ENJOLI GUILLORY

Dedicated to providing top-tier care for children and adults through collaborative teamwork.

• Evaluated revenue cycle processes, establishing actionable methods to enhance productivity and efficiency.
• Oversaw provider onboarding, and managed all credentialing, re-credentialing, and contracting processes.
• Maintained provider CAQH attestation to ensure compliance with industry standards.
• Identified opportunities for improvement in operational performance metrics.
• Negotiated agreements with external partners such as contractors or consultants.
• Directed the organization's daily operations, ensuring compliance with applicable laws and regulations.

Oversaw daily operations of revenue cycle team comprising 4 direct reports and 23 indirect reports.

• Supported 26 regional field offices with insurance authorizations, verification, client co-payment tracking, and collections.
• Implemented effective change management strategies to enhance business initiatives impacting accounts receivable and claim aging.
• Developed and facilitated employee training programs while providing peer coaching to enhance performance.
• Collaborated with clinical directors on industry changes and provided comparative analysis of payer practices across states.
• Managed credentialing processes, including re-credentialing, chart auditing, and Medicare/Medicaid enrollment.
• Led team of 15 in handling billing processes, including claims submission, payment posting, and denial management.
• Communicated with State Boards to ensure compliance with facility and provider regulations.

Via Health provided patient pay solutions to Health Care systems for underinsured patients.

• Phone/ web portal insurance eligibility and benefits verification
• Partnered with physician offices and area hospitals to confirm correct CPT and ICD-9 codes for patient prescribed radiologic/surgical procedures.
• Advised providers when patient insurance required authorizations
• Responsible for data analytics including inputting patient information in hospital EHR and scheduling database
• Support team in meeting required service level agreements

Collections Specialist

• Top performing outbound hospital collections
• Providing compassionate patient financial consultation on payment services
• Advisement on community resources and available assistance

WellPoint Inc./ Anthem Blue Cross Blue Shield is a leading health benefits company dedicated to improving lives, communities and making health care simpler.

• Reviewed and process claims in accordance to group and policy guidelines
• Partnered with insured group representatives to determine policy inclusions, exclusions and limitations
• Explained all benefit/policy inclusions and limitations to providers/members
• Responded to phone and e-mail inquiries regarding claim and policy concerns
• Received and entered direct claim submissions from members and providers
• Release of patient records
• Team lead providing peer support and training