Experience

American Health Partners, Inc.

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Senior Director of Revenue Integrity

  • Jun 2023 - Present

  Conduct in-depth analysis of multiple datasets, including claims and patient data. Utilizing data mining, data validation, and querying to identify and interpret trends. Provide monthly trend report and actionable items to C-Suite to for Unity Geriatric Psychiatric Care, Rehab America, American Health Communities Skilled Nursing, TruHealth (Nurse Practitioners, Physician Assistants and Psychiatric Nurse Practitioners) and Tennessee Quality Home Health & Hospice. Review of CMS Medicare or Medicaid reports to interpret data for areas of improvement, develop ongoing internal monitoring, and provide recommended operational steps for resolution.Communication with Operational Leaders of various divisions and throughout the organization to share division, facility, and provider performance issues identified in the trend reports to improve clinical documentation, revenue capture, and program or contractual compliance.• Lead a team of 19 Certified Nurse MDS Coordinators/Trainers/Auditors and Certified Billing Coders• Developed a training manual for facility based MDS Coordinators • Maintained ADR Win Rate from of 90% in 2023 • Increased Medicaid CMI Revenue in the SNF Division by $41.79 per patient per day ($21.5M Annually)• Increased Medicare and Medicare Advantage PDPM Revenue in the SNF Division by $90 per patient per day ($16.2M Annually) since joining the organization.• Increased PA/NPP/APN Revenue for Geriatric Psych Division • Bi-Weekly meetings with CEO, CFO, and COO regarding status of revenue in focus divisions• Quarterly presentations to the Board of Directors regarding revenue trends for the divisionsSkills: Revenue Enhancement · Strategic Initiatives · Pivot Tables · Managed Care · Quantitative Analytics · Revenue Cycle Management · Financial Analysis · Team Building · Public Speaking · Training · Customer Service · Time Management Show less

• Director of Revenue Integrity

  • Aug 2021 - May 2023

  Conduct in-depth analysis of multiple datasets, including claims and patient data. Utilizing data mining, data validation, and querying to identify and interpret trends. Provide monthly trend report and actionable items to C-Suite to for Unity Geriatric Psychiatric Care, Rehab America, American Health Communities Skilled Nursing, TruHealth (Nurse Practitioners, Physician Assistants and Psychiatric Nurse Practitioners) and Tennessee Quality Home Health & Hospice. Review of CMS Medicare or Medicaid reports to interpret data for areas of improvement, develop ongoing internal monitoring, and provide recommended operational steps for resolution.Communication with Operational Leaders of various divisions and throughout the organization to share division, facility, and provider performance issues identified in the trend reports to improve clinical documentation, revenue capture, and program or contractual compliance.• Lead a team of 19 Certified Nurse MDS Coordinators/Trainers/Auditors and Certified Billing Coders• Developed a training manual for facility based MDS Coordinators • Increased Medicare PDPM Revenue in the SNF Division by $1.2 Million in the last twelve months• Increased Medicaid CMI Revenue in the SNF Division by $2 Million in the last two quarters • Decreased ADR Risk across multiple divisions by $12 Million in the last year• Increased PA/NPP/APN Revenue for Geriatric Psych Division • Bi-Weekly meetings with CEO, CFO, and COO regarding status of revenue in focus divisions• Star Award Winner for 2021 Calendar Year – Performance award for employees who are recognized as the top 1% of the organization Show less

• Manager of Revenue Integrity

  • Aug 2019 - Jul 2021

  Oversee and implement processes, procedures, and monitor performance to ensure legal, ethical revenue capture; accurate MDS documentation; and reimbursement retention for Skilled Nursing Facilities, Unity Geriatric Psych Facilities, Rehab America, TN Quality Home Health/Hospice, and TruHealth.• Developed PDPM Data Trend Analysis Reporting and recommendations for actionable items to improve Revenue Capture, Reimbursement, and Clinical Documentation Compliance • Developed ADR Trend Reporting• Implemented focus reviews of Medicare Part B claims for the Rehab Division • Member of Compliance Committees for all lines of business (7) and American Health Partners Show less



PrimeCareHealth Community Health Centers

• United States
• Medical Practices
• 1 - 100 Employee

• Director of Revenue Cycle & Patient Access

  • Oct 2018 - Aug 2019

  • Responsible for maximizing the collection of medical, dental, & behavioral health services payments and reimbursements from patients, insurance carriers, financial assistance, and guarantors. • Responsible for evaluating, reviewing, and implementing all policies and procedures related to insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and accounts receivable management, denial management, reporting of results & analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, patient services, training and development as it pertains to the full revenue cycle. • Hire, train, supervise, and evaluate: 1) Directly; the Manager of Revenue Cycle and the Manager of Access & Enrollment 2) Indirectly; A/R Specialists, Patient Enrollment & Access Specialists, Registration, and Centralized Scheduling • Oversight of all business-related functions of the patient visit from point of entry to accurate adjudication of the patients’ account. • Develop and make recommendations on information analyzing claims, utilization, and medical cost data and prepare monthly statistics.. • Oversee the maintenance of enrollment rosters and empanelment services. • Manage revenue cycle projects at the organizational level, such as audits and budgets. • Develop, monitor, and address business metrics in order to refine processes and improve efficiencies by establishing internal goals and identifying external benchmarks. • Oversight of the enrollment and credentialing of all providers (physicians, physician assistants, nurse practitioners, mental health providers, dentists, hygienists, etc.) and clinics with all insurance companies, Medicaid, and Medicare. • Assist in preparing UDS reports. • Update PrimeCare’s Fee schedule on an annual basis. • Determine and provide training for all providers on proper billing techniques. Show less



