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Professional Summary

High performing professional with 15+ years experience in revenue cycle management, health care operations, compliance and auditing.  Comprehensive knowledge of clinical workflows from appointment scheduling/front office to claim payment including EDI claims and reimbursement, eligibility verification, (NextGen) practice management systems, electronic health records, and applicable software programs. Knowledgeable with Medicare, Medi-Cal, Managed Care and various payer programs.   Ability to communicate in a professional and confident manner with board members, clinicians, executive leadership, business audiences and direct reports. Competent in areas of leadership, training and education, innovation, and workflow improvement across diverse teams.

Certifications & Memberships
  • 2010 Certified Professional Coder (CPC License: 01102335) ICD-10 Proficient
  • Member of AAPC (American Academy of Professional Coders)
  • 2016 Certified Healthcare Financial Professional
  • Member of HFMA (Healthcare Financial Management Association)
  • 2017-2018 Executive Board Member of HFMA Southern CA Chapter
  • 2016-2018 UCSF Healthforce CLI Graduate
Skills & Accomplishments
  • Reduce days in A/R by 20 Days
  • Increase revenue per visit by 90%
  • Increase front office collection rates
  • 7 yrs NextGen EPM & File Maintenance (NCP)
  • Facilitate & develop revenue cycle training
  • MS Word, Excel, PowerPoint, Outlook proficient
  • Develop and maintain policies and procedures consistent with state and federal regulations
  • Improve clinical documentation and coding to support quality measures and initiatives
  • Network with community partners to stay current with workflows and best practices
Work History
Director of Revenue Cycle Operations, 02/2016 to Current
Parktree Community Health Center – Pomona, CA
  • Bring billing in-house, build and train billing department to adhere to FQHC billing standards, and create all EDI functionality (4 locations)
  • Create billing policies and procedures as well as strategic planning for current and future processes which support HRSA compliance and annual financial audits
  • Create RCM Dashboards and present to board and executive leadership  
  • Improve workflow operations to strengthen financial and clinical processes
  • Lead UDS/OSHPD annual submission
  • Prepare data for annual Medi-Cal Reconciliation & Medicare Cost Reports
Director of Legal Support Services, 08/2015 to 02/2016
Helton Law Group, APC – Huntington Beach, CA
  • Support hospital and health centers in their goals to achieve optimal revenue cycle solutions by strengthening provider and payer relationships, reducing bad debt, contract negotiation, and regulatory guidance.
  • Strategic planning for current and future business development
  • Oversee pre-litigation activities and workflows, including claim dispute analysis, reviewing medical records, managed care contracts, internal correspondence with attorneys, and monitor daily progress of revenue cycle outcomes.
Senior Healthcare Consultant, 12/2014 to 08/2015
Priority Management Group – Pawtucket, RI
  • Partner with community health centers across the nation to achieve their mission by optimizing various aspects of the revenue cycle, furnishing analytics, revenue cycle/billing operational assessments, medical record reviews, coding training, ICD-10 onsite boot camps and WebExs, fee schedule analysis, and other diversified principals to support community health centers and improve their financial position.Provide training to executive leadership, clinicians, front office, coders, and billing staff.
  • Speak at conferences and host national WebExs.
    •
    Revenue Cycle Manager, 11/2011 to 12/2014
    Shasta Community Health Center, FQHC – Redding, CA
    • Specializing in revenue cycle operations, education, development and quality management supporting 4 medical clinics and 3 dental clinics.
    • Responsible for EDI submission (837i & 837p) claims and payment processing
    • File Maintenance - Maintain current ICD, CPT, HCPCS, RVU, NDC
    • Facilitate department meetings to Billing Department as well as executive leadership presenting financial analytics.
    Claims Auditor, 11/2008 to 10/2011
    American Medical Bill Review/ExamWorks – Redding, CA
    • Provide bill review and support services for physician, hospital, surgery center, peer review and legal claims to facilitate the adjudication, settlement or resolution.
    • Utilize various methodologies/programs to provide accurate payment decisions based on national billing practices, coding guidelines, LCD, NCD and CCI edits
    • Deliver education and training to in-house staff and sister companies on software, coding, and company policies.
    • Responsible for processing and updating department policy and procedures as necessary.
    Medical Biller/Coder (Cardiology), 04/2007 to 11/2008
    California Physician Reimbursement – Redding, CA
  • Review medical records to confirm diagnosis and subsequent procedures.
  • Post charges and balanced to daily close.
  • Developed day-to-day work plans to meet service standards and deadlines.
  • Ensure all medical claims and documentation fall within state and federal regulations.
    •
    Medical Billing, Scheduler, Medical Assistant, 10/2002 to 07/2006
    Dr. Steven Mendelsohn (Cardiologist) – Redding, CA
  • Perform all aspects of medical billing
  • Code & bill office diagnostic testing (echo, treadmill, dobutamine stress test)
  • Complete Medi-Cal TARs for catherization, PTCA, stents
  • Assist in daily office procedures as needed such as rooming patients, scheduling appointments, answering phones, and various clerical duties.
    •
    Education
    Clinic Leadership Institute: 2016-2018
    University of California, San Francisco -
    MBA: Health Administration, Health Administration, Pending
    Indiana Wesleyan University - Marion
    Bachelor of Arts: Business and Human Resource Management, 2013
    Simpson University - Redding, CA

