Experience

The Cancer & Hematology Centers

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

• Director Revenue Cycle - Patient Access

  • Sep 2022 - Present

  -Build and manage high performing team, including but not limited to; insurance verifications, authorizations for chemo treatment, collections, financial counseling, coding and compliance including audits and education billing, cash posting, and AR management -Build relationships with external business partners and internal leadership -Leverage technology to optimize workflows that drive efficiency, quality and accuracy -Create strategies to identify root cause billing and coding issues -Optimize workflows to address issues through process improvement - Compliance Officer - Oversee the compliance program which includes HIPAA, provider documentation, auditing, education, HCC coding, Disaster Recovery -Direct supervision of staff including management and supervisory roles Show less



PNC

• United States
• Financial Services
• 700 & Above Employee

• Vice President, Operations Sr Manager

  • Dec 2017 - Sep 2022

  • PNC Healthcare is a clearinghouse for 835, 837 and EFT EDI transmissions  Manage team of Project Managers for new provider onboarding  Lead negotiations with payers to enroll for direct connections with PNC Clearinghouse  Direct and support the enrollment of providers with payers for 835, 837 and EFT EDI submissions  Received 2020 Celent Model Bank Award for technology – automating enrollment processes. o Reduced cycle time from 32 days to 4.5 days – 711% improvement o FTE reduction of 57% in growing area of business o Managed capital projects from manual preparation to an automated enrollment process improving quality, cycle time and reduced FTE count.  Coordinate and troubleshoot status meetings with payers and providers to mitigate problems or delays related to provider onboarding and enrollments.  Build reporting to establish metrics to hold staff accountable for productivity and quality while providing staffing analysis for rapidly growing business needs.  Monitor team performance using strategic plan and established KPI’s.  Highest Employee Satisfaction (eNPS) scores for Healthcare Division Show less



Priority Health

• United States
• Insurance
• 700 & Above Employee

• Director, Revenue Cycle

  • Apr 2013 - Nov 2017

  • Lead multiple operational teams including managers and supervisors of health insurance Revenue Cycle to complete timely enrollment and billing of plan’s groups and members through electronic (EDI) and paper processes while meeting and exceeding customer needs and objectives. • Primary responsibility for >$4M budget for several cost centers preparing annual financial budget and targets, reconciliation of monthly variances, preparation for monthly accruals for accurate cost reporting• Process Improvement professional. Bronze certified. Toyota Production System, Kaizen culture, A3, PDSA. Lean Process principals coach. • Monitor team performance using strategic plan and established KPI’s. • Staff planning to forecast and provide appropriate coverage during peak periods.• Complex regulation monitoring for compliance including Affordable Care Act(ACA), Center for Medicaid and Medicare Services(CMS), CAQH Committee for Operating Rules for information Exchange(CORE), Workgroup for Electronic Data Interchange(WEDI), Service Organization Control (SOC1), Model Audit Rule(MAR) and Health Insurance Portability and Accountability Act (HIPAA).• Identified, designed and developed automated processes for reconciliation of accounts receivable, enrollment, and billing reporting.• Project management and leadership. Several successful project implementations. Automation of “Quote to Card” processCORE Compliance with WEDINew ID card VendorElectronic Member Materials• Strong Gallup Scores; 2015-Most improved team Gallup scores across Priority Health and Spectrum Health system. • Proficient knowledge in array of products offered by health insurance plan including details regarding government programs and self-funded plans.• Proficiency in Microsoft Office Suite, Facets 5.3, Cognos TM1, Databases, Data Warehouse, Business Objects & WEBI, Tableau, SQL• Manage several vendor relationships. Show less

• Sr. Manager, Business Reporting & Automation

  • Jun 2000 - Apr 2013

  • Increased Third Party Liability Claim department savings from $10M to > $22M in 4 years.• OnBase Workflow Automation rolled out for substantial savings in time and resources corporately.• Pilot Business Objects corporate rollout• Reporting & Data Analysis support for Operation’s areas. • Built Audit databases to meet SAS70 control objectives.