Sr. Provider Engagement Specialist

• Oct 2021 - Present

Integral member of the Texas Network Management team. Responsible to deliver industry leading service to physicians, providers, practice managers, hospitals and/or ancillaries within the Texas provider network, focusing on the Dallas, Austin and Houston Markets. Additionally, responsible for on-boarding of new providers, educating about HCH operations, and solving escalated problems. Develops and maintains strong relationships with assigned providers. Resolves services issues timely for providers including root cause analysis and resolution, communicating resolution plans to the providers, and ensuring follow through on such resolutions to the problem. Works with internal customer service/claims and other teams to resolve issues for providers, improve overall service experience and workflows. Manages projects for providers experiencing issues. Responsible for the submission of provider adds/terms/changes. Provides on-going critical evaluation and improvement opportunities for the HCH provider service model. Exemplifying what it means to be a high-performance service excellence organization. Educates providers on contracts, policies, and procedures. Develops strong working relationships with internal staff. Works to increase provider usage of EDI and on-line solutions. Show less

Benefits Counselor

• Mar 2020 - Oct 2021

Provider Relations Representative

• Nov 2017 - Mar 2020

Responsible for managing the assigned Provider Network partnering with the Client for risk or non-risk programs. Including facilitating provider communication, program implementation and conflict resolution functions. I serve as a liaison between contracted health plans, providers and ancillary providers to promote superior customer service and seamless programs. *Provider group management, *strategic planning,*identify opportunities for improvement in processes, *training, *oversee maintenance of provider relations database, *physician contract roster maintenance Show less

Business Office Manager

• Nov 2016 - Jul 2017

in charge of the overall business operations,responsible for hiring and training office staff, addresses staff issues and conducts regular performance reviews, oversees the selection of equipment used in the facility and ensures that it works properly, supervises the selection and ordering of supplies, oversees the financial aspects of the business, such as billing, banking and accounting, ensures that staff uses the correct coding when designating the diagnosis or results of procedures used. oversees all billing Show less

Business Office Manager Maternal Fetal Medicine Clinic

• Aug 2014 - Nov 2016

Successfully opened this first of it's kind maternal fetal medicine clinic for the Seton network.Developed and managed operations related to release of protected health information, billing and denial management, referral and insurance eligibility, scheduling and front office operations. Responsible for ensuring clinic processes met objective metrics set forth by senior leaders. Work under the direction of director to meet budgetary goals. Trained and facilitated High Reliable Organization tactics to ensure patient safety. Implemented and maintained the compliance of office protocols. Created and outlined associate performance expectations and procured resources and tools necessary for them to perform clinic operations efficiently. Ran and analyzed special reports to summarize revenue activity, physician compensation, identified denial trends and followed up non-payments for specific funding sources and identify opportunities for optimization and process improvement. Supported billing operations that included communicating breakdown of charges to patients and resolving patient billing discrepancies, identified billing resolution for lab and medical billing denials patients would present to office, analyzed revenue cycle reports monthly, reconciled billing charges to claim submissions and confirmed physician billing was submitted timely for filing. Monitored and tracked write offs. Reviewed patient collection worklist and ensured accuracy of claims being turned over. Developed corrective solutions to denials, non-payments and patient discrepancies. Show less

Practice liaison

• Mar 2014 - Aug 2014

Served as a liaison for all revenue cycle related operations to local practices and clinic operators. Ensure proper communication of fee schedule changes. Provides system training, support and workflow optimization for new and existing users of the EMR. Serve as liaison between clinic managers and revenue cycle contacts that relate to enrollment, credentialing, contracting, central billing operations and insurance representatives. Identify and facilitates physician billing system related operational issues. Communicate and help transition billing tasks and workflows that directly relate to National Revenue Service Center initiatives. Work with managers and directors on claim denial management. Ensure proper balance resolution for claim submissions and serves as a clinic resource to provide understanding and training of Athena Collector functionality. Communicates as well as ensures compliance of national standards and practice flows as set forth by the Ascension Network. Produce reports and analyze clinic revenue cycle data that directly relate to Ascension targets for charge entry lag, collection of time of service monies, billing and charge entry reconciliation, timely filing and denial resolution details as it pertain to accounts receivable. Show less

System and Billing Trainer

• Aug 2012 - Mar 2014

Trained 1:1 eCW and Athena software classroom and webinar. Front and back end process and workflow training.New employee orientationAssisted with Athena implementation.Developed training materials/manuals and training tests, created enhancements to existing training programs and maintenance of on-line courses.Performed financial data analysis to support professional billing and collections teams and maximize cash flowDesigned more efficient business processes to improve billing accuracy, ensure billing compliance, and reduce denied claims by 15% Restructured and redesigned existing training courses to improve performance, increase revenue, and increase patient retention by 20% Enhanced end-to-end revenue cycle through training improvements in all areas of the cycle (front desk, medical coding, charge entry, and billing and collections) Show less

Billing Specialist-Revenue cycle management

• Aug 2010 - Aug 2012

Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid. Reviewing and appealing unpaid and denied claims. Verifying patients’ insurance coverage. Answering patients’ billing questions. Handling collections on unpaid accounts. Managing the facility’s Accounts Receivable reports. Provided direct feedback to the software development and product teams on the Practice Management software in regards to issues, work impediments and desired new Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid. Reviewing and appealing unpaid and denied claims. Verifying patients’ insurance coverage. Answering patients’ billing questions. Handling collections on unpaid accounts. Managing the facility’s Accounts Receivable reports. Provided direct feedback to the software development and product teams on the Practice Management software in regards to issues, work impediments and desired new

Business Office Supervisor

• 2004 - 2010