Overview
11
11
years of professional experience
Work History
Revenue Integrity Manager
Kaweah Delta Healthcare District
11.2021 - Current
- Company Overview: The Revenue Integrity team builds community trust and bolsters the financial security of Kaweah Health through the assessment of clinical workflows for operational efficiency and compliant charging practices.
- Identifies audit opportunities to reduce the organization's risk of payer recoupments and directs the resolution of internal findings to completion
- Spearheads an interdisciplinary committee to review claim edits and determine best practice resolutions, especially for Medically Unlikely Edits (MUEs) and National Coding Coverage (NCCI) edits
- Educates senior staff and service line appointees on these best practice resolutions in a proactive effort to avoid claim delays
- Creates a bi-weekly denials report and acts as a liaison on the denials committee
- Executes process improvement initiatives as assigned by the Director in partnership with teams such as Patient Accounting, Patient Access, HIM, and ISS
- Actively communicates with third party vendors to maintain positive working relationships and stay informed of new developments
- Manages internal projects to ensure efficient claim production, resulting in: Clean claim rate increasing from 84% in FY24 to 86% to date in FY25, Claim output increasing by 3% from last fiscal year, Timely payments increasing by 9% from last fiscal year
- Uses system reports to review the successes of new workflows and implement updates to continuously improve key metrics
- Provides Chargemaster oversight
- Manages Service Requests for charge and/or process related concerns at an average rate of 45 requests per month
- Maintains revenue capture and charge reconciliation workflows to optimize clinical charge capture for Kaweah's 9,000 unique charges and 42,000 ways that those charges can generate
- Ensures compliance with Price Transparency regulations
- Directs quarterly and annual reviews of code changes for elements such as Current Procedure Terminology (CPTs) and Revenue Codes to ensure maximum reimbursement with the health plans and Work Relative Value Units (wRVUs) for appropriate physician compensation
- Researches account discrepancies between the clinical and financial systems, and coordinates issue resolution efforts with team members across multiple departments
- Creates a collaborative team environment to foster employee engagement and retention
- Mentors and coaches team members both within Revenue Integrity and for external teams such as Patient Accounting and Patient Access
- Prepares and monitors department budget and performance reports to ensure minimal variance
- Engages team members through weekly team meetings and bi-weekly one on ones to foster an environment of openness and collaboration
- Facilitates monthly meeting with CFO to review Revenue Integrity's successes and current work efforts
- The Revenue Integrity team builds community trust and bolsters the financial security of Kaweah Health through the assessment of clinical workflows for operational efficiency and compliant charging practices.
Revenue Integrity Analyst
Kaweah Delta Healthcare District
07.2018 - 11.2021
- Built SQL queries, SAP BI reports, and Tableau reports to assist in audits as directed by the CFO and Director of Revenue Cycle
- Provided technical and operational analysis to ensure financial security
- Led work effort to reduce the Accounts Receivable through continuing efforts with a successful result of reducing the inventory of accounts from a high of 115 days to the 80 days in CY 2021
- Designed and presented monthly and annual financial reports to Directors and Executives
- Extracted insights using custom reports requested by revenue-generating Directors to optimize their operations
Consulting Analyst
Siemens Healthcare, Cerner Corporation
07.2014 - 07.2018
- Generated reports from SQL and SAP to support project implementations
- Wrote HTML code to customize software for client rules
- Analyzed current state and proposed recommendations for future state process improvement
- Organized and facilitated meetings between technical and operational teams
- Interpreted technical workflows and terminology for operational teams
- Translated operational requests to specs for technical teams
- Provided software implementation assistance, such as writing code for client-specified billing rules
Summary
Collaborative leader partners with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Education
Bachelor of Science - Business Administration
09.2012 - 06.2014
Skills
Decision-making
Financial records oversight
Strategic planning
Coaching and mentoring
Cross-functional team management
Key performance indicators
Project management
Trend analysis
Data analysis
Team leadership
Certification
Six Sigma
Certified Revenue Cycle Representative
Timeline
Revenue Integrity Manager - Kaweah Delta Healthcare District
11.2021 - Current
Revenue Integrity Analyst - Kaweah Delta Healthcare District
07.2018 - 11.2021
Consulting Analyst - Siemens Healthcare, Cerner Corporation
07.2014 - 07.2018
California State Univeristy - Bachelor of Science, Business Administration
09.2012 - 06.2014
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