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revenue cycle manager resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Profile

Proactive, innovative and motivated Claims Operations and Revenue Cycle Manager skilled in production solutions and support, claims operations, workflow management, patient billing and business process re-engineering with more than 20 years of experience working with insurance companies, reviewing claims, determining coverage, reducing delinquency and improving collection efforts. Highly effective at business analysis, process improvement, team building and documentation. I possess a high degree of integrity, outstanding work ethic, strong leadership qualities and strong interpersonal skills. Looking to share this expertise with a top-notch, cutting edge organization.

Summary of Skills
  • Multi-unit/state Operations Management
  • Procedure Development and Optimization
  • Business Process Re-engineering
  • Strong Team Building/Development/Motivation
  • Process Improvement strategies
  • Strong Cultivation of Positive and Productive Team Environment
  • Crystal Reporting
  • Database Management
  • Workflow Management
  • Systems Implementation
  • Contract Management
  • Business Analysis
  • Business Requirements
  • Client Relationships
  • Vendor Management
  • Productivity Improvement
  • SharePoint
  • Technical Support
  • Meeting SLAs and KPIs
  • Change Management
  • Troubleshooting and Problem Solving
  • Revenue Metrics Analysis
  • Sound Decision-Making
  • Budget Monitoring
  • Excellent Negotiation Skills
Accomplishments
  • Developed policies & procedures that standardized processes decreasing errors and increasing revenue.
  • Developed a performance management system/quality review process to provide monthly feedback on staff performance and the health of the revenue cycle.
  • Through coaching and mentoring increased productivity and improved quality review audit results.
  • Re-engineered the claims process, start to finish, and reduced a 9-month backlog after a new system implementation.
  • Identified a billing issue and successfully resolved the problem gaining the organization $185,000 and the ability to bill certain drugs via the pharmacy.
  • Created 2 positions within the department to allow for successful training and auditing which identified areas needing improvement.  With additional training and system changes reduced the need for 3 FTEs and brought the A/R over 90 & 120 days inline with the KPI/SLA.
  • Streamlined operations and prioritized tasks, allowing senior staff to increase revenue by 18%.
  • Successfully reduced an inherited backlog of claims, decreasing turnaround time from 26 days lag to 18 days lag allowing payment to go out 8 days ahead of target. Identified areas for improvement and developed a process to allow accurate 1st time claim processing, reducing the need for reprocessing, saving the organization value time and money.
Work Experience
Revenue Cycle Manager, 12/2011 - Current
Barrow Neurosurgical Associates Chandler, AZ,

Manage the contracting, training, documentation, quality review, benefit verification, billing, payment posting, collection, pharmacy support and incoming call processes for 40+ health centers across 6 states.

  • Daily monitoring of service levels and key performance indicators
  • Facilitate revenue and collection efforts
  • Identify areas of process improvement and ensure reimbursement systems are optimized
  • Identify and develop skills within the team for staff development and growth
  • Collect and analyze reports to make data driven recommendations
  • Review and evaluate processes and procedures to determine areas of effectiveness, efficiency and improvement
  • Collaborate with staff from all areas and to review and make recommendations for system requirements, documents and business or access analysis initiatives
  • Key liaison for Clinical Applications Services, Clinical Services and external vendors
  • Contract management
  • Pharmacy management
Operations Manager, 08/2008 - 05/2010
A.M. Castle Stockton, CA,

Led a team of Supervisors, Team Leads, Senior Claims Processors and Provider Data Administrators

  • Provided leadership, direction and management of the daily operations across multiple units within the operations department
  • Responsible for meeting service level agreements for multiple clients
  • Managing member of cross-functional team that created processes and procedures
  • Developed communication for new business and process improvement initiatives
  • Managed team development between claims processing and coding & configuration departments to streamline operational efficiencies across units
  • Performed performance appraisals and compensation recommendations of direct reports
  • Responsible for hiring staff and recommending changes to improve and support business solutions activities
  • Vendor Manager for SunGard/EXP Macess Product, TUI and TELA Outsourcing
EXP Macess Workflow System Administrator, 02/2005 - 08/2008
Dean Health Madison, WI,

Responsible for configuring, implementing, maintaining and upgrading the EXP Macess Database

  • Provided technical support for issues for customers using EXP Macess platform
  • Served as vital part of Production Support team providing general technology support services for both internal and external clients and ensuring overall customer satisfaction
  • Served as central figure supplying expertise regarding EXP Macess system to clients as well as to other Adaptis team members
  • Wrote business system requirements for database; wrote test cases and performed user testing
  • Eliminated daily operations (paper) batch jobs and need for overtime
  • Streamlined reporting outputs to meet clients need
  • Implemented inter-company HIPAA compliant request process through EXP Macess; created and Implemented several forms that were traceable for auditing
  • Created and ran reports using EXP Macess reporting tool, Crystal Reports and SQL to allow evidence-based decision making for clients, both internally and externally
  • Vendor Liaison for EXP Macess/SunGard and contracting
Claims Operations Supervisor, 03/2000 - 02/2005
Adaptis Inc City, STATE,

Supervised a team of 20 Claims Specialists.

  • Monitored daily activities and workflow of staff to ensure production and quality levels were being met
  • Worked with clients to research and resolve questions on claims billing and provider issues
  • Met SLA saving company from penalties and insuring customer satisfaction
Education
Certificate: Database Management, Expected in 2007
-
University of Washington - Seattle, WA,
GPA:
Status -

Learned to capture, store, retrieve and analyze information in meaningful ways. Familiar with the fundamentals of database management technology, design, development and administration. Gained experience working in distributed, mainframe, client-server and desktop environments. Learned the roles and responsibilities of a database administrator and how to diagnose and troubleshoot database issues.

: Communications, Expected in
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Highline Community College - Des Moines, WA,
GPA:
Status -

Coursework in Business Communications and Management Information Systems

: Fashion Design, Interior Design and Buying, Expected in
-
Fashion Institute of Design & Merchandising - San Diego and Los Angeles, CA
GPA:
Status -

Studies prepared me to enter the global industries of Fashion, Visual Arts, Interior Design, Buying and Entertainment.

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Resume Overview

School Attended

  • University of Washington
  • Highline Community College
  • Fashion Institute of Design & Merchandising

Job Titles Held:

  • Revenue Cycle Manager
  • Operations Manager
  • EXP Macess Workflow System Administrator
  • Claims Operations Supervisor

Degrees

  • Certificate

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