Janneane Politis

• Managing a team of A/R Managers for our National RCM team (across a dozen different markets)
• Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
• Identified and communicated customer needs to supply chain capacity and quality teams.
• Demonstrated exceptional adaptability in navigating complex situations or rapidly changing environments with ease.
• Implemented process improvements
• Analyzed complex data sets to derive actionable insights for improving internal processes related to revenue cycle management.
• Team's duties include:
• Complex A/R management-researching and resolving records that have not been matched to EMR related charges (including insurance payments, capitation payments, patient payments, remittance items and voided charges). Reconciliation of re-adjudicated claims/payer takebacks.
• Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring.
• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives.
• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
• Maintain web portal access for all payers and interface with Athena to update the master list of portal addresses for the EMR database.
• Makes policy updates as needed, to all RCM policies.
• Responsible for training internal teams (Operations, Sales) as well as care center staff when appropriate.
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality
• Laser focused drive toward achievement of department's daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
• Achieved departmental goals by developing and executing strategic plans and performance metrics.
• Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.

Responsible for researching and resolving unpaid or denied claims. This is achieved primarily through working a queue of claims in line with specified turn-around-times, and in compliance with department policies and processes. These resolution efforts consist of (1) outbound phone calls and/or (2) using on-line data, to drive analysis and gather information that will prompt accurate claim processing. The Revenue Analyst also aggregates data and monitors activity for trends that can be used to identify opportunities to prevent future unpaid or denied claims.

Job Responsibilities:
* Resolve outstanding medical claims, including those which have been denied and those for which status is unknown.
* Complete all work within specified turn-around-time frames, while meeting quality standards and production targets
* Become an expert and trusted client advisor for assigned payer(s) and/or national region(s)
* Timely resolution and response to all Client facing inquires via Sugar tasks/cases
* Conduct payer research and contact payers, directly by phone, to resolve unknown status and/or denied claims, in real time.
* Enhance athenahealth's payer relationships
* Resubmit claims in accordance with payer guidelines
* Identify payer adjudication trends
* Identify opportunities to enhance company's library of payer adjudication rules through either new rule creation or refinement of existing Rules
* Conduct accounts receivable analysis, as needed
* Accept full ownership of special work and/or project assignments

**Promoted to Team Lead in August 2005 where I acted in a supervisory role for a staff of up to 15 people. Responsibilities as team lead included interviewing potential candidates, training new employees, monitoring daily workloads for team members, quality analysis, special projects, and reaching out to existing clients.