Jessie McConnell
Worden,MT
Summary
Encouraging and friendly Director with Certification for Physician Practice Manager and Professional Billing with years of specialization in patient access, medical billing, coding, and management. Analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance. Representing the establishment with friendly, professional demeanor always.
Overview
17
17
years of professional experience
Work History
Acting RCM Director
RomTechnologies, Inc.
02.2023 - Current
- Directed the RCM teams and operation to maintain compliance, federal and state regulations on a national levels
- To include Intake, Data Entry, Prior Authorizations, Patient Access Program, Billing Claims, Audit, Reimbursement, A/R, Revenue Reporting, Financial Services, and Medical Records as well as contribute to other areas within the company to assist with Compliance, Credentialing and Payer/Market Access
- Experienced with multiple specialties including new DME devices, Orthopedic, Podiatry, Cardiac, Telemedicine, OB-GYN, Oncology and Geriatrics
- Directed and managed the team with 300% growth over the last quarter in volume and revenue
- Implemented the current Patient Access Program for the current company
- Onboarded several vendors with the company to support home teams with overnight coverage, administrative assistance, and workload delegation to provide a white glove service and customer care to physicians and patients. For the department as well as other areas of the company.
- Implemented processes and procedures for all areas and created SOPs for the company which were utilized for company compliance with payers, training of new team members and resources for all team members to reference
- Performed all hiring, PIP plan implementations, disciplinaries, terminations, PTO coverage and approvals, FMLA, Leaves of absences and payroll for a large team
- Maintained daily huddles, 1:1s, interdepartmental and departmental meetings
- Daily meetings were planned and executed with all other departments and area leadership and outside vendors to implement, maintain, improve, collaborate and plan to always strive to improve processes to streamline and improve productivity, efficiency, team member work life balance and job functions, customer satisfaction, lead time and revenue
- Ensured a positive and supportive team environment enabling everyone to work well together, were comfortable, collaborative and encouraging
- Culture was imperative to keep a fast paced, growing RCM team working well, continuously improving and striving to meet goals and exceed them
- Kept up a department employee engagement program for the team to provide encouragement and support with birthday, holiday, sympathy, get well, and congratulatory cards and celebratory affirmations on team channels
- Arrangements for flowers, meals and showers for our team members virtually and delivered
- Implemented and converted multiple software systems to include: Click up, Dr
- Chrono, Google, Microsoft, Justworks, UKG, Service Now, Okta, Odoo, Bright Tree, Advanced MD, Epic, GE, Medical Manager, NextGen, Rumba, Centricity, Kronos, Quickbooks, Ring Central, WestFax, Boost Lingo, Language line, Fortis, Stripe, Authorize.net and more
- Knowledgeable in all areas I have directed and have worked in all areas and am a very hands-on leader who does well to delegate but does not shy away from putting in effort, knowing all positions and helping the team when things are urgent, necessary and pushing to meet a goal, expectation or deadline.
Billing Manager
RomTechnologies, Inc.
08.2022 - 02.2023
- Doubled Revenue in the first quarter of department management.
- Reviewed billing problems, researched issues, and resolved concerns.
- Trained and mentored staff on procedures, compliance requirements, and collections techniques.
- Worked with customers to develop payment plans and bring accounts current.
- Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
- Performed testing for billing modules, enhancing new functionality and process improvements.
- Conducted performance reviews and implemented improvement plans.
- Established and checked coding procedures, monitored reports and updated internal files.
- Established internal audit procedures to validate and improve accuracy of financial reporting.
- Developed strategic plans for day-to-day financial operations.
- Utilized financial software to prepare consolidated financial statements.
- Checked payroll, vendor payments, commissions and other accounting disbursements for accuracy and compliance.
- Prepared cash flow projections, cost analysis and monthly, quarterly and annual reports.
- Supported financial director with special projects and additional job duties.
Prior Authorizations Lead
RomTechnologies, Inc.
