Description :

1. Collaborate directly with the CFO and revenue cycle team to identify and resolve issues impacting revenue capture.
2. Manage contracts and registrations with third-party payers, ensuring compliance with state regulations.
3. Conduct thorough billing audits and coordinate with external vendors to optimize revenue processes.
4. Address claim balance settlements, ensuring timely resolution and accuracy in system usage.
5. Stay updated on healthcare billing procedures and regulations to maintain compliance.
6. Oversee Medicaid and Medicare contracts across multiple states, ensuring adherence to guidelines.
7. Led a credentialing initiative that secured over 100 Medicare contracts in under a month.

Experience

10+ Years

Level

Management

Education

BSHA

Description :

1. Manages all aspects of the revenue cycle, ensuring accurate demographic information, coding, and claim submission.
2. Applies analytical skills to bill services accurately and address areas of concern.
3. Obtains and communicates authorizations for services in compliance with payer contracts.
4. Conducts thorough research on problem accounts, identifying solutions and executing corrective actions.
5. Serves as a resource for team members on coding compliance for ICD-10 and CPT codes.
6. Assigns appropriate codes after comprehensive review of medical records and clinical documentation.
7. Ensures timely processing of coding and claims output to meet payer deadlines.

Experience

5-7 Years

Level

Executive

Education

BS-HIM

Description :

1. Monitored and analyzed accounts receivable to ensure maximum revenue realization and stable cash collections.
2. Achieved and maintained industry-leading Key Performance Indicators, enhancing overall departmental performance.
3. Ensured compliance with internal controls within the revenue cycle system to safeguard financial integrity.
4. Identified and implemented cost reduction and revenue improvement strategies, increasing operational efficiency.
5. Streamlined processes and workflows to enhance effectiveness and reduce turnaround times.
6. Managed patient complaints professionally and compassionately, improving patient relations and satisfaction.
7. Collaborated with management in strategic planning and execution of revenue cycle objectives and special projects.

Experience

10+ Years

Level

Consultant

Education

B.S. Health Admin.

Description :

1. Managed claim submissions and resolutions for various insurance providers, ensuring prompt payment for CCS Medical patients.
2. Oversaw an individual portfolio of accounts, verifying all documentation for Medicare audits.
3. Identified and implemented process improvements, resulting in enhanced operational efficiency.
4. Conducted thorough follow-ups on correspondence related to assigned accounts.
5. Communicated effectively with physician offices to gather necessary documentation for billing accuracy.
6. Documented all correspondence and activities meticulously to maintain accurate account records.
7. Provided timely resolutions for account inquiries while escalating issues to management when necessary.

Experience

2-5 Years

Level

Junior

Education

B.S. HCA

Description :

1. Collaborated with hospital departments to enhance efficiency in billing operations and front desk activities.
2. Utilized customer service standards to identify and address patient billing needs effectively.
3. Maintained strict confidentiality of patient information while managing billing records.
4. Abstracted clinical data to support accurate billing and coding practices.
5. Conducted training sessions for IDX billing application users, improving team competency.
6. Partnered with healthcare providers to optimize revenue cycle operations and ensure compliance.
7. Implemented corrective action plans to enhance revenue cycle performance and provided coding education to staff.

Experience

5-7 Years

Level

Executive

Education

B.S. Health Admin.

Description :

1. Posted payments and denials in both billing systems efficiently.
2. Developed and ran reports to track employee productivity and effectiveness.
3. Performed thorough tracing of payments for outstanding claims to ensure timely deposits.
4. Created a systematic approach to match checks with their corresponding explanation of benefits.
5. Implemented initiatives to boost office morale while maintaining focus on productivity.
6. Resolved payment discrepancies involving insurance companies and patients.
7. Investigated missing payments, ensuring accurate application to patient accounts.

Experience

7-10 Years

Level

Senior

Education

B.S. Health Admin.

Description :

1. Utilized Epic systems to analyze denial data, facilitating timely claim submissions to the clearinghouse for optimal reimbursement.
2. Conducted thorough reviews of patient electronic health records in Epic to ensure accurate coding and compliance.
3. Ensured prompt and precise claim processing through both electronic and manual submissions.
4. Effectively resolved denied claims by contacting patients for necessary billing information.
5. Managed submission of claims, both electronically and via paper, to ensure proper reimbursement.
6. Maintained professionalism and productivity while multitasking in a high-volume environment.
7. Addressed billing discrepancies and escalated issues to the appropriate departments for resolution.

Experience

10+ Years

Level

Consultant

Education

B.S. Health Admin.

Description :

1. Monitored and improved Quality Assurance processes related to billing functions.
2. Reviewed and corrected claims prior to submission, ensuring compliance and accuracy.
3. Applied coding conventions to resolve claim issues and discrepancies effectively.
4. Handled customer service inquiries, documenting actions to improve future interactions.
5. Contacted responsible parties to assess payment capabilities and establish financial arrangements.
6. Facilitated payment plans and offered financial assistance options to patients.
7. Processed daily electronic payer rejections and completed assistance applications per guidelines.

