Eileen Rabor
Las Vegas,USA
Summary
Dynamic leader with a proven track record, specializing in operational efficiency and revenue cycle management. Expert in Lean Methodology, fostering cross-functional collaboration to enhance project outcomes. Demonstrated success in strategic financial analysis and KPI strategy implementation, resulting in significant growth and heightened client satisfaction.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Director of Insurance Services
Meduit
03.2024 - Current
- Oversee the analysis of denied claims to pinpoint denial reasons and assess the possibility of successful appeals
- Develop and execute strategies for appealing denied claims, collaborating with cross-functional teams to gather required documentation
- Produce consistent reports on trends in denials, outcomes of appeals, and departmental performance for senior management review
- Address client inquiries related to denied claims, offering clear and detailed explanations of the appeals process
- Identify opportunities to streamline claims handling and denial management to enhance efficiency and effectiveness
- Create training materials and programs for staff on best practices for managing claim denials and appeals, while overseeing improvements in client management, inventory tracking, and staff oversight at the Brea office
- Serve as the primary expert within the Insurance Division, identifying and implementing best practices to optimize operations
- Foster and sustain strong vendor relationships to support operational requirements
- Define and track key performance indicators (KPIs) to evaluate project operations and proactively address potential challenges
- Supervise projects to ensure they exceed client expectations, driving continuous improvement and satisfaction
- Finalize client invoices and prepare detailed monthly performance reports
- Maintain ongoing communication with clients to provide performance updates
- Assign staff to teams and clients based on operational requirements and project needs
- Provide support and guidance to leadership and staff, exemplifying company values in all interactions
Contract- Director of Revenue Cycle
Acclara
06.2023 - 03.2024
- Assist with the development of revenue cycle strategy and use a metric driven approach to managing revenue cycle functions and report on performance to ensure functions are operating at maximum efficiency
- Ensures strategies across all functional departments are properly implemented to enhance operational performance
- Directs tactical plans to achieve strategic goals; monitor progress toward goals throughout the year
- Analyzes identified problems to determine cause and desired resolution; takes steps necessary to implement resolution
- Solves escalated problems related to their areas of assignment and maintains a working knowledge of functions in these areas
- Maintains excellent patient, physician, and payer relationships through a proactive customer service-oriented approach
- Partners with other operational leadership on process improvement, training, analytics, and compliance
- Ensuring policies and procedures are current and enforced, business practices are compliant, and an elevated level of patient and client satisfaction is maintained
- May oversee billing and collections, ensuring compliance with established policies and procedures
- Establish a working relationship with the client and function as a liaison to ensure their expectations are met and any requests for information are responded to in a timely manner
- Provide strong, dynamic leadership that mentors, develops, and guides team members to efficiently leverage maximum net revenue to clients
- Maintain effective organization of responsibility, including efficient recruiting, training, coaching, recognition, workflow patterns, performance standards, delineation of duties and responsibilities, staffing levels and supervision
- Coordinate analytic, strategic, and technical resources to meet client expectations
- Ensure compliance with regulatory agency guidelines and standards
Contract- Director of Revenue Cycle Excellence
Healthrise Solutions
09.2022 - 07.2023
- Responsible for various projects geared towards increasing cash flow, managing growth, improving efficiency/quality, and optimizing workflows
- Work closely with practice managers/administrators, account managers, revenue cycle staff, vendors, managed care, credentialing, and medical center IT teams
- Directly supervise billing employees, establish priorities, assign work, and follow up to ensure assignments are complete
- Select, orient, and evaluate staff
- Compile statistical data as requested and reports data monthly to appropriate parties
- Prepare reports and analyses to assist in identification of cash flow variances, physician referral patterns, physician volume, and any other issues identified by Management
- Lead and collaborate with practice personnel and administration to implement change to practice operations where necessary
- Identify denial trends and train staff accordingly to avoid in the future, emphasizing improvement of accurate charge capture
- Analyze/audit notes and ensure the appropriate codes are charged to maintain billing compliance and prevent denials
- Serve as a liaison to the outside billing for questions, data request, and other inquiries
- Review charge encounter forms for complete CPT code, ICD-10 code, and other required billing information daily
- Ensure timely and accurate collection, preparation, and verification of billing information submitted to the outsourced billing service
Revenue Cycle Director
Vivida Dermatology
08.2021 - 09.2022
- Supervise and evaluate department for daily operations pertaining to patient billing, communications with health insurance, collections, cash posting, account management, and contract analysis
- Lead targeted revenue improvement opportunities and assist with analyzing the fiscal impact as related to health centers clinical departments
- Ensured continuous performance through proactive engagement with Finance Leadership.