12.2021 - 07.2022
- Lead the prior authorization team with daily huddles, meeting and communications resulting in a 90% retention rate.
- Provided support, assistance, training and resources for the teams to meet company, client and patient expectations as well as payer guidelines and requirements.
- Ensured all situations were escalated and handled appropriately to provide excellent patient and client customer care at all times.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Interviewed applicants and explained scope of different available benefits.
- Selected qualified applicants to refer to employers for possible job placement purposes.
Prior Authorizations Specialist
RomTechnologies, Inc.
04.2021 - 11.2021
- Responded to inquiries from healthcare providers regarding prior authorization requests meeting all productivity metrics and exceeding goals.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Interviewed applicants and explained scope of different available benefits.
Billing Manager
The Foot Care Center
03.2018 - 02.2021
- Managed billing team operations to maintain correct priorities and verify consistent delivery of highest customer service and company standards
- Supervised the billing team of three clinics in two states and oversaw revenue cycle workflows for maximum efficiency
- Recruited, hired, trained top quality candidates to fill biller and coder vacancies and maximize the team’s performance
- Effectively communicated with several departments to determine the status of pending charges under review by individual departments as well as insurance companies to provide timely information to customers regarding billing, cost estimates, and payment
- Compiled data and completed routine reports to keep management informed to aid in financial decision making, best practices, standards and forecasting trends
- Developed and maintained policies and procedures to keep team operations and company training systems on-track
- Provided internal audits to access front office and billing procedures to prevent fraud and abuse, timely filing, and meet compliance with state and federal agencies
- Distributed statements to patients on a timely basis
- Oversaw the refunds and take backs for patients and insurance companies
- Created and implemented the collections process for delinquent accounts as well as set up and working with outside agencies
- Trained staff on insurance, collection of monies, billing, coding, prior authorizations and payment plans
- Performed monthly and yearly evaluations of staff supervised to provide education, support and leadership in areas requiring improvement
- Worked and completed management team projects in marketing, business growth, employee engagement, education and development
- Experience with EMRs NextGen and Epic, Microsoft, Excel, Outlook, Google, Adobe, One Drive, Rumba, GE, Centricity, and Medical Manager
- Collaborated, developed and presented at all staff meetings to keep employees engaged and aware of different department roles and responsibilities promoting the core values of the organization and how their roles impact the revenue cycle
- Credentialed and on boarded new physicians with CAQH and insurance companies as well as trained the physician on EHR and billing and coding in the outpatient setting.
Billing Specialist/Receptionist
Billings OB-GYN Associates
10.2013 - 03.2018
- Operate office equipment, such as voice mail messaging systems, and use word processing, spreadsheet, or other software applications to prepare reports, invoices, financial statements, ledgers, or medical records
- Perform bookkeeping duties, such as credits and collections, preparing and sending financial statements or bills, and keeping financial records
- Complete insurance or other claim forms, work denials and A/R
- Complete prior authorization management for surgical and ob-gyn care
- Insurance payment posting, reconciliation, and resubmissions
- Interview patients to complete documents, or forms, such as intake or insurance forms
- Transmit correspondence or medical records by mail, e-mail, or fax
- Create, maintain, and enter information into databases
- Set up and manage paper or electronic filing systems, recording information, updating paperwork, or maintaining documents, such as correspondence, or other material
- Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions
- Greet visitors or callers and handle their inquiries or direct them to the appropriate persons according to their needs
- Consult with patients for financial consultations for delivery and surgery, payment arrangements and ABN paperwork
- Complete forms in accordance with company procedures
- Make copies of correspondence or other printed material
- Open, read, route, and distribute incoming mail or other materials and answer routine questions
- Provide services to customers, such as order placement or account information
- Establish work procedures or keep track of the daily work of clerical staff
- Prepare and mail checks
- Manage projects or contribute to committee or teamwork
- Mail financial applications, promotional material, or other information
- Learn to operate new office technologies upon implementation
- Provide training and orientation for new staff
- Train and assist staff with computer usage.
