Jose Villarreal
Cape Fear,NC
Summary
Experienced Director with over a decade of specialized knowledge in the healthcare industry, particularly within hospital settings. Demonstrated expertise in implementing and managing billing and collection systems and leading projects related to interim management, reorganization, and support analysis. Skilled in driving successful post go-live implementation of various financial IT systems, with a focus on development and support. Seasoned consultant with a strong skill set encompassing assessment, process re-design, workflow improvement, revenue cycle claims analysis, billing and accounts receivable management, and project optimization.
Overview
15
15
years of professional experience
Work History
Sr. Revenue Cycle Architect
Oracle
07.2023 - Current
- Lead revenue cycle integration, workflow and technical design across all revenue cycle solutions and venues across RevElate and Millennium platforms
- Identify workflow and process improvements and make recommendations to client and project leadership
- Created Revenue Cycle Action Team for hospital cashflow improvement
- Manage project timeline for all Revenue Cycle Solutions
- Lead solution advancement and methodology, recruiting, and internal training development, as appropriate
- Provide leadership to both consulting and client personnel to identify, quantify, implement and measure specific improvement initiatives
- Manage and resolve project escalations as point of contact for revenue cycle leadership.
Director of Revenue Cycle Optimization
Wellspan Health EPIC
10.2022 - 06.2023
- Partners with senior leaders to understand current operations and identify opportunities for improvement and transformation that should be included in the Stewardship program to support the journey to value that will make WellSpan thrive for years to come
- Assists with Patient Financial Services strategic plans, process improvement, reimbursement, claim processing, and denial management strategies in line with system goals
- Utilizes & analyzes data available in EPIC and other Access based tools to drive Revenue cycle work to focus on high priorities
- Provides Revenue Cycle support to Patient Financial Services, promoting strong cooperation and alignment with Contract Management, Patient Access, Coding, and other System entities
- Identifies and implements process/workflow redesign when appropriate to increase efficiencies, reduce waste (denials and adjustments), limit variation and improve Revenue cycle outcomes
- Monitors industry and organizational changes for opportunities and impacts to achievement of goals and plans and effectively adapts the Stewardship program, in conjunction with leadership, to ensure that the organization can continue to achieve the objectives of the program
- Collaborating with the Analytics team creates data sets, dashboards and analytic assets that clearly communicate the success of the Stewardship program
- Works discretely and collaboratively with senior leadership to perform strategic analysis of organizational opportunities as well as the development of process improvement programs that support the overall transformational goals of the Stewardship program
- Effectively communicates, to all levels of the organization, the purpose, goals, successes and challenges of the Stewardship program
- Participates in various ad-hoc Patient Financial analysis projects as assigned
- Recommends workflow optimization, staffing levels, evaluates performance, evaluates/tests competencies (as applicable), provides orientation, training and continuing education of staff, and initiates or makes recommendations for personnel actions
- Participates in the development of the department budget and monitors variance against budget items applicable to reimbursement management
- Continuously assesses and improves the work processes under their area of responsibility
- Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise
- Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
National Lead Revenue Cycle Architect
Federal-Cerner Corporation
09.2021 - 08.2022
- Lead revenue cycle integration, workflow, and technical design across all revenue cycle solutions and venues across Soarian and Millennium platforms
- Identify workflow and process improvements and make recommendations to client and project leadership
- Created Revenue Cycle Action Team for hospital cash flow improvement of MHS Genesis
- Lead solution advancement and methodology, recruiting, and internal training development, as appropriate
- Provide leadership to both consulting and client personnel to identify, quantify, implement, and measure specific improvement initiatives
- Manage and resolve project escalations as thepoint of contact for revenue cycle leadership
- Lead clinically driven revenue cycle (CDRC) conversations across venues consulting with CIO, CFO, and revenue cycle leadership to define financial metrics, key performance indicators, and reporting before conversion
- Project oversight for Revenue Cycle implementation of the Department of Defense Modernization of Healthcare
- Oversight of Revenue Cycle Architects assigned to the Department of Defense
- RevElate Champion for the Department of Defense
- RevElate model team committee.