Aperion Care

• Lincolnwood, IL

• Corporate Reimbursement Documentation Specialist

  • Sep 2017 - Apr 2018

  Claim ADRs Review clinical documentation to respond to claim ADRs, HEDIS Audits, Medicaid Audits and appeals Identify issues causing claim ADRs and Audits Train facility staff on more efficient systems to accurately document care provided. Updated claim ADR and Audit submission processes to align with HIPAA standards. Triple Check Process Training Educate interdisciplinary teams on more effective ways to Triple Check claim data and clinical documentation to avoid rejected claims, claim ADRs, and focus audits. Coordinated with Billers, Reimbursement Consultants, and facility IDT teams and created a recurring Triple Check meeting schedule to avoid inefficiencies. Internal Medicaid Mock Audits Team Lead during the mock audits, create and maintain audit and re-audit schedules. Select audit sample medical records in preparation for the mock audits. Review documentation in preparation for real Medicaid audits. Complete and submit the mock audit result reports. Train facility staff on more efficient systems to accurately document care provided for more successful real audit outcomes. CareWatch Work with vendor to set up seven newly acquired facilities, obtain usernames and passwords for all users at new facilities. Establish six new corporate regions within the software and ensure all existing users have appropriate access. Coordinate training for new and existing facilities. Subject Matter Expert Act as a resource for the Clinical Reimbursement and Billing Teams for billing and or regulatory questions related to Medicare/Medicaid. Presenting at Regional MDS meetings upon request on Medicare/Medicaid regulations, Triple Check process, ADRs and audit documentation compliance. Show less



Presbyterian Homes

• United States
• Hospitals and Health Care
• 200 - 300 Employee

• Corporate Billing Manager

  • Sep 2014 - Sep 2017

  Lead a team that encompasses Corporate Physician Billing/Coding Coordinator, Business Office Managers, Accounting Clerks & SNF Medicare Billing/Coding coordinators. Provide concierge-level customer service and engage residents participating in various committees to educate them on their rights and benefits within various payer programs. Serve as Subject Matter Expert on Medicare, Medicare Advantage, Medicaid, & commercial insurance plans and benefits. Collaborate with Admissions & Billing teams to obtain appropriate authorizations for care services. • Implement & manage Medicare Compliance program for all Life Care Community (LCC) Campuses and Outpatient Therapy Clinics o Audit Medicare, Medicare Advantage, Medicaid, & Insurance claims for regulatory compliance and accuracy o Increased Medicare A, B, & C initial claim submission success rate to over 90% for 15 consecutive months o Medicare 855 Credentialing applications for Re-organization, separating CCRC into individual entities • ICD-10 Training and Implementation at all LCC Campuses & Outpatient Therapy Clinics • Responsible for billing & collecting approximately $120M annually o Ensure the following: therapy logs meet requirements for MDS reimbursement RUG, campus census documentation supports the dates of service on claims, diagnosis codes support the claim for daily skilled services & ancillary charges support the diagnosis and MDS assessment • Create quarterly presentations for the Corporate Compliance Committee with detailed statistics and data analysis indicating the effectiveness of our billing compliance programs and the implemented adaptations for regulatory changes. • Complete & maintain credentialing for Physicians & Nurse Practitioners • Maintain, update and troubleshoot Vision and billing software for LCC Campuses and Outpatient Therapy Clinics • Create, implement and update corporate billing policies & procedures and author job descriptions for both corporate & campus-based billing employees Show less



Infinity Healthcare Inc

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Billing and Credentialing Manager

  • Dec 2013 - Sep 2014

  • Managed a group of 7 Medical Billing Specialists/Coders • Completed and maintained credentialing for 11 physicians • Supervised billing for 6 clinics, physician hospital rounds, nursing home visits, and home health certifications • Managed the implementation of new EMR program at 2 clinics (eClinical Works) • Managed a group of 7 Medical Billing Specialists/Coders • Completed and maintained credentialing for 11 physicians • Supervised billing for 6 clinics, physician hospital rounds, nursing home visits, and home health certifications • Managed the implementation of new EMR program at 2 clinics (eClinical Works)



Chicagoland Medical Billing Specialists, Inc

• Owner

  • May 2007 - Nov 2013

  • Managed billing for 17 medical practices with over 50 medical providers • (Family Practice, Physical Therapy, Pain Management, Social Worker, Psychologists, Psychiatrists, Chiropractors) • Completed and maintained Provider Credentialing with CAQH, insurance companies, and hospitals • Negotiated billing contracts with medical providers as prospective clients • Client meetings to ensure that CMBS was providing exceptional customer and billing services • Trained/Supervised billing, insurance verification, and credentialing employees • Quickbooks entries, accounts payable, payroll, banking, and invoicing billing clients • Marketing, Public Relations, Expo presentations • Office network set up, Managed IT support • Wrote policies, procedures, and employee handbook Show less