Driven and compassionate healthcare professional with 15 years hands-on experience in fast-paced hospital and outsource environments. Accountable and responsible with a strong focus on Revenue Cycle.
Supervise staff of thirty-five patient account reps for California Client. Interview and hire process. Provide initial training and follow up guidelines for new staff members. Ensure that all billing requirements are met and claims are billed out timely. Responsible for making sure our Clean Claim Rates are 80% or higher. Supervise in minimizing Credit Balance Accounts (success rate of decreasing Credit AR by 30% in 4 months). Implementing new Policy and Procedures for team based on California State Laws (AB1455). Tracking AR collections to ensure at least a minimum of 90% of monthly goal is met. (Consistently exceeding monthly goal set). Set Company-wide Cash Collections of $85M. Mentoring Associate Pars to be promoted within the company (success rate of 50%).
Assist in supervising a team of forty patient account reps for California based client. Provide initial training for new staff members. Assist Client Engagement Team with New Hire Set Up. Prepare weekly/daily/monthly high end client reports based on client needs. Prepare Legal Report for Legal Team to pursue for additional reimbursement for erroneously denied claims. Complete Quality Assurance Assessment for staff of 40 and provided training to help maintain QA standards of 95% or greater.
Interview and hire staff for multiple projects. Supervise a team of thirteen patient account reps for California Medi-cal clients. Completed initial training and onboarding of new staff members for both Government and Non-Government teams. Prepare weekly/daily/monthly reports based on client needs. Prepared monthly Credit balance reporting. Managed MediCal credits that resulted in a 75% reduction of credits. Ensure time cards are submitted in a timely manner. Complete Quality Assurance Assessment for staff Provide one on one training and counseling with staff as well as mentoring.
Supervised team during supervisor's leave of absence. Created bridge-routines for specialty billing that helped increase Clean Claim Rate by 40%. Mentored fellow co-workers. Assisted in the implementation of two California based hospitals. Trained new staff on hospital's host systems, created policy and procedures, and new hire materials. Researched and implemented billing guidelines for secondary MediCal claims after Medicare that resulted in a 100% increase in claims processing.
Evening Part-time Trainer for Inbound Call Center Reps for Sirius Satellite Radio. Trained staff on using Sirius STARRS System to renew subscriptions, mentored and educated staff on how to convert calls into sales (30% conversion increase). Assisted with answering costumer complaints. Developed training manuals for new employees and created opportunities for cross training and career development.
AR Billing & Follow up for Medicaid program for multiple states; including: NJ, PA, NY, CT, GA, MN, WY, IA, FL, and CA. Performed extensive research to obtain state specific guidelines for accurate billing and follow up for each Client. Worked on multiple Client hospitals at once while maintaining accuracy on each. Set record cash collections for Clients increasing revenue by 50% while reducing aged AR greater than 90 days.
AR Billing & Follow up for Medicaid and Non-Government payers. Identify and correct reimbursement errors and claim denials. Track trends in denials for mass appeals and payer meetings. Maintained Clean Claim Rate of 65% or higher.
Billed physician's claims to all insurance carriers on HCFA 1500 form. Reviewed and processed EDI applications for physicians electronic submission. Trained new staff on completion of EDI applications as well as billing functions. Handled daily system maintenance. Maintained Clean Claim Rate of 80% or higher average.
Managed outsource staff in AR Follow for Company based in Texas at three site hospitals: St. Joseph's Paterson, NJ & Yonkers, NY, Kingston Hospital, Kingston, NY. Responsible for generating revenue for Medicaid payer. Trained staff on specific state Medicaid guidelines. Identified trends in billing causing delays and/or denials on claims. Overall increase of Medicaid cash collections of 45%.
Billing and collections for Medicaid PAAD program, Medicare, Medicaid, Worker's Comp & No Fault Ins, and all Non-Government payers for Outpaitent services. Identified trends in denials for mass appeals. Complete billing and follow up from discharge to final resolution on accounts.
Member of National Dean's List GPA: 3.8
Member of National Dean's List GPA: 3.7
Course work: Financial Accounting I & II, Advanced Accounting, Quickbooks, Managerial Accounting, Cost Accounting, Taxation, Intermediate Accounting, Business Law
MS Office: Access, Excel, PowerPoint, Word, Outlook
Billing Software: Epremise, Claims Management, MDX, Caremedic, Epaces, Emdeon
Host Systems: Invision, PBAR, Affinity, Dairyland, Paragon, Promise, Meditech
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