Revenue Cycle Manager resume example with 12+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
Professional Summary
Adaptable Healthcare Operations Leader accustomed to the integration of new healthcare delivery systems and restructuring of work in an increasingly complex regulatory environment. Skilled at communicating, organizing and solving problems with expertise in all areas of healthcare management, including budgeting, program planning, project management and staff training and development.
  • Employee Relations & Performance Management
  • Revenue Cycle Operations Management
  • Account & Project Management
  • Client Relations, Sales & Marketing Management
  • Strategic, Implementation & Contingency Planning
  • SWOT Analysis, Gantt Chart and Process Mapping
  • Recruiting, Hiring, Training and Development 
  • Financial Forecasting & Budget Planning
  • Audit Analysis and Risk Assessment
  •  Quality Case Management
  • Six Sigma Lean and Kaizen Philosophies
  • InfusionSoft, MS Visio, PowerPoint, Project, Microsoft Office Suite
  • AS400, EPIC, Mainframe, IEX, CISCO, Avaya
  • Medical Billing & Terminology
  • HCPCS and ICD-9/ICD-10 Coding 
Work History
Revenue Cycle Manager, 11/2015 to 08/2016
Acadia HealthcareFordyce, AR,
  • Managing revenue cycle patient account staff in processing accounts and working with designated Medicare, Medicaid, and commercial payers to ensure proper reimbursement.
  • Facilitate the identification of issues and solutions by operations related to delays in achieving payment resolution.
  • Manage aging of accounts receivable by trending and analyzing A/R with thorough communication with payers.
  • Monitor collection processes to determine cash flow improvement opportunities.
  • Manage workflows to meet employee productivity and collection efforts across all client facilities.
  • Work with A/R supervisors to identify department training needs for system education, industry updates and changes in collection processes and protocols.
  • Work with A/R Supervisors and staff to ensure employee productivity and quality meets standards.
  • Maintain excellent working knowledge of Patient Financial Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payers.
  • Maintain a thorough understanding of health insurance and government programs, where necessary.
  • Ensure compliance with state and federal laws and regulations.
Director of Sales, 05/2015 to 09/2015
Csm CorporationLansing, MI,
  • Developing and executing overall strategic sales initiatives as well as advising executive team as a key partner for critical decision support.
  • Implementation of business development strategy and sales management across global markets.
  • Establish and execute the Annual Sales & Strategic Plan.
  • Develop key partnerships with other brand leaders including non---profits, food and nutrition companies, and technology companies.
  • Recruit and hire sales team, and lead the development and implementation of specific revenue benchmarks for team members, and all sales channels.
  • Help Account Managers create employee competitions, contests and other engagement tactics.
  • Ensure strategy aligns with and is achieving corporate goals in accordance with best in class sales practices.
  • Increase sales capacity and market coverage in key verticals.
  • Ensure sales team execution within InfusionSoft environment.
  • Increase channel visibility within B2B, multifamily and non--profit channels.
Insurance Operations Supervisor, 2012 to 06/2014
HcaOrlando, FL,
  • Managed, developed and motivated a team of forty Prior Authorization Pharmacy Technicians.
  • Completed monthly employee one on one meetings and yearly performance reviews.
  • Processed employee timecards, consisting of approvals, denials, and time off.
  • Conducted interviews, hiring, on-boarding and releasing of employees in collaboration with Recruiting and Human Resources.
  • Analyzed monthly financial negative margin reporting to ensure accurate reimbursement and claim adjudication.
  • Oversaw prior authorization claim submissions to commercial, Medicare and Medicaid payers.
  • Monitored rejected dialysis bundle billing claims with Medicare as well as grievance and appeals process.
  • Partnered with government policy department to ensure all Medicare and Medicaid policies were in compliance and workflows updated with new year policy changes.
  • Implemented intensive refresher training & competency testing for all four insurance departments.
  • Time studied queues to baseline prior authorization production metrics to increase productivity and minimize variable labor cost.
  • Created quality auditing tools and benchmarks for prior authorization processing and provided feedback to ensure quality patient case management.
  • Held team activities on and off site to improve employee engagement and employee morale.
  • Recognized by president and in company newsletter for zeroing production queues.
Regional Account Manager, 07/2010 to 09/2011
Harsco CorporationPomona, CA,
  • Managed, developed and motivated a team of forty contract Pharmacy Technicians.
  • Cultivated client relationships with drug manufacturer and internal sales teams.
  • Organized and hosted weekly meetings with the sales team, drug manufacturer, operations, and reimbursement departments.
  • Coordinated shipping operations to centralize across seven national pharmacies.
