Brian Mijares
Manager Revenue Cycle at Shriners Hospitals for Children - Northern California- Claim this Profile
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English -
Topline Score
Bio
Credentials
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CRCR
Healthcare Financial Management Association (HFMA)
Experience
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Shriners Children's Northern California
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United States
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Hospitals and Health Care
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100 - 200 Employee
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Manager Revenue Cycle
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Jun 2013 - Present
Facilitate daily revenue cycle specific needs and communications between the hospital, Shriners Hospital for Children headquarters, and external business office vendors. Interact with department directors in key clinical areas, as well as physicians, to obtain necessary documentation to support clinical services provided in efforts to clear pre-bill edits. Investigate denial trends and initiate communication with root cause owners and action owners to prevent future claim edits, denials, and report these issues in a timely manner to local leadership as well as the corporate Director of Patient Financial Services. Analyze Key Performance Indicator data and coordinate revenue cycle analytics for key functions, utilizing available data; quantify expected revenue impact and other characteristics supporting prioritization decisions. Oversight of the Patient Access Department ensuring the development, education, and performance of its employees. Perform quality assurance of all Patient Access functions consistently. Utilizing reports to analyze registration output to compile recommendations for improvement. Provide continuous training for quality improvement. Remain updated on State, Federal, and Managed Care regulations. Communicate and implement the appropriate changes when required. Show less
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Catholic Healthcare West
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Stockton, California
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Patient Financial Services Supervisor for Healthcare Clinical Labs
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Nov 2011 - Jun 2013
Responsible for oversight of the assigned functional departments at the Stockton Central Business Office and the staff assigned to those departments; including Pre-Billing, Billing, Accounts Receivables, Cash, and Customer Service. Implementation and on-going support of all Business Systems used in PFS and at the Stockton Central Business Office. Responsible for hiring, training, organizing, delegating, and monitoring staff. Act as a liaison/resource for auditors and responsible for performance improvement and problem solving of patient accounts, staff, third-party payers, vendors, and other internal and external customers. Adhere and support all HIPPA, OCEP and other compliance regulations as they relate to management of the Private Health Information (PHI). Perform Revenue Cycle meetings for Stockton, Sacramento, Oxnard, Glendale, Long Beach, and California labs focusing on cash goals and AR day reduction. Work in conjunction with the PFS Manager, Senior Director, and Chief Financial Officer and hospital presidents to implement policies and procedures which support the Dignity Health strategic plans. Show less
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Doctors Hospital of Manteca
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Manteca, CA
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Business Analyst
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Mar 2011 - Nov 2011
Responsible for analyzing, reporting, and trending hospital volume statistics. Net revenue, gross margin, and cost analysis for financial month end reporting and other requested information as needed. Consult with various hospital department directors, business office units, Tenet Healthcare entities, managed care operations, revenue and billing integrity groups for information related to various reporting projects. Assist with Director of Revenue Analysis with end process (eReserve), bill holds, accounts receivable, and payer issues as they arise. Effectively communicate with all levels of management. Show less
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Conifer Health Solutions
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United States
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Hospitals and Health Care
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700 & Above Employee
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Patient Financial Supervisor - Disputed Claims
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Mar 2010 - Mar 2011
Oversee, plan, organize, and direct the daily activities of subordinates within the Disputed Claims Department. Ensure proper and timely follow up of claim denial, and timely appeals on denied claims for less than expected reimbursement. Monitor and review variances to expected reimbursement (disputed and credit balance accounts) based on the contractual guidelines, escalating resolution by creating bulk resolution projects, coordinating with Manager to resolve issues/contract problems. Oversee, plan, organize, and direct the daily activities of subordinates within the Disputed Claims Department. Ensure proper and timely follow up of claim denial, and timely appeals on denied claims for less than expected reimbursement. Monitor and review variances to expected reimbursement (disputed and credit balance accounts) based on the contractual guidelines, escalating resolution by creating bulk resolution projects, coordinating with Manager to resolve issues/contract problems.
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Education
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2023 - 2025
San Jose State University
Business Administration and Management, General
Community
