Heather Day
Union,Kentucky
Summary
Critical thinking professional with talents in validating workflows, maintaining a knowledge of policy changes to insurance plans and sharing best practices with management. A reliable Revenue Cycle Analyst known for successfully handling various tasks in deadline-driven environments.
Overview
12
12
years of professional experience
5
5
Certifications
Work History
Performance Excellence Analyst
Ensemble Health Partners
08.2020 - Current
- Provide expertise in best-practice operations in partnership with Practice Management and Physician Business Office
- Thorough understanding of entire professional revenue cycle including pre-service, coding, compliance, provider education, and business office functions
- Monitor performance KPIs and routine reports
- Create, analyze, and implement reports to monitor key performance/operations indicators
- Review and monitor reimbursement trends
- Maintain continuous understanding of organizational payer contracts, fee schedules and related activities
- Run projects to determine root cause of issues surrounding resolution and stabilization plans, as well as continued monitoring of statuses following project completion
- Work independently to ensure Revenue Cycle operations are managed efficiently and effectively
- Coordinate with client leadership to discuss both strengths and opportunities for improvement to meet performance metrics.
- Evaluated diverse organizational systems to identify workflow, communication and resource utilization issues.
- Produced detailed and relevant reports for use in making business decisions.
- Improve payment capture by addressing issues related to coding errors, billing denials, payment posting, claim disputes, bad debt, and write-offs due to coding edits, missing charges, charge capture holding bins/task lists, and aging of edits
- Compiled research data and gave professional presentations highlighting finds and recommended optimizations.
- Collected, organized and modeled data using Smartsheet.
- Evaluated current processes to develop improvement plans.
- Reviewed internal systems and organized training plans to address areas in need of improvement.
Reimbursement Supervisor
Myriad Neuroscience
01.2019 - 08.2020
- Develop, maintain and implement standard operating procedures (SOPs) and processes for insurance eligibility, patient data management, claims submission and patient call and collection management including appropriate internal controls and key performance indicators (KPIs)
- Day-to-day team tasks include (but not limited to) insurance eligibility checks, accurate patient data and order entry, claim submission and resolution, billing call management and collections, billing anomaly and error management and continuous communication between systems vendor and partnering internal teams (Finance and Billing)
- Work with internal department leaders including Back-End Billing (Group/Team 2), Customer Support, Reimbursement and Payer Markets, Compliance, Finance and others to ensure effective, streamlined end to end Myriad Neuroscience Health revenue cycle management / billing and collection processes
- Work cross functionally to drive accuracy, efficiency and effectiveness
- Lead and direct collections
- Establish department and individual goals in line with company goals
- Develop appropriate monitoring and reporting processes to identify and communicate metric and issues
- Responsible for entire performance management cycle of direct reports, including hiring, performance management, training and development
- Maintain competent and knowledgeable billing staff to perform call center activities that adequately address and resolve clinic and patient exceptions and billing questions and issues
- Provide clear and accurate reimbursement consultation pre and post sales including all patient assistance programs
- Responsible for identifying and recommending required systems support to achieve department goals
- Monitor trends and patterns and maintain actionable dashboard with parts visible to team and senior leadership
- Proficient at utilizing billing and CRM system, running applicable billing reports and following up on open action items
- Ability to solve problems, deal with changing variables and participate in implementation and continuous improvement process of department.
- Organized spaces, materials and catering support for internal and client-focused meetings
Business Office Manager
Home Care Partners of Cincinnati
05.2018 - 11.2018
- Maintains office/branch manuals as needed, i.e
- Administrative binder
- Responsible for ordering of medical supplies and office supplies
- Performs technical billing audits per policy and follow-up with corrections
- Responsible for clerical functions in agency related to filing, workflow
- Assures that all telephone traffic is managed in professional, customer service-oriented manner and is relayed to appropriate people
- Responsible for customer service training for clerical and administrative support staff
- Participates in Performance Improvement Plan and processes
- Responsible for completion and tracking of PAFs (personnel action forms) references, health screenings, criminal background checks, and drug screens for new hires and existing staff if applicable
- Ensures completion and ongoing maintenance of HR/medical files for all agency employees and contract staff
- (Ex
- Primary Source license verification)
- Reviews OASIS, 485, and orders within appropriate time frame, report and takes appropriate action
- Responsible for procurement of goods and services of facility (ex
- Medical supplies, office supplies, and contracted services) within budgeted guidelines
- Responsible for monthly inventory of medical supplies
- Responsible for annual distribution of physician satisfaction surveys
- Responsible for timely evaluation of clerical support staff in conjunction with Executive Director and/or Clinical Director
- Responsible for day-to-day coordination, timely completion (reporting) and troubleshooting of all training and development activities
- New hire orientation, new to role training, and ongoing training and development
- Assumes active role in coordination, facilitation, tracking and reporting of professional development of staff, ongoing skill development, and other mentoring activities
- Responsible for maintaining office environment that fosters professional growth and development of staff
- Responsible for proficiency in and timely completion of Business Manager Task List
- Coordinates outgoing and incoming mail for agency
- Assists with administrative duties related to Human Resources department, including expediting recruitment advertisements, processing applications, and maintaining
- Databases
- Assists in processing of paperwork related to injury and accident logs
- Assists Executive Director and/or Clinical Director as needed in other agency processes and functions.
