Hilton Jackson
Mansfield,TX
Summary
As a customer-centric and outcomes-driven Reimbursement Manager, Hilton possesses exceptional skills in establishing partnerships, implementing medical devices, and collaborating with healthcare professionals, staff, or organizations to promote sustainable revenue growth. Hilton is a meticulous professional who manages a vast territory of accounts while effectively addressing obstacles related to denial prevention and resolution. Additionally, Hilton has demonstrated exemplary abilities in dealing with Government and Commercial payors, specialty pharmacy, compliance and regulatory, and Health Policy Access. Overall, Hilton has a deep understanding of all aspects of the revenue cycle, which enables Hilton to contribute to the corporate success of the organization.
Overview
16
16
years of professional experience
Work History
Field Reimbursement Manager
Medicem
07.2022 - Current
- As Reimbursement manager, Hilton executes reimbursement strategies for Southeastern US, Southwestern US, and Pacific regions: Conducts internal team training for new hires to provide Health Economics value overview and reimbursement training
- Accountable for updating all customer-facing reimbursement coding policies and reference guidelines
- Partner with Sales Representatives and Clinical teams to onboard, train, and educate HCP and staff regarding the implementation of the Medical Device while establishing a baseline of Health Economic benefits for patients, as well as Health Care Providers
- Meticulously conduct training sessions, webinars, and site visits, providing guidance on coding, billing, and documentation, resolving any issues or appeals related to claims or payments
- Deliver reimbursement and Health Economic presentations at regional conferences such as ACOG Annual District Meetings, comprised of Healthcare Executives, and HCPs
- Demonstrates highly organized-strategic thinking with excellent follow-up skills and communication abilities as well as providing diverse resources needed for consistent payment opportunities
- Co-managed Southeastern territory within the organization to achieve sales goals for the 3rd and 4th quarters of 2023 in comparison to the 1st and 2nd quarters, while being absent of the dedicated sales role.
Field Reimbursement Manager
NeuroStar Advanced Therapy
01.2017 - 07.2022
- Provides customer-centric reimbursement coverage for 20+ states within Central/Western US Ensure proper billing and compliance training of new HCPs within the designated-required timeline of on-boarding for Government and Commercial insurance plans
- Educate HCP staff specific to regulatory criteria, prior authorizations, and best practices to avoid denials
- Provide denial support and appeal tools to ensure maximum and consistent reimbursement
- Conduct training for new Reimbursement Managers, evaluating and managing their on-boarding process before approving individual field activities
- Support the internal customer service team by resolving calls from accounts that may be elevated for time-sensitive and critical scenarios
- Structure timelines for accounts for in-office visits once per quarter as required to evaluate reimbursement and collection activities during quarterly business reviews for account profitability
- Partner with team members on new accounts during “all hands” meetings and logistics meetings
- Also, partner with sales teams to exhibit reimbursement knowledge by illuminating specific industry regional trends
Regional Manager - Revenue Cycle Management
American Anesthesiology
09.2014 - 12.2016
- Perform oversight of operational flows and processors to ensure consistency, effectiveness, and efficiency with organizational policy and procedures within the revenue cycle for the region
- Steered leadership teams for each Revenue Cycle department to ensure organization, work priorities, and workflow metrics were met weekly
- Revise collection methods to increase revenue based on region-specific factors such as economic conditions, payor groups, and updated payment methods
- Owner of KPI's like DSO, % of received cash, within 30, 60, 90 days, and current collections
- Coordinate specific data needs and requests from and between specific departments and clinics
- Create financial and procedural analysis to identify trends and problems and work with all departments to assist in follow-up and implementation of solutions in all aspects of RCM.
Reimbursement Manager
US Renal Care
02.2014 - 09.2014
- Supervised and trained team leaders to efficiently manage daily reimbursement operations
- Established clear objectives for the department to prioritize quality and increase productivity
- Implemented new policies and procedures and proven HCP practice tactics and initiatives to improve cash flow, efficiency, AR, and staff performance
- Executed strategic hiring and development process to identify and cultivate top-performing staff
- Worked closely with the VP of reimbursement to successfully meet the organization's productivity and quality metrics, while adhering to established policies and procedures for reimbursement
- Resolved rejections and denials by appealing to the State Board of Insurance to report billing issues, lack of timely payments, and erroneous denials
- Negotiated OON reimbursement payments with 3rd Party administrators to achieve maximum revenue-generating payment agreements each month during the Executive Account review with organizational leadership
Accounts Receivable Manager
Schumacher Group
12.2011 - 02.2014
Accounts Receivable Manager
Presbyterian Communities and Services
01.2011 - 11.2011
Reimbursement Manager, Physician Billing
UT Southwestern Med Center
01.2008 - 12.2010
Education
Business Management - Business Administration And Management
Louisiana Tech University
Ruston, LouisianaSkills
Health Economics
Payment Rate & Contract Negotiations
Claims Analysis Management/Denial Resolution
EMR/Software Adaptability
Health Policy & Access
HCP Reimbursement Training
Healthcare Claims Reimbursement
Government/Commercial Payors Policy analysis
Offshore Vendor Management
Revenue Cycle Management
Training / Account Development
Microsoft Teams/Zoom
HIPAA Compliance/Government Regulations
Written and verbal communication
HCPCS Coding
Accomplishments
- November- December 2023 - As part of Medicem's Reimbursement team, we achieved the coveted objective of partnering with HCP's to submit comments to CMS, to have the medical device CPT code reviewed by CMS via the RUCC process that had not been reviewed in over 20 years. The result will achieve higher reimbursement within the Obstetrical spaces which is the lowest reimbursed in the Healthcare Industry.
- Reimbursement Manager of the Year 2018,2019,2021,2021, NeuroStar
- Values Award for Respect – 2020, NeuroStar
- Member of 202, 2021 Region of the Year, NeuroStar
- Management of International Offshore staff was responsible for day-to-day follow-up responsibilities.
- Led physician billing and collections teams of 17 employees for clinical departments including ophthalmology, pediatrics, neurology, dermatology, otolaryngology, and obstetrics, UT Southwestern
- Direct management impact in making March 2014 the largest collection month in the last calendar year.
- Negotiated prompt pay agreements from insurance carriers making sure agreements were negotiated at the highest rate documented. – US Renal Care
- Management of Accounts Receivable; approximately 756M in collections, Schumacher Group
Dates Format
03/27/2024
Timeline
Field Reimbursement Manager
Medicem
07.2022 - Current
Field Reimbursement Manager
NeuroStar Advanced Therapy
01.2017 - 07.2022
Regional Manager - Revenue Cycle Management
American Anesthesiology
09.2014 - 12.2016
Reimbursement Manager
US Renal Care
02.2014 - 09.2014
Accounts Receivable Manager
Schumacher Group
12.2011 - 02.2014
Accounts Receivable Manager
Presbyterian Communities and Services
01.2011 - 11.2011
Reimbursement Manager, Physician Billing
UT Southwestern Med Center
01.2008 - 12.2010
Business Management - Business Administration And Management
Louisiana Tech University
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