CRYSTAL BAKER
Yuba City,CA
Summary
Experienced Director of Operations proficient in managing revenue cycle operations with exceptional team supervision, project coordination and analytical problem-solving skills. Optimizes resource use to achieve challenging targets. Diplomatic in resolving disputes and coordinating diverse teams.
Overview
11
11
years of professional experience
Work History
Regional Director of Operations
Parallon Business Performance Group
Remote , CA
2018.06 - Current
- Manage revenue cycle for Medicaid Operations, Out of State Enrollment, and Authorizations & Billing
service lines including Medicaid/Medicare developments on a state and federal level. - Direct operations of 30 hospital systems in over five states with oversight and performance of 54
employees including the full spectrum of requisition management. - Direct the activities of the Quality Assurance team, gatekeeping all revenue activities for the eligibility
department, including but not limited to account reconciliation, approval review, billing follow-up,
payment posting, and invoice. - Direction of the OOS claims activities including the evaluation and transposing of UB04s for the claim
submissions, follow up and denial management for OOS clients. - Direction of the OOS Enrollment activities including but not limited to obtaining hospital administrator
and/or board advisor PHI for facility enrollment as well as provider PHI for physician enrollment of
out of state Medicaid for claim submission and reimbursement. - Direction of the Authorizations activities for Medicaid treatment authorization requests (TAR)
including but not limited to the evaluation of medical records to identify medical necessity and
congruency for admission to DRG, documentation, eTAR submission, adjudications, and denial
reviews. - Analyze monthly financial statements of month end for prior month with a review of 3/6/12 month
trending and SMLY. - Facilitate and build the MOR/QOR detail for monthly KPI reviews of prior month with research analysis
detail. - Travel to facilities on a quarterly basis for in-person meetings with the CFO and PAD providing the
review operational progress of KPIs and discuss anomalies and/or variances identified - Scheduled employees for shifts, taking into account customer traffic and employee strengths.
- Reduced financial inconsistencies while assessing and verifying billing invoices and expense reports.
Attending state and federal level public meetings and town halls to keep up to date with legislative
updates related to Medicaid/Medicare. - wn and maintain the BCP for my region, manage the BCP portfolio as a living document, and
participate in annual exercise reviews with senior leadership. - Lead and develop modernization to promote innovation of technology and processes within our
region. - Identify areas of inefficiency, make recommendations, and develop action plans as found.
- Keep a level of competitive intelligence to be ready and prepared to meet any changes in the industry.
Client Services Manager
Parallon Business Performance Group
Remote , CA
2016.06 - 2018.06
- Served as liaison, advocate, and mediator between Medicaid clients and Operations
- Drove client satisfaction and loyalty by identifying and resolving client needs and providing solutions
- Presented quarterly and monthly operating reports to C-suite and facility leaders
- Pioneered the Client Service Manager role for Medicaid eligibility services line
- Served as Project Manager for new business implementations, overseeing the playbook for Medicaid Eligibility
- Developed lucrative relationships with portfolio of seven Medicaid clients and 37 facilities by holding meet-and-greets, gatherings to discuss business concerns and status, and facilitating road shows in three states
- Enhanced Revenue Cycle Leadership Expo (RCLE) client rating and engagement from 76% to 92% within first year
- Built and streamlined reporting of each facilities’ key point indicators in MORs and QORs
- Applied exceptional relationship management and customer service skills that resulted in $48K of increased revenue from one client’s additional use of services.
Area Manager
Parallon Business Performance Group
Northern Territory , CA
2012.10 - 2016.06
- Oversaw field operations and eleven direct staff of an external Medicaid eligibility client consisting of 23 facilities across Northern California
- Built a successful team with training, motivation, and directives for maximum gains
- Boosted productivity by 40% within six months by establishing clear expectations and accountability, providing job aides and resources, and documenting work processes
- Motivated and directed an uninspired team for improved performance, resulting in $1.3M revenue increase within a year; also met and continued to meet quarterly bonuses.
Education
Master of Business Administration -
University of Phoenix
Bachelor of Science - Psychology
University of Phoenix
Skills
- Operational Efficiency
- Optimizing Profitability
- Business Management
- Organizational Leadership
- Cost Control
- Recruitment Strategizing
- Revenue Generation
- Data Recovery
- Current Trends
- Quarterly Reviews
- Process and Procedure Refinement
- Strategic Vision
Timeline
Regional Director of Operations
Parallon Business Performance Group
2018.06 - Current
Client Services Manager
Parallon Business Performance Group
2016.06 - 2018.06
Area Manager
Parallon Business Performance Group
2012.10 - 2016.06
Master of Business Administration -
University of Phoenix
Bachelor of Science - Psychology
University of Phoenix
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