Revenue Cycle Manager
Pain Associates of Northern Kentucky, Michael Walls
12.2013 - 01.2018
- Develop policies and procedures for overall management of successful clinical office, ensuring consistency across all company employees
- Create reporting and revenue projections for development and management of budget, and analyze monthly forecasts to provide correct and consistent data
- Manage provider credentialing process, including initial appointment and reappointment
- Directed installation and implementation of EMR system
- Interact with providers, clinical staff, licensing boards, CMS and medical malpractice companies, as well as patients with billing inquires to streamline all communication
Billing Supervisor
Paradigm
- Pain and Spine
- Direct end-to-end billing cycle to maximize reimbursement and efficiency, including management of the billing clearinghouse, querying providers for information related to claims, and confirming CPT and ICD codes
- Applied expert knowledge of government, third-party payors, and worker's compensation to reconcile claims quickly for payment
- Analyzed and reconciled monthly billing reports to minimize accounts receivable and appeal all claims denials as necessary
Patient Account Representative
MRSI, Children's Hospital
04.2011 - 09.2013
- Completed hospital-based patient financial services and revenue cycle, including submitting all claims after confirming CPT and ICD codes and HIPAA compliance regulations
- Reported to upper management regarding claims process and progress, suggesting avenues for improvement in procedures
- Prepared reports detailing billing actions, flags and other key information
- Utilized computer programs to create invoices, letters and other documents
- Electronically submitted bills according to compliance guidelines
- Responded to patient, family and external payer inquiries
- Maintained office inventory and organized supplies for efficiency and expected needs
- Generated and distributed monthly customer statements
- Located customers with overdue accounts and solicited payment in compliance with fair debt collection practices
- Deployed automated system tracking and skip tracing to locate hard-to-find, re-located customers
- Maintained accurate records of customer accounts, payments and payment plans
Education
Degree - Healthcare Information Technology
Beckfield College
Florence, KYincluded: Healthcare Supervision and Management, Medical Terminology, Hospital Coding for Reimbursement, Accounting, Diagnostic Coding, Procedural Coding, Advanced Coding, Legal and Ethical Aspect of Health Information, Business Law, Healthcare Delivery Systems, Anatomy and Physiology, Business Communication, Business Applications, Interpersonal Communication, Psychology -
Skills
Training and mentoring
Affiliations
American Academy of Professional Coders (AAPC), Member in good standing Medicare learning network (MLN), Certified in Medicare Billing Part B Provider
Certification
CRCR Certified Revenue Cycle Representative (HFMA)
Timeline
Performance Excellence Analyst
Ensemble Health Partners
08.2020 - Current
Reimbursement Supervisor
Myriad Neuroscience
01.2019 - 08.2020
Business Office Manager
Home Care Partners of Cincinnati
05.2018 - 11.2018
Revenue Cycle Manager
Pain Associates of Northern Kentucky, Michael Walls
12.2013 - 01.2018
Patient Account Representative
MRSI, Children's Hospital
04.2011 - 09.2013
Billing Supervisor
Paradigm
Degree - Healthcare Information Technology
Beckfield College
included: Healthcare Supervision and Management, Medical Terminology, Hospital Coding for Reimbursement, Accounting, Diagnostic Coding, Procedural Coding, Advanced Coding, Legal and Ethical Aspect of Health Information, Business Law, Healthcare Delivery Systems, Anatomy and Physiology, Business Communication, Business Applications, Interpersonal Communication, Psychology -
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