Unit Clerk/CNA
St. Vincent Healthcare
05.2007 - 06.2015
- Use computers for various applications, such as electronic medical records or word processing
- Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals
- Create, maintain, and enter information into databases
- Set up and manage paper or electronic filing systems, recording information, updating paperwork
- Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions
- Greet visitors or callers and handle their inquiries or direct them to the appropriate people according to their needs
- Complete forms in accordance with company procedures
- Maintain scheduling and procedure calendars
- Schedule and confirm procedures for clients, customers, or supervisors
- Make copies of correspondence or other printed material
- Conduct searches to find needed information, using such sources as the Internet
- Establish work procedures or schedules and keep track of the daily work of clerical staff
- Manage projects or contribute to committee or teamwork
- Order and dispense supplies
- Learn to operate new office technologies upon development and implementation
- Provide training and orientation to new staff
- Train and assist staff with computer usage
- Answer patient call signals, signal lights, bells, or intercom systems to determine patients' needs
- Turn or reposition bedridden patients
- Provide physical support to assist patients to perform daily living activities, such as getting out of bed, bathing, dressing, using the toilet, standing, walking, or exercising
- Review patients' dietary restrictions, food allergies, and preferences to ensure the patient receives an appropriate diet.
Education
AAPC - Certified Physician Practice Manager: Management - Management
AAPC
Remote10.2021
AAPC - Certified Professional Biller: Medical Billing and Coding - Medical Billing
AAPC
Remote2017
High School Diploma -
Huntley Project High School
Worden05.2000
Certified Nursing Assistant - CNA - Nursing Assistance
Hardin Hospital Association
Hardin, MT06.1998
Skills
- Healthcare business processes, workflows and reform Corporate compliance, fraud and abuse Quality initiatives and healthcare Medical office accounting, physician reimbursement and revenue cycle management Human resources management Marketing and business relationships HIPAA and data security HIM Tech, EHR/ EMR and HIM exchange Expert in effective claim follow up, patient follow up and denial resolution Healthcare industry rules and regulations, False Claims Act, Fair Debt Collection Act, Stark and Anti-Kickback Laws Knowledge of CPT, ICD-10-CM, and HCPCS Level II Coding guidelines Expertise in applying payer policy, LCDs and NCDs for successful claim submission Understanding of various types of insurance plans: federal, state, commercial and work comp
- Budget Control
- Project Management and Coordination
- Staff Management and Development
- Operations Management
- Hiring and Retention
- People Management
- Legal and Regulatory Compliance
- Financial Management and Reporting
- Strategies and Goals
- Observe or examine patients to detect symptoms that may require medical attention
- Provided patient cares and documentation
- Gather information from caregivers, nurses, or physicians about patient condition, treatment plans, or appropriate activities
- Document or otherwise report observations of patient behavior, complaints, or physical symptoms to nurses
- Test Director 80
Timeline
Acting RCM Director
RomTechnologies, Inc.
02.2023 - Current
Billing Manager
RomTechnologies, Inc.
08.2022 - 02.2023
Prior Authorizations Lead
RomTechnologies, Inc.
12.2021 - 07.2022
Prior Authorizations Specialist
RomTechnologies, Inc.
04.2021 - 11.2021
Billing Manager
The Foot Care Center
03.2018 - 02.2021
Billing Specialist/Receptionist
Billings OB-GYN Associates
10.2013 - 03.2018
Unit Clerk/CNA
St. Vincent Healthcare
05.2007 - 06.2015
AAPC - Certified Physician Practice Manager: Management - Management
AAPC
AAPC - Certified Professional Biller: Medical Billing and Coding - Medical Billing
AAPC
High School Diploma -
Huntley Project High School
Certified Nursing Assistant - CNA - Nursing Assistance
Hardin Hospital Association
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