REVENUE CYCLE PROFESSIONAL

Proven analytical proficiency and an in depth knowledge of revenue cycle processes, systems and best practice techniques gained through more than twenty years with several respected healthcare facilities and consulting organizations. Expertise includes analysis of A/R reports, staffing, account reconciliation and management, and standardization of procedures. Recognized for demonstrated success in financial process improvements and the training and development of revenue cycle professionals. Detail-oriented, proactive, multi-tasker adept in providing A/R results. Recognized for strong organizational, verbal and written communication skills.

CORE COMPETENCIES

• Complete understanding of flow of information throughout total hospital revenue cycle
• Project Management
• ATB Analysis Staffing Analysis
• Documentation of procedures creation of training programs
• Mapping and reconciliation between systems
• Outstanding time management PC skills

PROFESSIONAL EXPERIENCE

Confidential

Director

Assistant Director

• Responsible for Customer Service, Billing, Insurance Follow-Up and Cash Posting for 14 PPS hospitals 1 CAH.
• Directly responsible for 9 Managers, a HIPAA Security Coordinator and a Nurse Auditor. Indirectly responsible for 150 staff.
• Implemented new scrubber and Clearing House for 837s and 835s.
• Created and managed RFP process for new Early Out and new Primary Collection Agency.
• Implemented single self-pay lockbox and single insurance lockbox for 15 hospitals and hundreds of physicians.
• Held A/R days steady 50 days-Gross for system while bringing 8 facilities up on Epic and into the CBO and still working Legacy A/R in-house.
• Responsible for annual operating budgets for 9 departments.
• Managed all outsourcing companies used in the CBO.

Confidential

Director, Patient Financial Services, Admitting and Medical Records

• Responsible for Admitting and Patient Accounts as well as CDM and all RAC activities. Responsible for Medical Records during times when there was no Director.
• Created spreadsheet reports showing measurements for several KPIs for COO monthly
• Reduced AR from 69 days to 55 days in 6 months
• Responsible for facilitating several meetings monthly, including Chargemaster, Denials, RAC, and AR/Charity
• Hired and fully staffed two departments and cross-trained all staff
• Implemented several new bolt-on software packages
• Started a program for up-front collections collecting over 5,000 a month in first 6 mo.'s
• Implemented quality and productivity measures for all staff
• Created new Charity program
• Participated in managed care contracting
• Responsible for annual operating and capital equipment budgets for 3 departments
• Manage all outsourcing companies used in Patient Accounts and Medical Records

Confidential

Director, Patient Accounts and RAC Coordinator

• Confidential was purchased by Advocate Health and Hospitals in Confidential. I participated in all merger activities pertaining to managed care contracts, billing, cash posting and Patient Accounts/GL interface. Served on several corporate councils and I was part of the vetting team in conjunction with PricewaterhouseCoopers regarding the determination to create a Shared Revenue Cycle Service model for the whole system.
• Created analysis spreadsheets of several Confidential for local Confidential and corporate office
• Reduced AR by about 9 days during my tenure
• Restructured department after performing a staffing analysis
• Created and sent out a RFP to hire new vendors for Early Out and Collections.
• Negotiated with new company for excellent rate and service package
• Created and led a Revenue Cycle Team with monthly meetings
• Led and managed a system conversion for electronic billing, electronic remittance advices and a new denial management system.
• Trained staff and managed a major system Meditech upgrade.
• Put together a RAC team, led internal audits, decided upon RAC tracking software and was the RAC liaison for the system. Our RAC team hired EHR to handle our status concerns as well as to train case managers and physicians. Worked very closely with Compliance Director and trained her on many CMS/OIG issues.
• Mentored eight staff members to obtain CPAT certification.
• Responsible for CDM for both hospitals.
• Responsible for annual operating and capital equipment budget.

