of the review and advisory team tasked with initial requirements and objectives for the Medi Finance system.
Managed various patient assistance programs that allowed patients to start or continue therapy.

12/1999 to 06/2001

Insurance AnalystAccredo Health Group － Memphis, TN

Analyzed, researched and compiled utilization data for internal and external reporting.
Routinely collaborated with department managers to correct problems and improve services.
Completed monthly QA audits and provided feedback via trend reporting.
Identified process improvements in the day-to-day functioning of the department.
Closely collaborated with management teams to develop process and policy improvements.
Responsible for training and development of staff.
Interpreted and communicated new or revised state medicaid, medicare and CMS policies to staff.
Facilitated an on-going assessment of patient/family needs for patients participating in an internal assistance program.

10/1997 to 11/1999

Patient Account RepresentativeNova Factor, Inc － Memphis, TN

Verified patient insurance benefits to insure payment prior to dispensing.
Obtained prior authorizations, coordinated with physicians, payers and members of the clinical care department.
Negotiated payment plans with patients.
Solicited payers to include our organization in their network or agree to a negotiated rate agreement.
Completed HCFA-1500, universal claim forms or special reimbursement forms for submission to payers.
Processed claims electronically through Emdeon and NDC systems.
Reviewed explanation of benefits and payment vouchers, compared them to verified benefits and calculated to determine that correct payment was received and posted correctly.
Submitted claims to secondary payers for coordination of benefits.
Followed up with payer when payments did not match benefits or were not received timely.
Reviewed contract documents to verify billing compliance.
Wrote and submitted payment appeals.
Negotiate payment settlements to close out delinquent accounts.
Completed quarterly review of accounts to identify and resolve bad debt.

Accomplishments

Member of the Accredo Presidential Committee for Excellence.
Reduced AR for discharged patients from $4 million to less than $250,000.
Designated Department Subject matter expert for organizational, system and process issues.
Traveled to India to assist with on-boarding of back office team.

Previous Experiences

Pittman & Associates - Claims Examiner; Memphis, TN
KFC - General Store Manager; Memphis, TN
DOD: Department of the Army - Medical Clerk Receptionist; Honolulu; HI
California Pacific Insurance Services - Claims Examiner; Honolulu, HI
ABPA - Claims Examiner; Honolulu, HI
Operating Engineers Benefit Fund - Claims Examiner; Newark, NJ
NYS Insurance Fund - Compensation Claims Clerk; NY, NY

Education

Bachelor of Arts: Social Sciences and Business Administration Nazareth College of Rochester － Rochester, NY

Specialization Certificate: Introduction to Project Management Principles and PracticesCoursera: University of California, IrvineProfessional Development

Certifications

PTCB - Certified Pharmacy Technician 2001 to present

Resume Overview

Companies Worked For:

Accredo - An Express Scripts Company
Accredo Health Group
Nova Factor, Inc

School Attended

Nazareth College of Rochester
Coursera: University of California, Irvine

Job Titles Held:

Revenue Cycle Management Supervisor
Insurance Analyst
Patient Account Representative

Degrees

Bachelor of Arts : Social Sciences and Business Administration
Specialization Certificate : Introduction to Project Management Principles and Practices

Revenue Cycle Management Supervisor Resume Example

Resume Score: 80%

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