Ambitious Vice-President of Revenue Cycle Operations who builds and retains high performance teams by hiring, developing and motivating skilled professionals with demonstrated ability to deliver mission-critical results.Extensive experience in all areas of healthcare revenue cycle operation including coding, clinical documentation improvement, admissions, billing, federal, commercial/managed care, and self pay collections. Financial, general ledger accounting and budgeting knowledge. Meticulous, detail-oriented, highly organized with expert analytical and problem solving skills. Consistently exceeds revenue and cash goals. Managed Care and contracting experience.Process improvement work flow resulting in streamlined procedures. Implementation of Quality Assurance and training programs, self pay call center creation. Established central admissions from 18 hospital sites. Reduced AR days from 72 to 56 resulting in millions of dollars in additional cash flow. Successfully settled multi-claim denials for unbundling reductions with Aetna, Humana and Cigna resulting in multi-million dollar recovery. Denial recovery of 72% and reduction of accounts aged greater than 365 from 22% to 4%. Visionary Operations Executive with solid experience managing all levels of revenue cycle.
Promoted to VP of Revenue Cycle Operations from Director after 12 months based on outstanding performance. Managed team of 54 professionals with 5 direct reports. Accountable for complete revenue cycle including coding, clinical documentation improvement for 18 long-term care hospitals nationally and outpatient wound care clinics. Spearheaded monthly collections of $40 million. Created new revenue streams through implementation of charge capture for bedside surgical procedures, equipment and vaccinations. Reduced AR days from 72 to 56 resulting in millions of dollars in additional cash flow. Successfully settled multi-claim denials for unbundling reductions under stop loss with Aetna, Humana and Cigna resulting in multi-million dollar recovery. Successful in denial recovery of 72% and reduction of accounts aged greater than 365 from 22% to 4%. Implemented self pay collections, standardized charge master, removed routine supply charges remaining revenue neutral. Centralized admissions from 20 hospitals saving over $5 million in revenue errors and $500k in reduced salary cost. Automated authorization process, communication log, outpatient procedure log, electronic secondary billing and reduced R&B charges from 39 options to 12 options.
Provided revenue cycle consulting services to client hospitals, identified opportunities for improvement and provided recommendations for resolution. Developed processes that enabled the facility to maximize reimbursement and increase cash flow. Opportunities identified in work flow improvements and trained incumbent staff. Spearheaded revenue improvement in client hospital in upstate New York by serving as interim Director of Revenue Cycle for 90 days resulting in a 25% increase in cash collections and reduction of 3 AR days.
Managed team of 80 professionals in revenue cycle operation of 8 cardiac care specialty and medical/surgical facilities in Texas, California, Arizona, New Mexico and Louisiana. Achieved cash collections of $65 million plus monthly with daily cash reconciliation and 100% compliance with all quality regulations as evidenced by internal/external audits.
Reduced credit balance backlog from over $4 million per facility to less than $50K. Management of multiple contracts in multiple states and payment variances and appeals with a successful appeal rate of 68%.
Creation of self pay collection unit with an average collection of $1.5 million per month and reduction of expense by 10%. Supervision of billing and third party collections with successful conversion to new clearinghouse and implementation of bridge routines. Transition to web access payment system for electronic checks and credit card payments.
Spearheaded positions of Cash Management Supervisor and Billing Manager and received two promotions in three years. Managed team of 75 professionals including 2 managers, 5 supervisors, 4 quality assurance auditors, trainers. Oversaw monthly billing totaling $15 million in pathology charges. Managed the revenue cycle operation including billing, coding, collections, customer service, client billing and retention, cash posting, refunds, quality assurance, training, financial reporting. Achieved reduction of AR Days by 12 and increased cash collections. Launched quality assurance program including setting standards for production and quality for all positions. Directed installation of telephone call queue to provide efficiency in customer service; implemented scanning/imaging system for operational efficiency and cost savings. Spearheaded cross-functional initiative to achieve reorganized month end close process and streamline complicated billing processes.
Supervised staff of 24 in the timely and accurate posting of $50 million per month. Managed research and appropriate resolution of accounts receivable credit balances including payment transfers, contractual adjustments and refunds. Created production and quality standards for staff and implemented quality review.Resolved suspense credits for unidentified payments and completed unclaimed property state reporting. Created polices and procedures for department workflow and improved processes.
Manager of fiscal and operational services including finance, accounts receivable, accounts payable, payroll, housekeeping, maintenance, dietary, admissions and reception. Oversaw complete month end processing, financial reconciliation and statements, bank reconciliations, tax reporting and budgeting. Managed all aspects of the hospital business office including admissions, insurance verification, authorization, billing, collections, cash posting, customer service, chart audits and credit balance resolution. Served as Administrator on call. Performed patient advocate duties to quickly resolve patient concerns. Successfully completed two computer conversions. Prepared proformas for new business proposals and composed managed care contract agreements. Completed computation and recording of all statistical information and maintaining Medicare and Medicaid logs for cost reporting. Awarded Employee of the Month five times during tenure.
Analyzed and processed medical, dental and workman compensation claims for payment for 25 different companies. Consistently exceeded standards for speed and accuracy. Awarded employee of the month twice.
Responsible for training new employees in claims processing procedures, medical terminology and industry information. Extensive insurance knowledge including state mandated benefits and ERISA. Performed as customer service representative, claims analyst, and senior claims analyst receiving four promotions in four years.
Double major in Business Administration and Psychology
GPA: 3.79 5th in class of 87
Graduated Magna Cum Laude
Gamma Sigma Alpha and Phi Beta Kappa
Member of HFMA and ACHE
Role Model and Mentor Award
CPT, ICD10, DRG codes
Patient Accounting Software
MedAssets Contract Manager
Companies Worked For:
Job Titles Held: