Revenue Cycle Manager Resume Samples

Description :

1. Oversees Front Desk staff, Coordination of Precertification staff and Billing Department include but not limited Electronic claims submission, Reconcile bank statement.
2. Responsible for all aspects of daily operations through MacPractice.
3. Resolves unpaid and denied claims, oversaw payment posting process, front office, and clinical staff billing training, assisted with the development of the Billing Dept.
4. Processes, implemented new processes to cut down on Patient Responsibility AR prior to rendering services.
5. Ensures timely receipt of claim payments and minimization of unexpected bad debt by monitoring assigned worklists and ensuring collection of past due to balances to maintain profitability.
6. Identifies issues that may be keeping the claim from being paid such as insurance changes, coordination of benefits, and transfer of balances to the correct payer, process noncash related adjustments per establishment guidelines.
7. Analyzes critical operations on an ongoing basis, and developed reports that evaluated and demonstrated productivity and performance gains.

Experience

2-5 Years

Level

Junior

Education

Certificate

Description :

1. Manage revenue cycle operations for 6 interventional spine physicians, one orthopedic surgeon, one interventional radiologist, 2 EMG physicians, 2 nurse practitioners and 3 physician assistants in addition to an ambulatory surgery center.
2. Establish, implement and manage standards, information technology, and processes that are effective, support patient and referral-based access and achieve financial goals for the spine center.
3. Develop staff to implement communication mechanisms that optimize accurate billing and reimbursement of professional and facility services.
4. Negotiate and maintain managed care contracts for optimal professional and facility reimbursement.
5. Maintain compliance with State and Federal programs. Provide ongoing guidance, feedback, and forecasting to all investors on key indicator trends and performance measures.
6. Recommend actions to optimize revenue and reduce barriers that hinder revenue.
7. Implement, maintain, and report to investors on CMS programs for Meaningful Use measures documentation as well as Physicians Quality Reporting Systems and E-prescribing to optimize reimbursement and avoid revenue reductions.

Experience

10+ Years

Level

Consultant

Education

Bachelor Of Science

Description :

1. Manage, train and educate a newly certified team of professional medical coders.
2. Read and interpret medical record documentation and identify and code all relevant diagnoses and procedures by utilizing Current Procedural Terminology (CPT) and International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) coding references and tools to ensure proper code assignment.
3. Accurately code medical diagnoses per Centers for Medicare and Medicaid Services (CMS) requirements published in the official ICD-9-CM coding Guidelines, and knowledge of prospective payment systems.
4. Correspond with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations.
5. Obtain clarification regarding conflicting, ambiguous, or non-specific medical record documentation.
6. Research, analyze, and respond to inquiries regarding compliance, medical coding, billing denials, and billable services.
7. Ensure strict confidentiality of patient and financial records.
8. Support the retrieval, review, and delivery of medical records requests needed for compliance audits or payer requirements.

Experience

7-10 Years

Level

Senior

Education

Bachelor's

Description :

1. Recruited, trained and oversaw the revenue cycle team of 12 specialists and billing operation processes including patient access, medical management, and reimbursement management processes.
2. Defined annual goals and prepare strategies to achieve the goals Review, reconcile accounts and calculate monthly, quarterly and annual revenue.
3. Monitored to make sure agency is in compliance with revenue cycle processes Extensive knowledge of Managed Care, Private Insurance, Government Sponsored Programs, Illinois Medicaid and MMAI Demonstrations programs.
4. Participated in provider training to understand programs, trained staff and identified rejected claims to identify billing issues and correct.
5. Managed associates responsible for pre-authorization, utilization management, billing, and collection.
6. Exceeded goals of collecting 85% of revenue billed within 60 days in the first year in the position.
7. Participated in the implementation of a new Electronic Medical Records (EMR) system and trained team.
8. Assisted in the integration of the new EMR to the Clearinghouse to ensure claims were processed successfully.

Experience

10+ Years

Level

Management

Education

Master In Business Administration

Description :

1. Developed and implemented management controls and quality assurance processes to ensure the accuracy and efficiency of claims submission, payments, and postings.
2. Exhibited extensive knowledge of Managed Care, Medicare, and Medicaid industries with an understanding of importance under recent healthcare reform.
3. Assisted with the successful implementation of the Practice Management system for 30+ providers across 7 states.
4. Monitored and reported productivity and worked collaboratively with VP of Finance and Operations on periodic audits as well as annual training requirements.
5. Provided ongoing education to Billing Dept. staff and Midlevel Practitioners covering changes in billing and reimbursement rules, state and federal legislation, and billing software applications.
6. Managed physician fee schedules and updates system according to provider type, and respective payer/intermediary reimbursement levels.
7. Completed and monitored both group and provider credentialing applications for insurance payers through CAQH and respective provider portals.

Experience

5-7 Years

Level

Executive

Education

Bachelor Of Science

Description :

1. Managed the entire revenue cycle of a diagnostic laboratory including payer billing, collections, and patient account activities. Responsible for day-to-day operations and long term planning and budgeting.
2. Oversaw credentialing, client contracts, call center, and billing department.
3. Partnered with the sales and client representatives to help with client acquisition.
4. Responsible for the collection, aging, establishing write-off standards and claim denial management.
5. Evaluated the effectiveness of the process, recommended and implement changes to policies and procedures Responsible for hiring, firing, and disciplinary actions within the department.
6. Decreased billing cycle turnaround time by 40% by implementing automation into the process.
7. Improved productivity and decreased backlog by 25% within the first 3 months. Developed, implemented, and continually improved policies, processes, and procedures.
8. Organized regular meetings with the sales team and client representatives.

Experience

5-7 Years

Level

Executive

Education

Bachelor's

Description :

1. Developed a greater understanding of the needs of the clients and fulfilling these needs with the goal of broadening the relationship between the revenue cycle team and the clients.
2. Supervised of all business office functions including preregistration, registration, customer service, insurance verification, medical coding, point of service cash collection, financial counseling, medical records, coding, account follow-up and collections, and cash posting.
3. Responsible for Management of Patient Access, Patient Accounting and Medical Records departments.
4. Responsible for Creation of revenue reports by the department on a weekly basis.
5. Responsible for Adhoc Reporting Auditing of Unbilled, Unchecked and Billed A/R reports.
6. Initiated weekly Revenue Cycle meeting with CFO, Case Management, Medical Records/Coding, and billing departments in an attempt to resolve any issues and streamline revenue cycle.
7. Coached and motivated of Patient Access and Patients Accounting departments on a daily basis.

Experience

0-2 Years

Level

Entry Level

Education

Bachelors of Science

Description :

1. Designed and spearheaded targeted revenue acceleration workflows, including patient access, cash collection and posting, coding and charge capture and claims process and follow up as well as technology to support critical auxiliary processes.
2. Developed, implemented and administered policies and procedures to maximize cash flow, department efficiency, and regulatory compliance.
3. Supervised key personnel in day-to-day business operations in compliance with federal and state mandates.
4. Guided personnel to load Managed Care contracts in the adjudication system for the proper estimation of net revenue.
5. Supervised, trained, and coached 6 employees.
6. Decreased payment delays by 2 months by restructuring billing profiles.
7. Automated report compilation process used to file Medicare cost report, drastically reducing completion and submission timeframe from 2 weeks to 2 days.

Experience

5-7 Years

Level

Executive

Education

Master Of Business Administration

Description :

1. Performed QA checks and productivity audits; identify and resolve undesirable trends and reimbursement errors; prepare reports to assure quality and productivity requirements are being met.
2. Maintained personnel records including vacation and sick leave, approve weekly time sheets; conduct performance evaluations, promotions and disciplinary action, when needed.
3. Ability to identify training/education deficiencies and provide training, guidance, and coaching when needed.
4. Worked with other department supervisors to develop and implement staff performance standards and the coordination of intra- and inter-unit operations and procedures.
5. Responsible for Exceptional problem and conflict resolution skills while maintaining confidentiality and professionalism.
6. Created & maintained weekly receivables aging reports for sales/management.
7. Created & maintained monthly receivables aging reports for customers Direct supervision of six employees.

Experience

2-5 Years

Level

Junior

Education

Bachelor Of Science

Description :

1. Responsible for managing the Revenue Cycle for various specialty departments in an Article 28 setting.
2. Analyze financial data to assist Senior Management and Department Administrators/Chairpersons with decision-making tools that will maximize income and improve the revenue cycle.
3. Provide continuous training and mentorship to union associates to increase productivity.
4. Monitor key billing/collection statistics and compare to internal/national benchmarks including, but not limited to, Days in AR, Net Collections, Charge Lag, and Missing Charges.
5. Manage AR for Global and Provider-Based Billing sites.
6. Including managing billing protocols for Commercial, Governmental-APG/APC Payors, and Special billing payors.
7. Establish a missing charge initiative for various specialty departments resulting in a reduction of 85+% in missing charges.
8. Increase charges by $1m, resulting in $300k in additional revenue.

Experience

10+ Years

Level

Management

Education

Bachelors Of Science

Description :

1. Prepare month-end closing journal entries, reports, and balance sheet account reconciliations. Translate and creates policies and procedures for the accounting department for new goals and acquisitions.
2. Understand, document and maintain the billing and cash process, A/R status, Terms, Cash collections, Bad debt and develop monthly cash flow statement.
3. Prepare a quarterly budget for the accounting department.
4. Record Insurance Receivables in NRx as detailed in the 835 files Manage the company's bank and lockbox accounts and act as a signatory on those accounts.
5. Produce accurate financial reports, financial statements and project management details.
6. Reconcile bank accounts and research and resolve outstanding items.
7. Produce monthly Aged Receivables reports by store and distribute to the AR Supervisor.
8. Review revenue reconciliation processes and recommend improvements.

Experience

7-10 Years

Level

Senior

Education

Bachelor Of Accounting