April R Boehm
Ada,USA
Summary
Professional with robust background in directing and managing large-scale operations, consistently driving success through strategic planning and execution. Adept at implementing innovative solutions that enhance productivity and operational effectiveness. Known for fostering teamwork and adapting to evolving business needs, ensuring alignment with organizational goals.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Director, Revenue Cycle Management
AssuranceSD
07.2023 - Current
- Managed the entire revenue cycle process, from participant authorization and eligibility to billing and collections, ensuring compliance with federal and state regulations. Create and implement strategies to minimize bad debt, enhance revenue capture, and improve overall cash flow and profitability. Lead, mentor, and manage the revenue cycle team, setting performance standards and goals to achieve optimal productivity and efficiency. Analyze financial data and reports to identify trends, issues, and opportunities for improvement within the revenue cycle process. Review and enhance billing, collection, and payment posting processes for efficiency and best practices. Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
Director, Revenue Cycle Management, Authorizations and Eligibility
Public Consulting Group / Public Partnerships, LLC
07.2020 - 07.2023
- Responsible for the direct oversight of authorization and eligibility operations across 60 consumer directed homecare programs nationwide. Provided direction by establishing goals, policies, and procedures towards performance improvement while taking part in development of organizational plans and vision. Manages processes to advance the organization’s ability to meet and exceed key strategic goals and initiatives. Ensures compliance with contractual obligations, state and federal regulations for member enrollment, eligibility, and authorizations through HIPPA transactions and code set standardization in the electronic health record and other applicable health related information. Developed and supported effective internal controls for managing to front end processes to support accurate claiming and billing practices and proper reimbursement methodologies. Primary stakeholder to the development of a system wide platform to directly manage authorizations for 42 programs across the organizational portfolio.
Manager, Revenue Cycle Management, Authorization and Eligibility
Public Consulting Group / Public Partnerships, LLC
02.2019 - 06.2020
- Responsible for the direct oversight of all external and internal authorization, demographic and eligibility related items across the organization portfolio. Created baseline for newly established department through best practice recommendations and portfolio wide standardization of various Electronic Data Interchanges (EDI) including industry standard X12 HIPPA related transaction sets. Supported the coordination of the design, development and deployment of program setup and execution relative to member enrollment, authorization, and eligibility. Established departmental structure, roles, and responsibilities, reporting, staff KPI metrics and score cards for performance management and career development.
Manager, Business Implementations
Public Consulting Group / Public Partnerships, LLC
07.2016 - 02.2019
- Responsible for leading enterprise-wide projects and program activities and organizing resources to lead portfolio initiatives. Focus on management and oversight of projects including cross functional collaboration, execution, integration, training, and status reporting. Lead both internal and external program implementations; including new business development opportunities, Federal Labor Standard Act (FLSA) overtime compliance and federal policy guidelines surrounding Companionship and Live-In Exemptions across 27 state Medicaid home care programs, including ongoing research on federal policies and guidelines through the National Resource Center for Participant Directed Services (NRCPDS), client engagement and education, developed program questionnaires, tracking tools, training plans, project timelines, internal and external training. Served as a technical resource responsible for interacting with IT delivery and development staff for systems configuration needs specific to FLSA guidelines. Managed to user acceptance testing for new development to support authorizations, payroll, and reporting requirements.
Program Manager
Public Consulting Group / Public Partnerships, LLC
07.2013 - 07.2016
- Responsible for oversight and management of consumer-directed home care program operations in Colorado, including the leadership and supervision of 36 staff responsible for program service delivery. Achieved stabilization of operations, services and systems supporting 2,600 consumers and 4,200 providers. Functioned as the primary stakeholder to the Participant Directed Program Policy Collaboration (PDPPC) group developed to work in collaboration with Colorado Health Care Policy and Finance (HCPF) on issues relating to Participant Directed Services under Colorado Consumer Directed Attendant Support Services (CDASS) and In-Home Service and Supports (IHSS). Initiated a Consumer Directed Forum servicing as an avenue in which consumers and providers can openly discuss program and federal policies associated to managing to their personal health care needs with direct oversight by community and organizational moderators. Supported account receivable A/R initiatives focused on reducing the number rejected claims by working directly with RCM staff, case management and Xerox, resulting in a decrease of A/R balance of 1.5M. Focused efforts on ensuring audit/contract compliance and the coordination cross-functionally to address corrective actions plans or process improvements, as needed.
