Toluwalope ( Tolu) Jose, MBA, CRCR
Revenue Cycle Supervisor at Saint John's Physician Partners- Claim this Profile
Click to upgrade to our gold package
for the full feature experience.
Topline Score
Bio
Credentials
-
Certified SAFe® 4 Scrum Master
Scaled Agile, Inc. -
HFMA's Certified Revenue Cycle Representative (CRCR)
Healthcare Financial Management Association (HFMA) -
Scrum Master Certified (SMC)
Scrum Alliance
Experience
-
Saint John's Physician Partners
-
United States
-
Hospitals and Health Care
-
1 - 100 Employee
-
Revenue Cycle Supervisor
-
Nov 2020 - Present
•Lead a high-performing team of over 40 revenue cycle professionals, providing mentorship, training, and performance evaluations to drive individual and team success •Cultivate and maintain strong relationships with payers and third-party vendors, negotiating favorable contracts and resolving reimbursement issues promptly •Collaborate cross-functionally with physicians, department managers, and finance team to streamline revenue cycle processes, enhance efficiency, and facilitate accurate charge capture •Utilize data analytics to monitor and analyze financial metrics, identifying trends and areas of improvement, resulting in a 30% decrease in revenue leakage •Prepare and present ad hoc financial reports to physicians, clinic managers, AVP, VP on Key Performance Indicators (KPI) •Develop and execute comprehensive strategies to optimize revenue cycle performance, improve cash flow, and reduce denials, resulting in a 30% increase in revenue •Orchestrated end-to-end revenue cycle operations for an ASC, including coding, billing, claims submission, and collections, resulting in a 50% increase in revenue collection •Support the Collaborative Care Program with their unique billing and ensure denials are appealed Show less
-
-
-
Kaiser Permanente
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Financial Analyst
-
Jun 2019 - Dec 2019
• Successfully cross-referenced 835 reason and remark codes from payer Explanation of Benefits (EOBs) to the ANSI standard code, utilizing the Healthlogic system • Collaborated closely with vendors to effectively address and resolve any mapping issues that were impacting denials • Conducted comprehensive analysis of financial data to identify opportunities for optimizing claims processing, leading to a significant reduction in denials • Utilized data extraction techniques from Epic to identify trends and patterns in denials, enabling proactive measures to be taken. Reviewed partially paid claims and promptly engaged with insurance companies to rectify any discrepancies • Produced monthly financial reports and performed thorough analysis of extensive claims data to gain valuable insights and inform decision-making processes Show less
-
-
-
NYU Langone Health
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Outpatient Revenue Cycle Supervisor
-
Jan 2017 - Nov 2018
• Conducted comprehensive data mining and extensive analysis of accounts receivables to effectively identify payer denial patterns, claim rejections, and reimbursement trends, resulting in increased monthly cash flow. • Generated monthly dashboard reports that provided detailed insights into initial and final denials, cash flow, aging metrics, and presented findings to refine processes and enhance overall effectiveness. • Skillfully extracted and formatted large datasets to discern reimbursement trends, driving improvements in efficiency, productivity, and financial performance. • Demonstrated strong leadership by supervising a team of 16 employees, overseeing their daily functions, coordinating training programs for both new and existing staff, and identifying areas for improvement within the follow-up teams' operations. • Conducted monthly audits to monitor staff performance, conducted individual and team meetings to review results, and provided constructive feedback to address any issues. • Cultivated relationships with key department contacts to gather and analyze additional information necessary for reimbursement processes. • Identified inconsistencies in contract rates and collaborated with relevant stakeholders to develop and execute Managed Care Contracts. • Developed and implemented procedures for an escalation team handling high-value accounts, accounts nearing timely filing limits, and challenging credit accounts. • Maintained up-to-date knowledge of relevant coding systems (e.g., CPT, ICD9, ICD10) and hospital billing systems (DRG/APC). Show less
-
-
-
Northwell Health
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Credit and Collection Supervisor
-
Mar 2015 - Jan 2017
• Ensured prompt reimbursement policies and procedures that improved cash flow and minimized account receivables • Supervised and evaluated 7-10 employee’s daily work performances while maintaining high productivity levels and following federal collection laws• Resolved all customer and insurance carrier inquiries regarding paid, unpaid bills and outstanding bills• Facilitated the rapid development and implementation of key company initiatives through collaborative efforts with all levels of management and departments• Directed successful completion of projects by creating tasks and assigning drivers responsible for implementation and measuring results against industry benchmark• Coordinated with the clearing house and payers to ensure all claims were processed and received by insurance in a timely manner• Analyzed top denials for all provider accounts and created solutions to increase monthly cash flow by 14%• Reduced rates of delinquent accounts by following up on insurance companies or offering discounts to patients• Investigated and resolved data issues and discrepancies on patient demographics causing claims to drop to collection and driving up revenue by 35% Show less
-
-
Medical Billing Specialist
-
Nov 2013 - Mar 2015
• Monitored payment denials and reductions to determine operational or coding problems on laboratory claims in XIFIN• Translated patient information into ICD- 10 codes and input them into internal database while ensuring accurate timely filing of claims • Evaluated aspects of the billing process and provide efficient ways in processing claims• Researched and resolved denials and EOB rejections within standard billing cycle timeframe• Prepared bills for reimbursement, patients and physician offices while utilizing multiple billing interfaces• Retrieved Electronic Remittance Advice (ERA) and reconcile all insurance and patient payments accordingly Show less
-
-
Education
-
Western Governors University
Master of Business Administration (MBA), Health/Health Care Administration/Management -
City University of New York-Baruch College
Bachelor of Business Administration (B.B.A.), Finance
Community