Experience

5-7 Years

Level

Executive

Education

B.S. in HCA

Description :

1. Maximize insurance payment efficiency by proactively engaging with third-party payers and patients.
2. Accurately assign unique identifiers for patient accounts to ensure efficient tracking.
3. Enhance customer service while securing patient accounts for optimal reimbursement outcomes.
4. Drive upfront collections and maintain detailed billing reports to improve cash flow.
5. Document all required patient information, including consent and directives, in accordance with regulations.
6. Investigate and resolve non-payment issues by liaising with payers and patients.
7. Provide clear and timely responses to external inquiries regarding account statuses.

Experience

7-10 Years

Level

Senior

Education

B.S. Health Admin.

Description :

1. Efficiently resolve patient billing discrepancies by investigating issues and implementing corrective actions.
2. Manage outstanding guarantor balances and insurance denials to optimize revenue recovery.
3. Accurately document and update patient accounts, ensuring timely submission of corrected claims.
4. Utilize SharePoint for managing patient claims and outstanding balance documentation.
5. Maintain a safe and compliant work environment in line with organizational policies.
6. Update the accounts receivable database to reflect new accounts and payments accurately.
7. Input and verify patient demographic information and surgical charges to ensure billing accuracy.

Experience

5-7 Years

Level

Executive

Education

B.S. in HCA

Description :

1. Managed end-to-end claims processing, ensuring timely follow-up and resolution of outstanding claims.
2. Implemented effective appeals strategies, resulting in a significant increase in successful claim recoveries.
3. Analyzed billing discrepancies and developed solutions to enhance accuracy and compliance.
4. Coordinated financial functions including charge capture, coding, and reimbursement analysis.
5. Trained and mentored staff on best practices in revenue cycle management.
6. Collaborated with cross-functional teams to optimize operational workflows and enhance revenue capture.
7. Monitored regulatory changes and ensured compliance with industry standards.

Experience

10+ Years

Level

Management

Education

B.S. Health Admin.

Description :

1. Generated comprehensive revenue reports for senior management, driving strategic decisions.
2. Managed denial postings and recoupments, ensuring accurate financial tracking.
3. Evaluated and approved account adjustments in line with hospital policies.
4. Conducted medical necessity verification in compliance with CMS regulations.
5. Secured necessary insurance authorizations for both scheduled and unscheduled services.
6. Facilitated the implementation of improved business processes to enhance efficiency.
7. Executed quality assurance audits across the revenue cycle, identifying areas for improvement.

Experience

7-10 Years

Level

Management

Education

B.S. HCA

Description :

1. Collaborated with healthcare providers and payers to enhance surgical authorizations by ensuring adherence to regulations.
2. Designed process flow charts that improved operational efficiencies in the revenue cycle.
3. Conducted training sessions on coding and revenue cycle processes for staff and coders.
4. Supported quality control initiatives to evaluate and enhance billing procedures.
5. Facilitated training programs aimed at improving registration quality across multiple departments.
6. Identified and mentored high-potential employees for roles as Super Users in the revenue cycle.
7. Managed day-to-day workflows and error resolution in work queues, reducing account discrepancies.

Experience

2-5 Years

Level

Executive

Education

B.S. in HA

Description :

1. Managed comprehensive accounts receivable analysis to identify collection patterns and trends.
2. Conducted regular audits of outstanding balances to ensure accuracy and compliance.
3. Developed and implemented strategies to enhance cash flow and reduce outstanding receivables.
4. Collaborated with clinical staff to optimize billing workflows and reduce errors.
5. Utilized data analytics to drive improvements in collection processes and operational efficiency.
6. Facilitated training sessions to educate staff on best practices in revenue cycle management.
7. Monitored key performance indicators to assess and improve financial performance.

Experience

5-7 Years

Level

Executive

Education

B.S. in HA

Description :

1. Assigned accurate Diagnosis and CPT Codes to maximize reimbursement rates.
2. Analyzed payor trends and payments, presenting findings to management for strategic decisions.
3. Verified patient eligibility and updated demographics in the Epic system.
4. Submitted comprehensive appeals to insurance companies, ensuring proper documentation.
5. Collaborated with various specialty practices to optimize revenue cycle strategies.
6. Reviewed payor contracts to ensure accurate reimbursement for services rendered.
7. Identified discrepancies in reimbursement rates impacting accounts receivable.

Experience

7-10 Years

Level

Management

Education

BSHA

Description :

1. Reduced accounts receivable by diligently following up on unpaid claims with payors and patients, ensuring proper reimbursement.
2. Maintained comprehensive knowledge of billing and collections, including regulations and coding requirements.
3. Responded to inquiries from insurance, patients, and departments to resolve issues effectively.
4. Collaborated on solutions addressing changes in insurance policies impacting billing.
5. Managed multiple projects while consistently meeting high productivity standards.
6. Registered patients professionally and efficiently, focusing on exceptional service.
7. Conducted patient interviews to explain financial responsibilities and billing policies.

Experience

5-7 Years

Level

Executive

Education

B.S. in HCA

Description :

1. Managed the input of physician referrals and orders, ensuring accurate assignment of hospital and patient accounts.
2. Addressed routine patient inquiries regarding registration and payment processes, enhancing customer service.
3. Collaborated with the outpatient radiology authorization team to streamline pre-service tasks.
4. Conducted thorough coding work and researched queues for potential coding edits.
5. Set and defined business objectives to align with organizational goals.
6. Worked alongside Sales & Marketing to develop strategies that meet defined business targets.
7. Partnered with Business Development to identify customer needs and appropriate solutions.

Experience

10+ Years

Level

Senior

Education

B.S. in HA