- Established strong connections with peer leaders of Revenue Cycle and core support departments to enhance collaboration.
- Ensure that the audit of denial management processes occurs consistently, and coordinate with others to identify trends and implement a denial prevention/recovery program.
- Strong working knowledge of billing and collection processes and functions, charging processes, general revenue cycle management strategies, and industry best practices.
- Strong analytical and critical thinking, organizational, and business process optimization skills, with an in-depth ability to develop and apply innovative solutions.
- Analyzed denial data trends and partnered with functional areas to prevent avoidable write-offs.
Revenue Cycle Manager
Scripps Health
06.2019 - 11.2021
- Designed, developed, and facilitated the deployment of the Epic Training Curriculum.
- Ensured training environments were refreshed with collaboration from Epic Application Teams.
- Certified Super User for configuring reports within Epic Systems to optimize daily operations.
- Knowledge of medical terminology, commercial and government health insurance, billing guidelines, ACA requirements, understanding of DRGs, medical ICD-9/ICD-10 codes, CPT/HCPCS codes, and modifiers are preferred.
- Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
- Oversaw and performed quality audits to assure consistency and standardization of procedures, and optimize patient experience.
- Ensured compliance with policies, procedures, and standards of care.
- Actively involved in improvement efforts, workflow design, and validation with input on policies and procedures.
- Performed quality audits, providing retraining or action plans as needed to improve accuracy and meet production and patient satisfaction targets.
- Generated and reviewed reports to track performance outcomes, and performed root cause analysis to identify performance improvement needs.
- Built financial models to allocate resources, forecast cash and investment needs and make capital budgeting decisions.
Patient Access Director- Optum 360 Revenue Cycle
St. Rose Dominican Hospital
06.2017 - 05.2019
- Directed analysis, implementation, and testing of updates and modifications to Epic modules and related applications.
- Managed operations of Epic ADT, HB, and PB teams.
- Optimized workflows by creating customized templates and queues.
- Streamlined both front and back-end billing processes for improved collaboration.
- Managed critical trauma situations, including Route 91 Harvest Festival.
- Achieved and maintained monthly collection and KPI targets.
- Performed patient registration functions, secure financial clearance, signatures, release of medical information, ensure all insurance benefits and payment of services are legally responsible for patient care
- Directed payroll operations and developed schedules to guarantee adequate staffing.
- Managed the full cycle of hiring including recruitment, selection, interviews, and training.
- Participated in meetings with other departments throughout the organization to discuss best practices and strategies related to patient access services.
- Collaborated with various departments such as medical records, billing office and health information management to ensure timely resolution of issues related to registration process.
- Maintained communication and transparency with governing boards, department heads and medical staff.
- Identified potential revenue cycle issues before they arise by monitoring accounts receivables aging report on a regular basis.
Outpatient Revenue Cycle Director
University of Illinois Hospital & Health Science System
10.2011 - 06.2017
- Lead in development of Epic Applications, as well as recovery work, gathering issues, developed fixes/solutions, implementations and monitor solutions
- Outpatient Care Center/ Maxwell Clinic Department of Physical and Occupational Therapy
- Cleared insurance benefits for each patient is accurate and authorizations is updated per insurance plan (Medicare, Medicaid, Workers Comp Claims)
- Assigned monthly insurance meetings for update and accurate changes with state plans, analyzing monthly reports of billing system
- Managed office budgeting; order supplies and equipment utilizing state funding; create employees' work schedules
- Assisted with monthly processing of payroll and maintain employee requests
- Collected authorizations for insurances; perform auditing billing (validating insurances for private and state plans, billing and modifying charges)
- Improved the department by organizing clerical procedures, obtaining patient's scheduling, registering new patients for evaluation
Patient Financial Director
Wheaton Franciscan Healthcare
01.2006 - 10.2011
- Executed assessments to enhance processes within Revenue Cycle Finance and coding.
