Jill Elder
Kirkland,WA
Summary
Goal-oriented Healthcare Leader with excellent communication skills demonstrated by 26 years of experience in healthcare. Extensive experience in revenue cycle, clinic and hospital operations, P&L management, managed care contracting and network development. Maintained an expert level of communication skills with physicians, C-suite level stakeholders, board of directors and staff. Experienced with both hospital and physician stakeholders. Self-motivated, organized and committed to the pursuit and achievement of institutional goals and objectives.
Overview
23
23
years of professional experience
Work History
Director Revenue Cycle
Providence Health Care
10.2022 - Current
- Responsible for facility and physician billing
- Manage relationships amongst all of Revenue cycle leaders
- Report out goals and accomplishments to C-suite level stakeholders
- Participated in contracting conversations and provided contracting language guidance to protect the collection process
- Responsible for understanding payer contracting, claim adjudication and patient responsibilities
- Oversee all areas of price estimates including people management, compliance, regulations and accuracy
- Applied business and marketing knowledge to develop transparency tools across the organization.
- Oversaw operations and provided corrective feedback to achieve daily and long-term goals.
- Monitored and coordinated workflows to optimize resources.
- Directed organizational projects with eye for quality and customer needs.
- Engaged in product training, demonstrations and branding to raise awareness and point of service revenues.
- Motivated team members to meet and exceed estimate targets.
- Maintained deep understanding of company services and products in order to offer most knowledgeable customer support.
- Achieved service targets by cultivating and securing new innovative ideas for delivering estimates to patients.
Director Revenue Cycle and Clinic Operations
Overlake Medical Center & Clinics
06.2016 - 10.2022
- Responsible for every aspect of Revenue Cycle management for both facility and professional billing.
- Implemented a denials management task force, resulting in a decrease of overall denials
- Responsible for reporting revenue cycle accomplishments to C-suite level stakeholders.
- Administrative lead for Clinic Credentialing Committee
- Areas of responsibility include centralized business office, credentialing, HIM, coding, call center, and referral coordinators. Additional areas under my direction are the clinical training, float pool, RN triage unit, centralized pharmacists and DME department. I managed 5 physicians that covered openings in Primary care clinics
- Responsible for leading project scope, planning, acquisition and assimilation of practice acquisitions. I work collaboratively with the health system's centralized departments to meet the needs of Overlake Medical Clinics (OMC).
- Foster a service and support culture, ensuring the clinics and revenue cycle function efficiently and effectively to meet patient satisfaction, quality, and financial goals. Responsible to partner with clinic based physicians (both employed and contracted physicians) to achieve clinic, program and performance goals and targets.
- Plan and integrate functions and services to support Overlake Medical Clinics (OMC) and Overlake Hospital Association (OHA) goals and priorities. Create and implement strategies to achieve and maintain benchmark revenue cycle metrics.
- Successfully integrated five new clinics into the Overlake profile
- Conduct proforma and acquisition analysis for future acquisitions
- Continually assess and improve care and services provided to meet or exceed the needs and expectations of customers. Foster continuous quality improvement by leading teams in use of quality management tools and processes.
- Maintain appropriate internal control safeguards over AR records and collection of cash. Maintain compliance standards for providing accurate information on all clinics.
- Ensure compliance with relevant regulations, standards and directives from regulatory agencies and third party payers.
- Direct the staffing and operations of Revenue cycle, Credentialing Department, Coding, Call Center and HIM Departments, Training Department, Clinical float staff including providers, Centralized Call Center, Referral Coordinators and Centralized Pharmacists.
- Develop and implement policies to audit claims to ensure compliance with contracts, and assess claims processing improvements for consistency with managed care and reimbursement requirements. Implemented under/over-payment positions to ensure all payer contracts are paid in accordance with agreed upon rates.
- Created annual budget and developed comprehensive plan to accomplish company objectives while staying within budget.
- Worked with Epic team on implementation of new claims manager and denial management system.
- Working with Epic team on implementing a Patient Financial Experience module by teaming with Waystar.
Asst Director, Patient Access
UCI Medical Center
11.2015 - 06.2016
- Provide leadership within the Admissions and ED registration departments by developing and implementing strategic plans to create lean processes with excellent outcomes.
- Oversee a staff of 58 union employees and 3 managers.
- Set department goals and objectives that are in line with the organizational goals.
- Responsible for overseeing operations and program management for the Admitting and Emergency departments.
- Review and analyze various organization reports to determine outcomes within the department and work with the managers to make changes as needed.
Regional Manager, Payer Contracting
Pediatrix Medical Group
10.2014 - 11.2015
- Responsible for maintaining contracts with payers in five states; California, Nevada, Oregon, Washington and Alaska, Activities include rate and contracting negotiations (over 250 contracts), serve on the government relations team and participate in all aspects of provider/ payer relations including ACO contracts and developing quality measures that are built into the managed care contracts.
- Responsible for execution and management with Master Service Agreements (MSAs)
- Responsible for reviewing all new healthcare regulations that affected the practice in all five states. Worked with lobbyists on new bills and initiates to help with the organization's narrative. Worked with in house attorneys on updating policy and procedures to ensure compliance with new regulations.
