Genesis Health At Home - Remote EmploymentJune 01, 2023 - Current (Independent Contract)Revenue Cycle Management Director
Strategy Development: Responsible for developing and implementing strategies to optimize the revenue cycle process. This involves analyzing data, identifying areas for improvement, and designing action plans to enhance revenue generation and cash flow.Team Leadership: Managing a team of RCM professionals, including billing specialists, coders, and financial analysts. You provide guidance, support, and mentorship to ensure that the tea-----------ets its objectives -----------pliance Management: Ensuring compliance with healthcare regulations and billing standards such as HIPAA (Health Insurance Portability and Accountability Act) and ICD (International Classification of Diseases) coding guidelines. You stay updated on regulatory changes and implement necessary adjustments to maintain compliance.Performance Monitoring: Monitoring key performance indicators (KPIs) related to revenue cycle metrics, such as days in accounts receivable (AR), denial rates, and collection rates. You analyze trends, identify issues, and implement strategies to improve performance.Technology Integration: Overseeing the implementation and optimization of revenue cycle management software and technologies. This includes Electronic Health Record (EHR) systems, billing software, and other tools aimed at streamlining processes and improving efficiency.Financial Analysis: Conducting financial analysis to identify opportunities for revenue enhancement and cost reduction. You may analyze payer contracts, reimbursement rates, and pricing structures to maximize revenue potential.Collaboration: Collaborating with other departments such as finance, IT, and clinical operations to ensure alignment of goals and effective communication. Building strong relationships with stakeholders across the organization is essential for success in this role.Training and Development: Providing training and development opportunities for RCM staff to enhance their skills and knowledge. This ensures that the team stays updated on industry best practices and regulatory requirements.Problem Solving: Addressing issues and resolving challenges that arise within the revenue cycle process. This may involve investigating billing discrepancies, resolving denied claims, and implementing corrective actions to prevent future issues.Continuous Improvement: Fostering a culture of continuous improvement within the RCM department. Encouraging innovation and efficiency gains to drive better financial outcomes for the organization.Provider Enrollment for Private Practice, HHA, HCA, and etc for Medicare Provider -----------mercial Payer Credentialing and Network Participation Application.ERA/EFT/ EDI Enrollment
Simitree - Imark BillingMarch 25, 2022 - May 25,2023Account Success Specialist - Project Manager - Post Acute Revenue Cycle Management - US Medical Billing, AR Claims, Denial Management, Pre Claim Review Policies, Billing Increment and Coding DisciplineAssisting Imark manager in all tasksExperienced with Health care software for medical claims processingHandle Inbound and Outbound Calls from customer queries and insurances and home health agencies.Experienced with clearinghouse softwareKnowledge in Billing for Medicare and Commercial insuranceFollowing up with customers, resolving issuesBilling home health claims expertA/R and aging follow up Posting paymentsGenerating billing reportsResearching insurance claimsFollowing up on rejected or denied claimsCreating training videosContacting insurance companies and software companiesFacilitate New Hire Training - Product Training for RCM - Certification and Nesting Period.Creation of PPT Presentations as a Training Material and HIPAA Training. EMR/EHR Training.Client TrainingSending reports to clientsCreating PDF documents
BP Global Response Solutions Incorporated September 15, 2021 - March 20,2022Operations & Business Development Manager - Recruitmentment ManagerSet goals and developed plans for business and revenue growth, including researching and implementing new target market initiatives and pursuing leads through the sales cycle.Sourcing, Pooling, Onboarding and Operations Endorsement. Developed quotes and proposals for prospective clients and trained business development staff to meet team goals.Attended conferences and industry events to stay up-to-date on business development strategies.Managed company equipment purchase requisition, IT inventory, and utilities.Possessed skills in business development, B2B, change management, and HR.Preparation of invoicing for provided services to the client and Operations Payroll.
Virtual Staffing Solutions OPC Dragon Ball Compound Tacloban City, Philippines October 8, 2020 – September 10, 2021 Operations Manager - Revenue Cycle Management / Healthcare Account/ Human Resource Supervisor/Recruitment Supervisor/ Trainer - Team LeadOversaw the Revenue Cycle Team/Cluster, managed business operations, and provided leadership.Conducted forecasting, data mining, and metrics interpretation to inform important policy, planning, and strategy -----------veloped, implemented, and reviewed operational policies and procedures, and assisted HR with recruiting when necessary.Managed the operations process, including design, planning, control, performance improvement, and operations strategy.Emphasized organization and communication, and provided reporting and benchmarking as needed.Handled Medical Billers and Did Medical Billing for an OCD Therapy. Responsible for onboarding, client invoicing and payroll validation. Approving Pre-shift OTs, Post-shift OTs and RDOTs.Facilitate New Hire Training - Product Training for RCM - Certification and Nesting Period.Creation of PPT Presentations as a Training Material and HIPAA Training. EMR/EHR Training.Client TrainingProvider Enrollment for Private Practice, HHA, HCA, and etc for Medicare Provider Network.
Abbott Rapid Diagnostics 02/22/2019 – 09/ 21/ 2020 Verifications of Benefits Representative - Appointment Specialist/ Team LeadProvided DME services for HOME INR MONITORING, including member verification, benefit and eligibility verification, authorization processing, and follow-up for multiple insurances.Handle Inbound and Outbound Calls from customer queries and insurances.Processed claims for individual providers and medical institutions, with expertise in resubmission and codes.Ensured attachments of authorizations and medical necessity to prevent denied claims, using Salesforce and Microsoft Office Suite/Google Suite.Reviewed EOBs and handled ERA and EFT for correct payment and disputes.Processed Medical Claims for DME and sending it to medical insurance companies.Managed medical invoicing, accounts receivable, accounts payable, and missing payments tracking.
Microsourcing Philippines 08/30/2015 – 02/18/2019 Medical UnderwriterProcessed medical claims and conducted follow-up for multiple doctors' offices.Handle Inbound and Outbound Calls from customer queries and insurances.Reviewed medical records for validity and qualification of claims.Ensured attachments of authorizations and medical necessity to prevent denied claims.Resubmitted, voided, or corrected claims as needed using Salesforce tools.Edited claim forms using Microsoft Office Suite/Google Suite.Arranged medical record appointments with hospitals for partnership deals.Processed Professional Medical Billing.
The Results Companies 08/22/2014 – 08/25/2015 Healthcare Representative | Team Lead 1 year and 6 months 02/17/-----------/25/2017: Team Leader Profiled for Provider Services Line, handling claims, denials, appeals, and disputes.Handle Inbound and Outbound Calls from customer queries and clinics.Processed claims for individual providers and medical institutions, with expertise in resubmission and codes.Experienced in claims resubmission with Code 1 (Original Claim) and Code 6/7 (Corrected Claim).Managed eligibility, benefits, authorization inquiries, and medical -----------dical Billing Education
HIPAA CERTIFIED: License#: 347538 CERTIFIED LEAN SIX SIGMA WHITE BELT: License #: FLQLCDDBDL-QHKGSQKQ-WNHTFKFHDN
Verified