Senior RevCycle Optimization Consultant
CommunityWorks-Cerner Corporation
03.2020 - 09.2021
- Decrease Denial rates for client by 50% due to better workflow redesign
- Create strategic plan with client to obtain value achievement across service line
- Identify workflow and process improvements and make recommendations to client and project leadership
- Increased Clean Claim rate from 65% to 100%
- Decrease A/R days from 108 to 60 days
- Dropped Late charge billing from 40% to 3%
- Created Revenue Cycle Action Team for hospital cashflow improvement
- Collaborates with other members of the Finance senior leadership team including C-Suite to standardize reporting and prioritize information processes to focus on those that have the greatest impact on decisions to effect revenue and cost-drivers
- Manage Multiple projects across Revenue Cycle
- Project management for several client projects
- Conduct client interviews related to Cerner build and workflow design to identify, recommend, and solve system and business problems
- Assist in preparation and review of client deliverables including system analysis, Cerner workflow design and integration points in process flows, training, and presentations
- Increased Revenue by a minimum of a $1M per month.
Lead Senior Patient Accounting Consultant
Community Works ADT-Cerner Corporation
05.2018 - 03.2020
- Advise clients on workflows across service lines, and guide clients through interdependencies and design decision impacts
- Create strategic plan with client to obtain value achievement across service line
- Identify workflow and process improvements and make recommendations to client and project leadership
- Drive cross-functional collaboration with internal stakeholders to identify and propose solution enhancements, workflow efficiencies and client relationship strategies
- Contribute to organizational initiatives
- Manage cross solution conversations for client resolution
- Lead Patient Accounting implementation and provide guidance to new consultants on Operational and Technical Revenue Cycle workflows
- Train clients on current Workflows and Process
- Manage Multiple projects across the Patient Accounting solution
- Supervisor and mentor associate growth.
Director- Consulting
Cape Fear
05.2017 - 06.2018
- Maintain and build within Soarian Scheduling 4.1 and 4.2
- Build and maintain ClairVia application as the only support for hospital
- Managed ClairVia cleanup project
- Solely Responsible for all Scheduling changes and fixes
- Build of new departments, resources, resource groups, activities
- Scheduling Service Pack upgrades
- Supervisor and mentor employee growth
- Provide sole Support for Dragon software for all physicians
- OMS maintenance.
Soarian Scheduling /Invision Management Consultant-Manager
Virtua Health system
05.2016 - 01.2018
- Maintain and build within Soarian Scheduling
- Solely Responsible for all Scheduling changes and fixes
- Build of new departments, resources, resource groups, activities
- Scheduling Service Pack upgrades
- Provide sole Support for Dragon software for all physicians
- Creating new EDM job types and managing Work Queues
- Invision build and maintenance.
Soarian Architect Consultant- Director Of Revenue Cycle
Health System
11.2016 - 08.2017
- Delegates authority to admission/PFS supervisor for management of day-to-day operations and the completion of special projects
- Responsible for developing regional training strategy, including budget, focus, and process to ensure Admission and PFS staff is properly trained resulting in compliance with billing guidelines and accuracy/completeness of bills and admissions
- Increased cash collections by $1M per month
- Hired New Staff and Trained for Business Office
- Responsible for Claims analysis for all payors( 835 Processing rules)
- Developed a Denial Committee with department directors for monthly review of top denials for payors
- Oversee Agency manager and staff including charity, early out and Work comp/Commercial agencies
- Remit processing (837 file)
- Patient Access Workflow redesign for Soarian Financials
- Maintain Physician Profiles in EDM
- Collaborates with other members of the Finance senior leadership team to standardize reporting and prioritize information processes to focus on those that have the greatest impact on decisions to effect revenue and cost-drivers
- Decreased A/R days from 69 days to 40 currently
- Dropped Late charge billing from 40% to 5%
- Strong knowledge of enhanced workflows, Payor rules and Linking rules, CDQR
- Maintain and build within Soarian Financials 4.1
- Configure Worklists
- HL7/Stream review and troubleshoot
- Redesign Process Workflows
- GL build and maintain in financials
- Maintain and build with Soarian Masterfile
- Enhance workflow for optimal Revenue Cycle efficiency
- Write Policy and Procedures
- Payor Rule updates.
MEDITECH Revenue Cycle Consultant - Performance Improvement Manager
Gila Regional Medical Center
06.2015 - 06.2016
- MEDITECH Best Practice Implementation
- Provided training to hospital staff for follow-up
- Account audit for accurate billing/rebilling
- Run Reports for ATB assignment
- Maintain current knowledge of CMS, Novitas, and the RAC program
- Enhance workflow for optimal Revenue Cycle efficiency
- Review and Submit Appeals
- AR Improvement
- Claims Analysis.
