Jeannette Santiago-Rivera
Spencerport,NY
Summary
Over 20 years of experience in medical claims reimbursement oversight, consistently taking on increasing levels of responsibility. Expertise in analyzing insurance contracts and billing processes to identify areas for improvement. Skilled at assessing information systems for enhancement opportunities. Experience in leading profitable A/R recovery, provider training, and denial management initiatives.
Overview
37
37
years of professional experience
1
1
Certification
Work History
Provider Enrollment Director
North American Partners In Anesthesia
03.2021 - Current
- Oversee daily Provider Enrollment Credentialing functions
- Monitor activities within the territories to assure department structure and hierarchal workflow
- Manage Management Team whose overarching task(s) assist Provider Enrollment functions
- Produce weekly/monthly provider enrollment holds reports for Senior Director and Senior Vice President
- Establish and maintain departmental policies and procedures
- Other duties and responsibilities as needed
Assistant Director Revenue Cycle
North American Partners In Anesthesia
10.2016 - 03.2021
- Oversee Billing and Payment Posting functions for professional billing
- Direct Daily Cash Posting and Cash Reconciliation activities
- Oversee daily Claims Follow Up productivity
- Analyze Payor Payment performance
- Denial Management
- Produce daily/weekly/monthly/quarterly/annual reports
- Ensure proper training of all staff in Billing and Payment Posting staff
- Weekly report out of Revenue Cycle Metrics
Revenue Cycle Interim Director
ST. JOSEPHS PHYSICIANS HEALTH
01.2012 - 05.2016
- Oversee Billing and Coding functions for Ambulatory and Acute professional billing
- Direct Daily Cash Posting and Cash Reconciliation activities
- Oversee daily Claims Follow Up productivity
- Oversee daily Charge Capture productivity
- Oversee Customer Service and Financial Assistance activities
- Analyze Payor Payment performance
- Denial Management
- Produce daily/weekly/monthly/quarterly/annual reports
- Mentor and Coach manager subordinates
- Perform progressive disciplinary functions as appropriate
- Prepare, Analyze, and Monitor Annual and Monthly budget
- Oversee Payroll Activities
Senior Practice Operations Manager
UNIVERSITY OF ROCHESTER MEDICAL CENTER
01.2010 - 01.2012
- Oversee Accounts Receivable activity for Dermatology, Radiation Oncology, Neurosurgery, Urology, and School of Nursing Flu Clinic
- Construct policies and procedures relative to Third Party billing guidelines
- Provide high level and granular analysis for department managers to target A/R areas Of opportunity
- Prepare analysis on department operating and financial reports as well as departmental policy rules, regulations and procedures.
Revenue Integrity Coordinator
LAKESIDE MEMORIAL HOSPITAL
01.2008 - 01.2010
- Assist Director of Revenue Cycle with Central Scheduling, Central Registration, Switchboard/Cashier and Patient Financial Services areas. Assisted with Revenue Cycle functions including Credentialing, Registration, Charge Entry, Third-Party Payer billing, Payment Posting, and Denial Management.
- Collaborate with various departments to ensure proper charge capture, appropriate pricing and CPT-4 coding attached to charges
- Work with Revenue Cycle Director to delegate work, problem solve, prioritize work and conduct departmental meetings
- Review Denial Management Reports and Reimbursement Rating Tables
- Share Oversight of Charge Master Maintenance
- Create/Maintain Electronic Submission Tracking System to ensure complete transmissions to Third Party Payers
- Provide staff performance input to Revenue Cycle Director for annual reviews
- Conduct periodic bill audits to identify billing problems and correct discrepancies
- Received and reviewed accounts being sent to collections
Supervisor
UNIVERSITY OF ROCHESTER MEDICAL CENTER
01.2004 - 01.2008
- Supervised staff of 15 with responsibility of maximizing Accounts Receivable reimbursement for Preferred Care, Blue Cross Blue Shield, Medicaid, Medicare, Commercial, Worker’s Compensation, And No Fault. Assisted Manager with accounts receivable (A/R) operations for Emergency Department with multiple billing centers. Assisted with all revenue cycle functions, including credentialing, registration, charge entry, third-party payer billing, payment posting, and denial management.
- Training and mentoring staff
- Update department charge master
- Oversee daily office operations
- Cash reconciliation
- Provide staff performance input for annual review
Supervisor
ViaHEALTH
01.2002 - 01.2004
- Supervise staff of 16 with the responsibility of maximizing Accounts Receivable for Workers Compensation, No-fault, Commercial, Preferred Care and Special Billings. Negotiated claim settlements with outside vendors and third party payers.
Group Leader
ViaHEALTH
01.2001 - 01.2002
- Identified and documented issues that had a negative impact on billing and reimbursement. Meet weekly with staff to compile data on outstanding issues. Assist Training Coordinators with staff training. Weekly control of distribution and collection of reports including edits and remittances.
IDX Trainer
ViaHEALTH
01.1998 - 01.1999
- Responsible for training a 4 facility organization in all available software programs to include IDX, PMPA, SHAS, Labforce as well as verification programs such as PC Easy, BC Quick link, Omnipro, And Medicaid eligibility system.
Account Rep
ViaHEALTH
01.1988 - 01.1998
- Billed and Followed-Up on Medicaid, Workers Compensation, No-fault and Commercial billing according to payer guidelines. Reconciled insurance remittances. Analyzed and resolved denials.
Education
Liberal Arts
Monroe Community College
Rochester, New YorkSkills
- Billing Systems: EPIC, Allscripts, Medent, IDX, PM/PA, McKesson - Paragon
- Microsoft Office: Microsoft Office, Excel, Word, Visio
- Athen IDX , QGenda , VerityStream, Zoom , CRM
Certification
Certified Medical Billing Specialist (CMBS)
Languages
Spanish
Native or Bilingual
Affiliations
- Healthcare Finance Managers Association (HFMA)
- Rochester Area Patient Account Managers Association (RAPAMA)
- American Association of Certified Coders (AAPC)
Timeline
Provider Enrollment Director
North American Partners In Anesthesia
03.2021 - Current
Assistant Director Revenue Cycle
North American Partners In Anesthesia
10.2016 - 03.2021
Revenue Cycle Interim Director
ST. JOSEPHS PHYSICIANS HEALTH
01.2012 - 05.2016
Senior Practice Operations Manager
UNIVERSITY OF ROCHESTER MEDICAL CENTER
01.2010 - 01.2012
Revenue Integrity Coordinator
LAKESIDE MEMORIAL HOSPITAL
01.2008 - 01.2010
Supervisor
UNIVERSITY OF ROCHESTER MEDICAL CENTER
01.2004 - 01.2008
Supervisor
ViaHEALTH
01.2002 - 01.2004
Group Leader
ViaHEALTH
01.2001 - 01.2002
IDX Trainer
ViaHEALTH
01.1998 - 01.1999
Account Rep
ViaHEALTH
01.1988 - 01.1998
Liberal Arts
Monroe Community College
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