Joshua Charette
Rangeley
Summary
Detail-oriented and results-driven professional with 8 of experience in revenue cycle management within the healthcare industry. Proven track record of optimizing billing processes, improving collection rates, and ensuring compliance with regulations. Strong analytical and problem-solving skills with a commitment to enhancing operational efficiency and patient satisfaction.
Overview
9
9
years of professional experience
Work History
Senior Revenue Cycle Specialist
Brightline
11.2022 - Current
- Invoicing: Perform invoicing on a monthly basis to optimize cash collection from customers/partners. Creating, delivering, and tracking invoices. Ensuring timely and accurate payments. Minimizing errors. Maintaining strong partner relationships
- Verify coverage and submit claims: Perform eligibility checks with third party payers. Ensure financial records are loaded into the billing system appropriately. Confirm if prior authorization and/or referral(s) are required, as well as validate that claims meet billing rules and/or contractual requirements. Submit claims electronically to third party payers.
- Perform claim management: Ensure claims get processed appropriately by working rejections and denials. Document and escalate any issues promptly to management.
- Cash applications: Collect member payments and post payments and adjustments while ensuring all deposits are balanced daily. Retrieve missing payment information from payers, and resolve debit and credits on accounts appropriately.
- Support the growth of the organization: Act as a subject matter expert for all claims billing related inquiries. Identify opportunities for improvement to overall billing operational processes and share best practices with management.
Manager, Member Support
Brightline
02.2022 - 11.2022
- Created and stood up the Member Support 2 "billing" team.
- Create trainings, and meet with individuals on the team weekly to enhance the department functionality.
- Cross-trained existing employees to maximize team agility and performance.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Analyzed Member Support work through Quality Analysis. Met with each employee about quality score and what can be improved to enhance member experience.
- Mentored team members for career advancement, fostering a pipeline of future leaders within the organization.
Senior Revenue Cycle Specialist
Brightline
10.2021 - 02.2022
- Stand up the Revenue Cycle Department: Create trainings for new hires. Work with engineering/product on RCM department needs. Fine-tune processes to enhance claim submission and cash collection.
- Verify coverage and submit claims: Perform eligibility checks with third party payers. Ensure financial records are loaded into the billing system appropriately. Confirm if prior authorization and/or referral(s) are required, as well as validate that claims meet billing rules and/or contractual requirements. Submit claims electronically to third party payers.
- Perform claim management: Ensure claims get processed appropriately by working rejections and denials. Document and escalate any issues promptly to management.
- Cash applications: Collect member payments and post payments and adjustments while ensuring all deposits are balanced daily. Retrieve missing payment information from payers, and resolve debit and credits on accounts appropriately.
- Support the growth of the organization: Act as a subject matter expert for all claims billing related inquiries. Identify opportunities for improvement to overall billing operational processes and share best practices with management.
Team Lead - Claims Advocacy
Included Health
04.2018 - 10.2021
- Provides workflow management, guidance, coaching, and display subject matter expertise to provide thorough support for the team
- Demonstrates thorough understanding of team performance through KPIs specific to designated service type.
- Identifies opportunities, and consistently increase/maintain high performance, quality case reviews, and quality call monitoring
- Provides training, support, and technical leadership to team members
- Assists in maintaining high employee engagement
- Displays focus towards continuous improvement, suggests alternative solutions, as well as new ideas that improve employee workflow, member experience, efficiency etc. aligning directly with our company values, and goals
Compliance Officer - Claims & Billing
Advance Orthotic Prosthetic Service
02.2017 - 05.2018
- Responsible for oversight of the compliance program.
- Knowledge of all departments and their functions, and manage those internal relationships with compliance.
- Reviewed and analyzed new, proposed, or revised laws, regulations, policies, procedures and emerging risks, in order to interpret their meaning and determine their impact.
- Monitored the resolution of compliance related patient complaints, and reviews responses.
- Oversee a team of 5 billing individuals. Ensure that insurance and patient billing meets accuracy standards of the company.
- Have weekly meetings with the team to talk about cash collection, and how the department can succeed.
Infusion Benefits Coordinator / Senior AR
Portland Gastroenterology
04.2016 - 01.2017
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Initiate appeals for denied authorizations and claims
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Member Services Associate
Community Health Options
05.2015 - 03.2016
- Assisted members with their insurance needs (invoicing issues, payments, benefit information, claims, etc).
- Assisted providers with claims, billing and benefit inquiries.
- Created medical authorizations with providers for patients who have procedures being scheduled.
- Worked closely with nurses for approval or denials on prior authorizations for members.
Education
Brunswick High School
2011
Timeline
Senior Revenue Cycle Specialist
Brightline
11.2022 - Current
Manager, Member Support
Brightline
02.2022 - 11.2022
Senior Revenue Cycle Specialist
Brightline
10.2021 - 02.2022
Team Lead - Claims Advocacy
Included Health
04.2018 - 10.2021
Compliance Officer - Claims & Billing
Advance Orthotic Prosthetic Service
02.2017 - 05.2018
Infusion Benefits Coordinator / Senior AR
Portland Gastroenterology
04.2016 - 01.2017
Member Services Associate
Community Health Options
05.2015 - 03.2016
Brunswick High School