Soarian Financial Lead Analyst
Bay Area Regional Medical Center
06.2014 - 09.2015
- Train all Patient Access staff, including Schedulers, ED Registration, and Financial Counselors
- Increased upfront collections from $8k to $45k per month
- Maintained Precertification Denials to 5%
- Responsible for Meaningful Use for Patient Portal utilizing MobileMD
- Identified Medical Necessity issues and discussed alternatives with clinics and hospital registration to make them aware and assist with lower medical necessity admissions
- Increased Revenue from 1.3 million a month to 2 million per month
- Wrote Charity policy to be inline with State Poverty Guidelines
- Operations and the completion of special projects
- Train Business Office staff including billers, collectors and cashier and management on the system
- Implementation of Soarian Financials including interface testing for SIS,MS4, Pharmacy, and Soarian Clinicals
- Responsible for Claims analysis for all payors
- Ensuring all claims processed through STREAM to the correct payors with correct edits
- Strong knowledge of enhanced workflows, Payor rules and Linking rules, CDQR
- Charge Reconciliation
- Import/Export of Charges, Insurance, and employers
- Maintain and build within Soarian Financials 3.4.200, Soarian Scheduling 4.1
- Maintain current knowledge of CMS, Novitas, and the RAC program
- Configure Worklists
- Work and build within Reports and Cubes
- GL build and maintain in financials
- Responsible for all IT functions for Financials
- Build and maintain claims for Business office staff
- Maintain and build with Soarian Masterfile, and Adaptability
- Responsible for security for all financial staff
- Form Building and maintaining in EDM.
MEDITECH Business Office Analyst
Patients Hospital
01.2010 - 01.2014
- Build and maintain Insurance dictionary, Biller Dictionary, Collector Dictionary, Letters, Journal, Charge, and Non- Charge Dictionary
- Access Dictionary knowledge
- Selection Reports; Creating Ad-hoc, Auto Compile
- Build and and maintain Claim Dictionary
- Appeal all denials including RAC through Audapro system
- Responsible for all RTP, ADR, and denied accounts from Medicare
- Track employee time utilizing Kronos
- Extensive knowledge of SSI
- MEDITECH transition
- Administrative responsibility of Esolutions
- Employee training for collectors and Self pay patient balance accounts
- Work through all Collections desktop, Denials Management Desktop, and all reminders
- Maintain current knowledge of CMS, Novitas, and the RAC program
- Maintain all records for the Scorecard and the Dashboard required for Revenue Cycle
- Cash Posting including but not limited to Refunds, Adjustments, Third Party Payments, and patient payments
- Responsible for Medicare Credit Balance Report, Medicare Bad Debt Report, including the Denial Log for all payers
- Oversee reimbursement of the Medicare Program and assist with daily cash posting for all payors.
Education
Skills
- Optimization Project Management
- Billing and AR
- Process Re-design
- HIPAA Regulations
- ICD-10 Proficiency
- Denial Management
- Workflow Improvement
- CRCR
- Leadership Development
- CHFP
Applications and technical competencies
MEDITECH, RevElate/Soarian Financials/Scheduling, Cerner Charge Services, Registration, Patient Accounting, OMS, Invision OAS Gold/HDX, Soarian EDM, ClairVia, EPIC, Revenue Cycle, RAC, EMTALA, HFMA-CRCR, DNFB
Roles and experience
Revenue Cycle, Director, Manager, Implementation
Timeline
Sr. Revenue Cycle Architect
Oracle
07.2023 - Current
Director of Revenue Cycle Optimization
Wellspan Health EPIC
10.2022 - 06.2023
National Lead Revenue Cycle Architect
Federal-Cerner Corporation
09.2021 - 08.2022
Senior RevCycle Optimization Consultant
CommunityWorks-Cerner Corporation
03.2020 - 09.2021
Lead Senior Patient Accounting Consultant
Community Works ADT-Cerner Corporation
05.2018 - 03.2020
Director- Consulting
Cape Fear
05.2017 - 06.2018
Soarian Architect Consultant- Director Of Revenue Cycle
Health System
11.2016 - 08.2017
Soarian Scheduling /Invision Management Consultant-Manager
Virtua Health system
05.2016 - 01.2018
MEDITECH Revenue Cycle Consultant - Performance Improvement Manager
Gila Regional Medical Center
06.2015 - 06.2016
Soarian Financial Lead Analyst
Bay Area Regional Medical Center
06.2014 - 09.2015
MEDITECH Business Office Analyst
Patients Hospital
01.2010 - 01.2014