Experience

Sycamores

• United States
• Mental Health Care
• 200 - 300 Employee

• Manager, Claiming and Revenue Management

  • 2015 - Present

  •Collaboratively engages with stake holders from the Los Angeles Department of Mental Health and partnered with software vendor to efficiently gather comprehensive business requirements for system configuration. Provides expert guidance and data to determine revenue cycle workflow requirements for Medical and contract-related processes, ensuring seamless integration and optimal efficiency.•Managed and led projects involving the strategic configuration of Cal AIM Payment Reform Initiative. Lead the transition of our agency to value-cased care from cost-based reimbursement. Configuring updates to HCPCS and CPT codes, aligning with California Department of Health Care Services systems.•Developed and implemented comprehensive revenue cycle policies, encompassing payer follow-up, write-offs, and rejected claims, resulting in improved financial outcomes.•Utilized various data applications to proactively monitor and track trends, enabling data-driven decision-making and process optimization.•Accountable for configuring the Electronic Health Record System, ensuring seamless integration of monthly enhancements and updates, including reviewing User Acceptance Testing (UAT) and testing scripts from the software vendor. Adhered to County and State claiming guidelines.•Identified discrepancies and recommended effective enhancements and fixes, significantly contributing to process improvement and operational efficiency.•Oversaw and supervised the successful implementation of new initiatives, ensuring smooth transitions into the claiming systems.•Expertly reviewed and established State and County EDI files for 270/271 eligibility, Claim Responses 277, 274, 835, and 837 transactions, taking full responsibility for contract reconciliation. •Demonstrated exceptional leadership skills by supervising and guiding subordinates to achieve objectives, including training, coaching, motivating, optimizing workflow, providing unwavering team support, and fostering continuous growth. Show less

• Lead Claiming Analyst, Claiming and Revenue Management

  • 2011 - 2015

  • Managed mental health billing for assigned clients, handling billing information, claims submission, payment posting, and accounts receivable tasks. Ensured accurate and timely submission of claims to Los Angeles County of Mental Health and DHCS.• Oversaw data management, including reviewing and entering data into the EHRS system, managing electronic report submissions, and maintaining organized paperwork in the database.• Conducted thorough research on claims with errors and executed complete claim reconciliations based on findings.• Proactively monitored the efficiency of systems, policies, and procedures, offering appropriate recommendations to optimize daily operations and achieve departmental goals. Show less

• Claiming Analyst, Claiming and Revenue Management

  • 2008 - 2011

  • Verified eligibility, benefits, and requested consumer documentation to ensure accurate billing.• Collaborated with teams to provide outstanding support to clients and clinicians, ensuring a positive experience.• Effectively resolved discrepancies with advisors and provided valuable support to clinicians.• Ran error reports to identify and address billing discrepancies before claiming.• Successfully transitioned from academic student affairs to the technology industry, demonstrating the ability to excel in new domains. Show less

• Claiming Entry Coordinator, Claiming and Revenue Management

  • 2005 - 2008

  • Reviewed and entered data for written progress notes into Los Angeles Department of Mental Health EHRS system.• Managed the electronic submission of reports including review, edits, and reconciliation. Filed and maintained outstanding paperwork and information in the database and communicated effectively with advisors to resolve any discrepancies. • Provided a high level of customer service to clinicians to ensure a positive experience. Show less