Experience

Connective Health Strategies

• United States
• Business Consulting and Services
• 1 - 100 Employee

• Vendor and Claims Resolution Manager

  • Sep 2021 - Present

  • Create and implement RCM operational processes or a process improvement for offshore vendors. • Create and implement RCM audit process for charge entry, payment posting, AR Follow Up, and Denials. • Collaborate with the data team to build new insights program to provide clients with enhanced details on their inventory and revenue. • Perform all duties around functional areas to identify gaps and improve processes. • Establish a month-end revenue reconciliation process. • Maintain and improve client and vendor relationships through deliverables and frequent meetings. • Assist clients in implementing new patient payment products. • Act as liaison between clients and vendors. • Develop denials strategy to further offshore production areas of RCM. • Ensure project goals and SLAs are met. • Act as SME for startup business. • Manage and develop daily productivity of project team members. • Act as a founder in establishing a functional RCM Operations company. Show less



Nobilis Health Corp.

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

• Revenue Cycle Manager, Revenue Integrity

  • Jan 2018 - Dec 2020

  Ensuring all revenue is captured within hospitals. Focused on process improvements within the organization and hospitals. Developing tools to enhance Department Directors involvement in the Revenue Cycle process. Ensuring all revenue is captured within hospitals. Focused on process improvements within the organization and hospitals. Developing tools to enhance Department Directors involvement in the Revenue Cycle process.



FTGU Medical Consulting, LLC.

• Revenue Cycle Manager

  • Jan 2017 - Jan 2018

• Business Consultant

  • Aug 2016 - Jan 2017



Gateway Diagnostic Imaging

• Plano, TX

• Project Manager - Implementations

  • Jul 2016 - Aug 2016

  Oversaw the research and logistics associated with the implementation of a new electronic time of service payment system. Analyzed timed studies to identify and confirm the advantages of the new electronic benefits verification. Established new Standard Operating Procedures based on in-depth processes from each timed study. Prepared variance analyses to determine benefits of new data processes compared to current data methods. Developed new best practices to improve workflow, authorization, time of service quotes, front office protocols and regulatory compliance functions and activities. Facilitated the advancement of the company through a comprehensive presentation for senior leadership that formulated strategies to grow company strengths and correct areas of deficiency. Guided the in-depth analysis of company performance to devise new processes, systems and workflow. Show less



MediGain

• Hospitals and Health Care
• 100 - 200 Employee

• Client Account Manager

  • Jul 2015 - Jul 2016

  Drove the planning and execution of client development and relationship programs with an emphasis on optimal service and support.Distinguished as a Subject Matter Expert for ability to properly close new accounts and on-boarded new clients. Monitored client accounts and overall performance to ensure adherence to forecasted goals and objectives. Coordinated the communication and workflow across the new client and Operations Team to expedite the execution of on-boarding standard operating procedures and delivery of client contractual expectations. Conducted client training and education on healthcare requirements, out-of-network reimbursement and compliance requirements. Crafted monthly invoices and reports with a focus on quality assurance and the inclusion of the entire scope of service. Show less

• ASC RCM Operations Supervisor

  • Jan 2014 - Jul 2015

  Directed the delivery of a wide range of aspects within client agreements including payment posting, charge entry, coding and accounts receivable follow-up teams. Managed and evaluated the performance of on-site and off-shore teams in exceeding client expectations.Aligned the communication and service expectations across Account Managers and Executive Management as the primary liaison with Operations Department. Produced monthly client revenue reports and positively resolve any invoice discrepancies and issues. Implemented new internal processes to reduce aging days with out-of-network clients by 30%. Reduced the processing time on charge entry and payment posting from over four days to 2.8 days. Built successful appeal, negotiation and recoupment request methods for settling escalated reconciliation, aging days and collections challenges. Steered the oversight of denials and relevant trends throughout Ambulatory Surgery Center, Plastic Surgery, Orthopedic Surgeons, General Surgery and Anesthesia clients. Administered departmental hiring, training, evaluation and advancement activities.Software/Systems/WebsitesMedWare, HST, NexTech, Advantx, Zirmed, Trizetto, Vision, Greenway, AMD, InstaMed, Availity, Navinet, Csnap, Cigna, UHC, Optum, Ebridge, SourcePlus. Show less



True Results (AIGB)

• United States
• Wellness and Fitness Services
• 1 - 100 Employee

• Account Manager

  • 2013 - 2014

  Supervised the accounts receivable requirements for select clients with a focus on out-of-network appeals and negotiation settlements. Delivered a 23% increase in monthly receivable goals for 10 months. Streamlined internal systems and processing requirements to decrease days in aging. Built productive relationships with clients through the positive communication of claims and appeals needs. Led the resolution and completion of escalated carrier issues within the Special Investigative Unit (SIU). Prepared monthly reports for clients to improve the understanding of their status. Show less



United Surgical Partners International, Inc

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Insurance Specialist

  • Aug 2011 - Mar 2013

  Orchestrated the scheduling, review and verification of authorizations for pain and radiology procedures. Organized the fulfillment of all CMS and WC authorization and chart documentation requirements. Conceptualized new procedures to improve internal processes and minimize long-term escalated issues. Supported clients with education and recommendations on financial obligations and payment options. Partnered with the Billing Team to verify that the claim was properly distributed. Orchestrated the scheduling, review and verification of authorizations for pain and radiology procedures. Organized the fulfillment of all CMS and WC authorization and chart documentation requirements. Conceptualized new procedures to improve internal processes and minimize long-term escalated issues. Supported clients with education and recommendations on financial obligations and payment options. Partnered with the Billing Team to verify that the claim was properly distributed.



Prime Diagnostic Imaging

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

• Insurance and Billing Specialist

  • Jan 2009 - Jun 2011

  Send claims thru clearinghouse for reimbursement. Work carrier correspondence. File appeals as needed. Keep detailed records of LOP payments. Create and distribute standard operating procedures. Verify insurance for radiology, pain management and surgical procedures. Obtain authorizations as needed. Working with major med carriers, Medicaid, Medicare, worker's comp and supplement policies. Contacting patients with financial responsibility, explaining benefits and if needed setting up payment plans. Company operating system Centricity. Show less



BenefitMall

• United States
• Insurance
• 700 & Above Employee

• Operations Supervisor

  • 2007 - 2009

  Supervised daily productivity from team. Maintained production spreadsheets and reports. Data entry. Created and distributed standard operating procedures. Setting up new groups/making changes to existing groups that are adding/changing carriers. Includes benefits, rates, commissions, enrollment, billing and posting of initial check. Transmission of new groups to on line carriers. Prepare and process enrollments for medical, dental, and ancillary lines of coverage in several different data systems. Coordinates receipt of carrier group numbers. Sets up groups in the billing system. Reviews carrier benefit material for accuracy. Meets 98% accuracy requirement within a 24 hour turnaround requirement Show less



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Clinical Coverage Review

  • 2005 - 2007

  Reviewed incoming predetermination requests from providers. Reviewed summary plan descriptions and certificates of coverage for plan language used to determine coverage. Requested and reviewed medical records for medical policy requirements. Sent authorization letters to providers and consumers. Handled appeals from providers regarding authorization determination. Reviewed state and federal mandates on specific procedures when determining authorization. Reviewed GAP request when there was not an INN specialist within the policies required mile range. Show less