Revenue Cycle Manager Medical Billing And Collections Specialist resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:

Meticulous Revenue Cycle/Billing Manager offering over 15 years of comprehensive experience in RCM, Billing, AR/Collections, and Authorizations. Comfortable in all Management positions and as part of a supportive team. Extensive familiarity with Waystar, Availity, Epic, Eservices, and all other Insurance portals. Core competencies include diligent billing professional bringing a demonstrated history of success in drafting financial reports and effectively reconciling outstanding invoices. Quick-learning and ambitious with a passion for challenges and applying new skills for professional growth.

  • Time Management
  • HCPC, CPT, and ICD10 proficient
  • Prioritizing and Planning
  • Goal Setting
  • Financial Resources Management
  • Customer Service
  • Team Building Leadership
  • Staff Recruitment and Hiring
  • Account Monitoring
  • Revenue Metrics Analysis
  • Billing Cycle Performance
  • Cash Flow Management
  • Collections Actions
  • Insurance Negotiation
  • Attention to Detail
  • Spreadsheet Tracking
  • HHA Exchange-Medicaid and MCO Billing
Revenue Cycle Manager/Medical Billing and Collections Specialist, 10/2014 - Current
Visiting Nurse Association Of FL, INC City, STATE,
  • Evaluate revenue cycle processes and established actionable methods to increase productivity and efficiency.
  • Analyze and report billing cycle data to inform management.
  • Participate in revenue cycle processes, working to maximize profitability and increase revenue.
  • Assist in both Manual and ERA cash posting
  • Provide revenue cycle process support to all clinical personnel, including resolving procedure challenges.
  • Complete month-end and year-end closings, keep records audit-ready and monitored timely recording of accounting transactions.
  • Maintained current and accurate cash balances for all programs, departments and projects.
  • Directed work of team of 12-20 Medical Billing, Insurance, and Collection Specialist handling AP/AR, collections and all other accounting functions.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Completed and submitted appeals for denied claims.
  • Reviewed claims for coding accuracy.
  • Coordinated communications between patients, billing personnel and insurance carriers.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Handle billing, waivers and claims for private and commercial clients.
  • Kept accounts current with facility-approved reporting and analysis strategies.
  • Submitted and accurately processed both 1500 and UB claims with related medical code verifications and assessments.
  • Maintained high accuracy rate on daily production of completed reviews.
  • Use various Insurance Billing portals and storage retrieval systems to manage medical billing.
  • Kept operations in full compliance with state, federal and TJC requirements.
  • Prepare and update new system to handle billing needs with improved accuracy, reliability and overall performance.
  • Maintain open contact with insurance carriers, policy underwriters and marketing team members.
  • Enter time cards on ADP and approve time off
  • Work closely with the accountants to ensure all EFT and checks reconcile on a daily basis
  • Identifies all credit balances from Insurance's, as well as self pay
  • Gather and disseminate information to billing and reimbursement
  • Conduct bi-weekly AR meetings with Billing Specialists to ascertain status of accounts, discuss collection strategies, and drive continuous improvement
  • Over 15 years experience in Lead or Management positions, as well as highly proficient in Billing and Authorization with Commercial, Private Pay, Medicaid, VA, Medicare Replacements, and Medicare
  • Advanced knowledge with HCPC, CPT, and ICD10 codes
Lead Patient Care Coordinator/Authorization Specialist, 09/2001 - 12/2011
Cleveland Clinic-Martin Memorial North City, STATE,
  • Explained eligibility details and affordability options to patients with kindness and respect.
  • Contacted customers to notify of delinquent payments and resolve.
  • Verified patient reimbursement eligibility and coverage for Inpatient Hospital, Radiologist, ER Physicians, and Hospitalist
  • Prior Authorization for all Inpatient and Outpatient services
  • Obtained re-authorization if required by Insurance Company
  • Coordinated Benefits with in-house Case Managers
  • Checked patients in by obtaining the correct demographics
  • Collected any copays or deductibles
  • Made payment arrangements if necessary
  • Worked closely with Authorization Specialist to ensure authorization was approved and Insurance was active
Lead Billing-Coding Specialist, 01/1998 - 09/2001
Cleveland Clinic-Martin Memorial North City, STATE,
  • Processed and sent invoices, adjustments and credit memos to customers.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Performed data import, scanning or manual keying processes to verify invoice accuracy.
  • Investigated and resolved issues to maintain billing accuracy.
  • Prepared manual billing data using related billing and service reports.
  • Resolved reimbursement discrepancies by analyzing information and notifying manager.
  • Worked with team members and leadership to identify and develop process improvements.
  • Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
Education and Training
High School Diploma: , Expected in 06/1995
Port St. Lucie High School - Port Saint Lucie, FL
: Health Administration, Expected in
Indian River State College - Ft. Pierce, FL
  • The National Association of Healthcare Access Management (Certified Healthcare Access Associate) Certified with NAHAM since 4/4/2001

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Resume Overview

School Attended

  • Port St. Lucie High School
  • Indian River State College

Job Titles Held:

  • Revenue Cycle Manager/Medical Billing and Collections Specialist
  • Lead Patient Care Coordinator/Authorization Specialist
  • Lead Billing-Coding Specialist


  • High School Diploma
  • Some College (No Degree)

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