- Enhanced Management Consulting processes to align with industry-leading practices for EHR-Cerner.
- Ensured continuity of operations through effective management of AR and KPI metrics.
- Directed various aspects of RCM team functions: coding, charge-entry, claims submissions and collections.
- Directed and enhanced the skills of RCM personnel.
- Negotiated contracts and agreements with vendors, suppliers, and service providers to reduce costs and improve terms.
- Managed and developed finance department staff, fostering a culture of continuous improvement and professional growth.
- Analyzed competitors and market trends to facilitate business growth.
- Created and enforced company-wide controls regarding revenue and expenses in concerted effort to protect organization's assets.
- Analyzed actionable claims data, including revenue and volume, by region, payor, hospital, surgeon, and procedure code
- Ensured compliance with coding and billing regulations, relevant healthcare regulations and data privacy issues (e.g., HIPAA)
Education
MBA -
University of Wisconsin, Milwaukee
Milwaukee, WI05-2017
Bachelor of Science - Nutritional Science
Kaplan University
Davenport, IA05-2014
Bachelor of Science - Kinesiology
University of Wisconsin, Milwaukee
Milwaukee, WI05-2012
Skills
Operational Efficiency Management
Project Execution
Lean Methodology Expertise
Health Data Analysis
Data-Driven Quality Metrics
Strategic Financial Analysis
Proposal Development
Change Process Optimization
Financial Planning
KPI, Strategy Implementation
Subject Matter Expert Projects
SaaS Management
Insurance Claims Processing
Operational Efficiency in Healthcare
Regulatory Compliance Execution
Patient Satisfaction Management
HIPAA Regulations Expertise
Healthcare Management Consultant
Service Line Development
No Surprise Act
Revenue Cycle Management
Patient Access Workflow Development
Patient Safety Oversight
Healthcare Contract Negotiations
Experience with Cerner EMR
Experience with EPIC Health Software
Healthcare Data Management
Cross-departmental training
Road Mapping Methodologies
Leadership Development
Cross-Functional Collaboration
Operational Capacity Management
Mentoring
Application Development
Business Strategy Formulation
Strategic Decision-Making
Certification
· Epic Certified, 03/17
· Cerner Certified, 03/11
· HBI Certified Revenue Cycle Leader, 03/21
· CHAA NAHAM, 01/22
· SSGI Lean Six Sigma Green Belt, 12/23, 91568897
· SSGI Lean Six Sigma Black Belt, 01/24, 91684919
· SSGI Lean Six Sigma Master Belt, 01/24
· Certified Revenue Cycle Certification, 01/24
References
References available upon request.
Timeline
Director of Insurance Services
Meduit
03.2024 - Current
Contract- Director of Revenue Cycle
Acclara
06.2023 - 03.2024
Contract- Director of Revenue Cycle Excellence
Healthrise Solutions
09.2022 - 07.2023
Revenue Cycle Director
Vivida Dermatology
08.2021 - 09.2022
Revenue Cycle Manager
Scripps Health
06.2019 - 11.2021
Patient Access Director- Optum 360 Revenue Cycle
St. Rose Dominican Hospital
06.2017 - 05.2019
Outpatient Revenue Cycle Director
University of Illinois Hospital & Health Science System
10.2011 - 06.2017
Patient Financial Director
Wheaton Franciscan Healthcare
01.2006 - 10.2011
· Epic Certified, 03/17
· Cerner Certified, 03/11
· HBI Certified Revenue Cycle Leader, 03/21
· CHAA NAHAM, 01/22
· SSGI Lean Six Sigma Green Belt, 12/23, 91568897
· SSGI Lean Six Sigma Black Belt, 01/24, 91684919
· SSGI Lean Six Sigma Master Belt, 01/24
· Certified Revenue Cycle Certification, 01/24
MBA -
University of Wisconsin, Milwaukee
Bachelor of Science - Nutritional Science
Kaplan University
Bachelor of Science - Kinesiology
University of Wisconsin, Milwaukee
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