Program Support Manager
Public Consulting Group / Public Partnerships, LLC
07.2011 - 07.2013
- Responsible for the direct oversight of a team of program support specialists, training coordinators and peer trainers supporting adherence to enrollment and program training requirements for the Colorado Consumer Directed Attendant Support Services (CDASS) program. Developed program specific training material broken down into two distinct focus areas; CDASS Managing Employer Training and CDASS Program Training which is still being used by Consumer Direct to meet training requirements under separate contract. Managed to training schedules, venues, program support and peer trainer training assignments for group sessions and one on one training courses. Supported initial development as well as ongoing enhancements to the single-entry PAR design to support direct entry of authorizations into organizational Web Portal by case managers. Maintained business continuity, procedures, tools, and training resources for use both internally and externally. Served as a technical resource responsible for interacting with IT delivery and development staff for systems configuration needs specific to the Single-Entry Prior Authorization (PAR). Conducted user acceptance testing for new development to support authorizations, payroll, and reporting requirements. Served as a subject matter expert responsible for program activities, program information, operations, and significant development.
Customer Service/Operations Manager
Public Consulting Group / Public Partnerships, LLC
12.2006 - 07.2011
- Responsible for all customer service interactions, escalations, and direct oversight of all supervisors, lead staff for 40 programs across 21 states, within portfolio. Advanced the first installation of the ShoreTel, a strategic telephony system upgrade across the organization. Conducted weekly internal and external status meetings as well as internal status reporting for senior leadership. Developed standardized reporting dashboards capturing call volume, SLA compliance, enrollment statistics, payroll statistics and pend management. Defined quality assurance program including, call monitoring, performance evaluations, performance action plans, coaching and floor monitoring. Primary contact for implementation of customer service for all new programs, including phone line and voicemail set up. Supported the initial office set up in Colorado upon the implementation of the Colorado CDASS program. Served as a technical resource responsible for interacting with IT delivery and development staff for systems configuration needs. Primary point of contact for facilities, property management, telephony set up and monitoring, server maintenance and overall office management.
Customer Service Supervisor/Ground Service Coordinator
Alaska Airlines/Peninsula Airways
09.2003 - 10.2006
Special Education Instructor (ED/BD)
Matanuska Susitna Borough School District
09.1994 - 06.2001
Administrative Assistant, Activities Director
Matanuska Susitna Borough School District
09.1991 - 06.1994
Education
Public Health Administration -
University of Phoenix
Business Administration - undefined
Estrella Mountain Community College
Avondale, AZPsychology - undefined
University of Anchorage Alaska
Anchorage, AKSkills
- Professional Development:
- Project Management
- Product Management
- Agile Methodologies
- Scrum Master
- Relationship building
- Strategic planning
- Verbal and written communication
- Decision-making
- Technology Proficiency:
- MS Office (Word, Excel, PowerPoint)
- MS Project
- Scribe
- JIRA
- Azure
Certification
- Project Management Training
- Product Management Training
Timeline
Director, Revenue Cycle Management
AssuranceSD
07.2023 - Current
Director, Revenue Cycle Management, Authorizations and Eligibility
Public Consulting Group / Public Partnerships, LLC
07.2020 - 07.2023
Manager, Revenue Cycle Management, Authorization and Eligibility
Public Consulting Group / Public Partnerships, LLC
02.2019 - 06.2020
Manager, Business Implementations
Public Consulting Group / Public Partnerships, LLC
07.2016 - 02.2019
Program Manager
Public Consulting Group / Public Partnerships, LLC
07.2013 - 07.2016
Program Support Manager
Public Consulting Group / Public Partnerships, LLC
07.2011 - 07.2013
Customer Service/Operations Manager
Public Consulting Group / Public Partnerships, LLC
12.2006 - 07.2011
Customer Service Supervisor/Ground Service Coordinator
Alaska Airlines/Peninsula Airways
09.2003 - 10.2006
Special Education Instructor (ED/BD)
Matanuska Susitna Borough School District
09.1994 - 06.2001
Administrative Assistant, Activities Director
Matanuska Susitna Borough School District
09.1991 - 06.1994
Business Administration - undefined
Estrella Mountain Community College
Psychology - undefined
University of Anchorage Alaska
Public Health Administration -
University of Phoenix
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