Cecilia Cervantes
Lakewood,CA
Summary
Knowledgeable leader prepared for senior roles in driving efficiency and growth. Proven track record in optimizing processes, enhancing productivity, and leading cross-functional teams to success. Known for adaptability, fostering collaboration, and delivering measurable results in dynamic environments.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Senior Medical Billing Manager
Quality Health Partners
02.2024 - Current
- Improved revenue cycle by managing and overseeing the entire medical billing process.
- Managed high caseloads while maintaining excellent attention to detail throughout each claim''s lifecycle from initial reporting to final payment
- Facilitated collaboration between departments for more efficient resolution of interrelated billing issues.
- Maintained compliance with industry regulations by staying current on changes in coding and billing practices.
- Analyzed financial reports to identify trends and areas for improvement in the overall revenue cycle process and meet company revenue recognition policies.
- Established strong relationships with insurance carriers to expedite claim processing times and improve reimbursements.
- Successfully negotiated contracts with external vendors, achieving cost savings while maintaining high-quality services.
- Implemented quality controls to prevent fraud or abuse in the medical billing system, safeguarding company resources and reputation.
- Developed policies and procedures for the medical billing department, establishing a strong foundation that supported growth and operational success within the organization.
- Optimized cash flow by regularly reviewing aging account balances and implementing tactics for timely collections from payers.
- Managed a team of dedicated medical billers, focusing on professional development opportunities and maintaining a positive work environment conducive to high levels of productivity.
Contract Consultant
Self Employed
01.2019 - Current
- Collaborated with cross-functional teams to develop comprehensive proposals that met client requirements and expectations.
- Reviewed existing contracts to identify opportunities for renegotiation or consolidation, resulting in cost savings for clients without compromising service quality.
- Developed strong working relationships with clients through regular communication and proactive problem-solving approaches.
- Managed a diverse portfolio of contracts, demonstrating adaptability and expertise in various industries.
- Implemented effective contract tracking systems, ensuring timely renewals and reducing potential liabilities.
Provider Relations Manager
Optum
10.2013 - 01.2024
- Successfully resolved complex disputes involving reimbursement rates or other contractual disagreements between providers and the organization through skilled negotiation tactics.
- Provided exceptional support to healthcare providers during times of transition or crisis, resulting in minimal disruption to patient care delivery and maintaining high levels of satisfaction among partners.
- Coordinated educational events for providers aimed at increasing awareness of regulatory changes as well as best practices in patient care delivery.
- Developed comprehensive reports highlighting trends and performance metrics of providers, enabling informed decision-making at all levels of management.
- Contributed significantly towards achieving company''s growth targets by effectively managing a large portfolio of healthcare providers across different geographical regions.
- Monitored changes in industry regulations and government policies that could impact healthcare providers, ensuring timely communication of relevant information to affected parties.
- Streamlined operations for network expansion, identifying potential providers and negotiating contracts to onboard them efficiently.
- Served as a liaison between healthcare providers and internal departments such as claims processing or customer service, facilitating effective resolution of any issues that arose during day-to-day operations.
- Initiated physician and hospital orientations to support ongoing education of health care provider community.
- Promoted a culture of continuous improvement within the provider relations team, regularly soliciting feedback from healthcare providers and incorporating suggestions into strategic plans.
- Supported healthcare providers in navigating complex regulatory guidelines related to risk adjustment policies and procedures.
- Assisted in the design of risk adjustment training programs to foster organizational understanding of best practices in the field.
Education
Bachelor of Science - Business Management
University of Phoenix
Tempe, AZ02-2023
Skills
- Conflict resolution strategies
- Effective communication
- Team leadership qualities
- Project management
- Strategic planning
- Operations management
Certification
- PMP - Project Management Professional
Timeline
Senior Medical Billing Manager
Quality Health Partners
02.2024 - Current
Contract Consultant
Self Employed
01.2019 - Current
Provider Relations Manager
Optum
10.2013 - 01.2024
Bachelor of Science - Business Management
University of Phoenix
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