  • Root cause analysis of FedEx exceptions to minimize shipping shrinkage impact.
  • Collaborated with Finance and Reimbursement departments to analyze, forecast and maintain department and pharmacy budgets.
  • Ensured monthly product quotas met and quarterly drug manufacturer rebates collected.
  • Maintained strong rapport with Sales Account Managers, Manufacturer Regional Account Managers, Manufacturer Account Executives, and pharmacy personnel.
  • Heavily communicated with Medicaid payers to ensure accurate claim submission practices followed as well as policies and procedures remained in compliance.
  • Trained Pharmacy Technicians on proper CPT coding for claim submission as well as claim correction for both commercial and Medicaid payers, grievance and appeal processing and aging account flagging.
  • Implemented numerous measures for processing prescriptions, verifying benefits and eligibility, and handling payer compliance of brick and mortar Medicaid regulations within region.
  • Implemented the creation of a database and reporting tools for Home Health accounts.
  • Processed employee timecards, consisting of approvals, denials, and time off.
  • Fostered rapport and collaborative relationships with numerous staffing agencies for seasonal hiring.
  • Conducted interviews, hiring and releasing process of employees in partnership with Human Resources and staffing agencies.
QA Training Specialist/Process Improvement Analyst, 09/2007 to 07/2010
Wellstar Health SystemKennesaw, GA,
  • Extrapolated and analyzed audit data for reporting to clients, including Medicare Part D.
  • Conducted URAC requirement meetings and training of weights and measures with frontline staff.
  • Developed audit tool and audit measurement definitions, policies and procedures.
  • Conducted weekly calibration meetings with auditors across multiple sites to ensure consistency.
  • Quality audited staff to meet and maintain quality service levels via monthly audits.
  • Trained new hire employees on auditing process and policies.
  • Lead project development of documenting Desktop Procedures, coordinating with Prior Authorization and Customer Service departments across multiple sites.
  • Trained employees on new Desktop Procedures implementation, and policies.
  • Created a Rewards and Recognition Program to incentivize employees to improve audit scores and increase quality and accuracy.
  • Increased quality improvement project initiatives by 75% within the first year.
  • Reduced number of staff falling below benchmark by 35%.
Prior Authorization Supervisor, 03/2006 to 08/2007
Dlh Holdings Corp.North Charleston, SC,
  • Managed, trained and motivated a team of twelve Prior Authorization Pharmacy Technicians.
  • Conducted biweekly team meetings and provided ongoing mentoring sessions.
  • Silent audited calls and provided side by side coaching and training to employees.
  • Developed training materials for Training department and reporting tools for management.
  • Monitored and maintained Medicare Part D client service levels, surpassing service level requirement by 10% in all 4 quarters of 2007.
  • Monitored employee average call time, speed of answer, RONAs, after call work and provided coaching.
  • Partnered with leads across multiple sites in daily meetings to manage call center metrics.
  • Developed and maintained a current and thorough knowledge of plan prior authorization benefits.
  • UAT tested new system software pre and post implementation.
Lead Certified Pharmacy Technician, 06/2005 to 02/2006
Winn-DixieCity, STATE,
  • Streamlined inventory systems for improved count accuracy.
  • Refined documentation processes for new and renewal prescriptions.
  • Executed inventory improvements that reduced yearly waste by $4,000.
Script-Pro Trainer/Certified Pharmacy Technician, 01/2004 to 05/2005
RiteAidCity, STATE,
  • Trained staff in various stores on robotic filling and computer programs.
  • Directed marketing that generated the addition of two assisted living facilities.
  • Aided doctors, nurses, medical assistants, and authorized agents in prior authorization process.
Certified Pharmacy Technician, 11/2002 to 01/2004
Sentara Norfolk General HospitalCity, STATE,
  • Performed intravenous admixture and total parenteral nutrition compounding.
  • Operated Pyxis medication systems and drug re-packing equipment.
  • Improved OSHA inspection ratings with revamped pharmacy processes.
Bachelor of Science: , Expected in 1997 - 1998
Virginia Wesleyan College - Virginia Beach, VA
30 Credit Hours Completed
High School Diploma: , Expected in 1997
Granby High School - Norfolk, VA
Advanced Academic Diploma

National Certified Pharmacy Technician: 2003 - 2018 - License# 2501-0103-0358-416

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Resume Overview

School Attended

  • Virginia Wesleyan College
  • Granby High School

Job Titles Held:

  • Revenue Cycle Manager
  • Director of Sales
  • Insurance Operations Supervisor
  • Regional Account Manager
  • QA Training Specialist/Process Improvement Analyst
  • Prior Authorization Supervisor
  • Lead Certified Pharmacy Technician
  • Script-Pro Trainer/Certified Pharmacy Technician
  • Certified Pharmacy Technician


  • Bachelor of Science
  • High School Diploma

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