Revenue Cycle Manager Medical Billing And Collections Specialist resume example with 20+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Summary
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.
Skills
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
Experience
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 GPA:
: Health Administration, Expected in - Indian River State College - Ft. Pierce, FL GPA:
Certifications
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