    This resume is created in 7 minutes.
    Professional Summary

    Experienced and driven patient financial services professional, with experience in all aspects of revenue cycle management, including billing, collections, cash applications, A/R Analysis, denial management, contract interpretation, clinical, call centers, and customer service.  Strong interpersonal and organizational skills.. Demonstrates, ongoing enthusiasm, and manages time appropriately.

    Skills
    • Policy and program development expertise
    • Training and Development
    • Customer Service Specialist
    • Procedural Implementation
    • Project Management
    • A/R Analysis
    • Quality improvement competency
    • Multi-Tasking
    • Strong Organizational skills
    • Problem Solving
    • Strategic planning capability
    Work History
    Consultant/Interim PFS Manager, 04/2016 to Current
     Northwestern Memorial Hospital – Chicago, Illinois
    • Project Manager for Receivables Improvement Plan engagement for multi-specialty facilities with 1500+ beds.
    • Provided direction and leadership to 100 + professionals involved in billing and collection activities 
    • Established internal controls to ensure timely and accurate billing to all payers.
    • Monitor Employee Production, creating more efficient methods of working to optimize performance and reduce cost.
    • Implemented WQ structure for all Payer areas, to increase production, decrease agings.
    • Increased overall production from 22% to 115%
    • Denial management; created working solutions to help decrease denials.
    • Decreased Missed Follow up/Past Timely adjustments  from $6.7 Million to $300k 
    •  AR Analysis to establish effective processes for decreasing aged accounts.
    • Managed monthly Government revenue of $25 Million
    • Decreased Medicaid/Medicaid replacement credit work queues from 1525 accounts to 100 accounts in 14 days.
    • Implemented KPI Reports for specialty billing
    • Provided and implemented accountability measures and standards.
    • Created and Implemented measurements for Quality standards.
    • Increased overall Quality from 32% to 90%
    • Reviewed and analyzed company healthcare procedures and workflow within Cash applications, Collections, Billing, Admitting, to identify areas for optimization. 
    • Overseeing the day to day business operations of the business office, Denials, Collections, Billing, Cash.
    • Oversee department managers, and facilitate methods and practices for cleaning up aged AR.
    • Created efficient front end processes to decrease denials on back end.
    • Implemented necessary changes based on evaluation of staffing requirements and floor assignments.
    • Managing Vendors to decrease their timely filing adjustments to increase total revenue.
    Revenue Cycle Management, 09/2015 to 03/2016
     Iasis Healthcare – Phoenix, AZ
    • Managed the work of employees to ensure adherence to quality standards, deadlines, and proper procedures.
    • Manage staff of 25+
    • Provides employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes.
    • Trains or instructs employees in job duties or company policies or arrange for training to be provided.
    • A/R analysis for trending and tracking denials to establish practices to lower agings.
    • Created and Implemented a Quality Measurement system for monthly audits.
    • Worked closely with hiring agencies to bring in qualified staff.
    • Create/Implement processes for reconciling offsets/forward balances. 
    • Evaluate employees' job performance and conformance to regulations and recommend appropriate personnel action.
    • Managed A/R for non-government and government payers.
    • Determine and implement procedures and processes that help create efficient practices for employees.
    • Created and implemented Training guidelines and procedures for collectors.
    Revenue Cycle Manager, 05/2003 to 09/2015
     Healthcare Financial Resources Inc. – Scottsdale, AZ