Confidential

Director of Business Office and Medical Records full Revenue Cycle

• Responsible for overall management of Pre-Admissions, Insurance Verification, Registration, Medical Records, Billing/Collections/Denial Analysis, Financial Counseling, Cash Posting, Customer Service, Internal Audit, Managed Care Contracts and Switchboard.
• Managed 5 direct reports and a total of 90 indirect reports.
• Renegotiated several managed care contracts for better reimbursement.
• Responsible for creating a Denial/Underpayment Analyst position to track and trend denials as well as working at process redesign to stop denials from happening.
• Responsible for annual operating and capital equipment budgets for 5 departments. Re-wrote charity care policy.
• Responsible for outsourcing insurance follow-up at 90 days as well as work-comp/MVA claims.
• Project managed physical re-design of Lobby to include a Volunteer/Info desk as well as 2 registration cubicles and implemented a patient pager system to secure HIPAA privacy.
• Lowered AR days from 60 to 47.
• Lowered coding errors - coding accuracy rate went from 71 to 95 .
• Worked very closely with Compliance Director and trained him on many CMS/OIG issues.

Confidential

Director of Patient Accounts

• Responsible for overall management of claims submissions, follow up processes, cash posting, credit balance resolution and customer service.
• Prepared monthly A/R reports for CFO.
• Lowered AR from 129 to 75.
• Created and implemented new 'flow' of all patient accounts including both system utilization and process development.
• Created and administered staff competencies in preparation for and in compliance with JCAHO.
• Responsible for 30 FTEs including a QA Coordinator, Sr. Systems Analyst, a Denial/Reimbursement Coordinator and CDM/PI Coordinator dedicated to the PFS areas.
• Created and implemented new policies and procedures, flow of patient information and comprehensive training program including Preceptors and a Quality Assurance program.
• Responsible for annual operating and capital equipment budgets for two departments
• Participated in a hospital-wide re-organization initiative.

Confidential

Senior Consultant

PROGECT HIGHLIGHTS

Customer: Confidential

• Performed system assessment for Patient Accounting system Master Files Siemens Invision System.
• Created and marketed a three phase system assessment tool. Phases included the system Assessment and developing a concrete operational flow to accounts based upon payer and changes to the Master Files.

Customer: Confidential

• Acted as Interim Systems Analyst in the Patient Accounts office Siemens Invision System.
• Re-designed and coded Variable Option File in the SMS Invision System their Receivables Management Workstation RMW worklists creating lists for Collectors resulting in more efficient and aggressive account follow-up aimed at reducing days in AR.
• Developed training materials for their Trainer.
• Taught the first round of education to Management and then acted as a resource for the Trainer as the new processes were rolled out to Collectors.

Customer: Confidential

• Performed an in-depth assessment of their Patient Access and Patient Accounting areas.
• Delivered strategic recommendations for changes and enhancements to their operational procedures as well as their system utilization.

Confidential

Senior Consultant

PROJECT HIGHLIGHTS

Customer: Confidential

• Performed Project Manager responsibilities including monitoring and controlling budget on this assignment.
• Served as Interim Manager over a team of temporary employees responsible for 100 validation of face sheets from all Registration points.
• Provided consulting and assessment services at the same time to give hospital documentation and statistics regarding system problems and human errors occurring in Registration. Streamlined QA and scanning processes.
• Taught their Director about what their system could and could not do for them.

Customer: Confidential

• Developed and facilitated several different payer teams whose charge it was to design workflows and logics for all areas of a CBO for two hospitals and several off-site clinics.
• The scope of these logics included Pre-Registration, Patient Intake and Insurance Verification, Pre-Billing, Billing, Follow-up, Collections and transfer to Bad Debt.
• Wrote their Receivables Management Workstation RMW worklists creating lists resulting in more efficient account follow-up and aimed at reducing days in AR by aggressively pursuing collection measures.

Customer: Confidential

• Performed post-live assessment of systems.
• Rewrote their entire Variable Option File VOF and Receivables Management Workstation RMW .
• This project was acknowledged as an extreme success because I was able to turn-around negative feelings the client had for the SMS field office and in doing so created a very positive relationship between the Patient Accounts Director and SMS/SSG.