- Monitor all contract performance and work with Revenue Cycle Management on ensuring accurate collections. Oversee the rate modeling to develop Contracting strategies with the managed care team. Responsible for all managed care negotiations including strategic planning within the organization around ACO negotiations. Work with the Medical Directors to develop quality metrics. Worked closely with government relations team to educate on the needs of the organization around proposed regulations Participate in large scale contract negotiations and hold JOC meetings with major payers on a quarterly basis.
Regional Manager, Revenue Cycle Management
Pediatrix Medical Group
04.2006 - 10.2014
- Manage a large-scale multi-specialty physician organization in the patient accounting department.
- Specialties within the organization consist of Neonatology, Perinatology, Radiology, Cardiology, Emergency Room and Pediatrics Directly responsible for four Collection Managers, Customer service coordinator, underpayment specialists, commercial appeals specialist and billing analyst.
- Key Results: Responsible for twelve direct reports and 45 indirect reports Direct reports included four managers, customer service coordinators and revenue reimbursement analysts Directly responsible for decreasing DSO from 65 days to 42 days by improving claim edits and decreasing denials Worked with a team of registration and collection staff to decrease payer denials to less than 10% monthly Provide leadership working with Medi/cal, Cal Optima and CCS claims Created a cohesive successful management team.
- Created Performance objectives and targets Maintained relationship with payers and the provider relations department Implemented a cohesive customer service team to help patients resolve dissatisfaction Worked with the management team to develop a productivity tool for each patient account position Worked with MedData (outsourcing company) to increase self-pay collections.
Manager, Patient Financial Services
South Coast Medical Center
10.2004 - 04.2006
- Manage the patient accounting department in a 200 bed facility.
- Responsible for staff training, development and motivation to ensure employees are prepared to perform their jobs.
- Responsible for interpretation of payer contracts, including working with the payers to resolve outstanding accounts.
- The patient accounting positions that were direct reports included; receptionist, EOB reviewers, reimbursement specialist, collectors, posters, refund specialist, underpayment specialist and billers.
- Key Results: Maintained monthly collections of 101% of goal.
- Reduced overall bad debt write off amount to less than 2% a year.
- Developed a process to identify and collect underpayments per the contracted rate Developed a process to work with medical records department to ensure timely coding to ensure timely billing of all accounts.
Manager, Patient Access
South Coast Medical Center
10.2002 - 10.2004
- Manage the Admitting department in a 200 bed facility, responsible for all registrations in areas of inpatient, outpatient and emergency room patients.
- Responsible for staff who performed in areas of pre-registration, scheduling, check-in, eligibility and authorization.
- Work with the staff to maintain a less than 9% denial rate by ensuring 100% pre-registration which included obtaining an authorization for pre-scheduled procedures.
- Key Results: Responsible for hiring and maintaining staff in the admitting department Reduced patient wait times and increased customer service Maintained a less than 9% denial rate Improved cash collections by 25% Worked with staff to improve quality of work to decrease denials.
Manager, Patient Access
Anaheim Memorial Medical Center
10.2000 - 10.2002
- Manage the Admitting department in a 223 bed facility, responsible for all registrations in areas of inpatient, outpatient.
- And emergency room patients.
- Directly responsible for managing forty-five full time employees and two supervisors
- Productivity results and overall performance.
- Key Results: Worked with vendors to link patients to Medi/cal Restructured the Emergency Room registration procedures to meet EMTALA Prepared and educated staff on HIPAA compliant procedures Implemented department customer service standards Worked with a team to design the registration and collections screens for a newly installed system used throughout patient accounting.
Education
MBA - Business Administration
University of California Irvine
Irvine, CA2014
Bachelor of Arts - Business Administration And Management
California State University At Fullerton
Fullerton, CA2011
Skills
- Revenue performance
- Price negotiation
- Price quoting
- Denial Management
- Clinical team guidance
- Process implementation
- Relationship building and management
- Budget forecasting
- Profit and loss statements
- Team Building
Affiliations
ACHE member, MGMA, HFMA, and Rotary Club of Bellevue
Timeline
Director Revenue Cycle
Providence Health Care
10.2022 - Current
Director Revenue Cycle and Clinic Operations
Overlake Medical Center & Clinics
06.2016 - 10.2022
Asst Director, Patient Access
UCI Medical Center
11.2015 - 06.2016
Regional Manager, Payer Contracting
Pediatrix Medical Group
10.2014 - 11.2015
Regional Manager, Revenue Cycle Management
Pediatrix Medical Group
04.2006 - 10.2014
Manager, Patient Financial Services
South Coast Medical Center
10.2004 - 04.2006
Manager, Patient Access
South Coast Medical Center
10.2002 - 10.2004
Manager, Patient Access
Anaheim Memorial Medical Center
10.2000 - 10.2002
MBA - Business Administration
University of California Irvine
Bachelor of Arts - Business Administration And Management
California State University At Fullerton
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