    • Manage employee work queues, to ensure aging and high dollars are being worked appropriately.
    • Manage staff of 40+
    • Assist Supervisors in creating and filing complex appeals to payers to maximize reimbursement.
    • Maintained detailed payer knowledge for, Government, Non-Government, Commercial Payers' billing Requirements and reimbursement language.
    • Maintain, and train employees on multiple client preferences.
    • Compliant with all relevant policies required for each hospital. Assist employees with training, coaching, and mentoring.
    • Managed employees to the company's procedures and provided disciplinary measures if needed.
    • Create ways to optimize production and work with employees to help achieve production goals or standards.
    • Organize and set up weekly work lists geared towards accomplishing goals.
    • Analyze AR by creating pivots off Excel to identify trends, and implement strategies for efficiency.
    • Work with supervisors and managers to help resolve high dollar and difficult to collect accounts that are aging.
    • Review, report and provide recommendations for improvement to senior management. 
    • Develop and maintain staff productivity reports. 
    • Evaluate performance of staff and prepare and present annual performance appraisals
    •  Train, audit, and evaluate staff members to ensure a competent and productive workforce.  
    • Analyze AR and create action plans for establishing goals, and completion of goals within a set time frame.
    • Monitor Quality for 150+ employees, to ensure client standards are being met.
    Education
    Associate of Applied Science: Business, Management, 2011
     Mesa Community College - Mesa, AZ
    BBA: Business, Emphasis in Management, 2015
     Northern Arizona University - Flagstaff
    Additional Information
    Computer Systems:

    • Epic
    • Star
    • Meditech
    • Valco
    • ROI
    • Microsoft Office Applications
    • Healthlogic Systems

    This resume is created in 7 minutes.
    Professional Summary
    Highly analytical healthcare management professional combining more than 20 years of work in physician/dentist clinics with proficiency in financial management, leadership and positive clinical outcomes.
    Skills
    • Strategic planning capability
    • Operational planning and development

     
    • Promotes positive behavior
    • Analytical thinker
    Work History
    03/2016 to Current
    Manager Of Operations Methodist Le Bonheur Healthcare – Memphis, TN
    • Manage key operations personnel in our 200+ physicians pediatric multi-specialty clinics including office managers, medical office assistants, schedulers, medical assistants and nurses.
    • Encourage creative thinking, problem solving, and empowerment to create a workplace where associates have the tools and resources to deliver patient and family centered healthcare.
    • Developing curriculum for standardized workflows and front end processes to provide our patients and families with consistent, high quality patient experiences.
    • Provide leadership training opportunities for operations team including mentorships, book studies and job shadowing.
    02/2013 to 03/2016
    Revenue Cycle Manager Baptist Medical Group – Memphis, TN
    • Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
    • Created and organized the registration department for the Physician Revenue Cycle in accordance with administrative guidelines in order to provide registration support for all BMG physician practices.
    • Coordinated registration processes for all physician practices working with nine practice management systems. Converted and standardized all practices to Epic in 2014.
    • Led the BMG leadership team and consultants in producing a business plan for the Registration Department that focused on all aspects of facility operations, including setting priorities and job assignments.
    • Supervised and managed the daily activities of registration support team consisting of 22 specialists and coordinators.
    06/1999 to 02/2013
    Business Manager Turner Family Dentistry – Munford, TN
    • Developed a system of staff communication that ensured proper implementation of treatment plans and comprehensive patient care.
    • Oversaw all customer service, patient registration, insurance billing, payroll, AP, and AR and verified that proper procedures were followed.
    • Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating a proactive work environment.
    Education
    1994
    MBA: Finance
     The University of Memphis - Memphis, TN
    1986
    Bachelor of Science: Finance
     The University of Tennessee - Knoxville, TN

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