Summary
Overview
Work History
Education
Skills
Locations
References
Timeline
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Keisha Murray

Keisha Murray

Bloomingdale,IL

Summary

Results-Driven Manager of Provider Network with Credentialing & Contracting, RCM (SME), Provider & Client Relationship Experience. Professional with over 15 years of Business Healthcare Management. Adept at managing complex healthcare operations, optimizing revenue cycle performance, and ensuring compliance with regulatory requirements. Proven track-record of successfully leading high-performing large teams, negotiating contracts, and streamlining credentialing processes. Strong analytical skills combined with strategic thinking to drive organizational growth and financial success. Seeking a challenging executive role to utilize my expertise in Healthcare Corporate Management Services.

Overview

25
25
years of professional experience

Work History

Manager of Credentialing & Contracting - Compliance - Provider Network

Doctors of Physical Therapy
03.2020 - Current
  • Develop and execute strategies for building and maintaining a robust provider network to meet the organization's needs and objectives
  • Lead negotiations to establish contractual agreements
  • Elevate and select providers based on quality metrics, cost-effectiveness, geographic coverage, and patient needs
  • Monitor network performance and identify opportunities for improvement, expansion, or consolidation
  • Oversee the credentialing process for over three-hundred therapists & oversee the day to day of credentialing and contracting functions, ensuring accurate and timely processing of provider credentials and contracts
  • Manage Denovo's & Acquisitions
  • Manage provider enrollment in payer networks, including Medicare, Medicaid and Commercial insurance plans, to facilitate reimbursement and access to care
  • Collaborate with internal departments, such as legal, compliance, and billing department to ensure adherence to credentialing standards and regulatory requirements
  • Develop and maintain positive relationships with providers, payers, and external stakeholders to ensure effective contract negotiations and resolve issues or concerns
  • Manage the negotiation, re-negotiation, implementation, and administration of contracts with healthcare providers, payers, and vendors to maximize reimbursement rates and minimize contractual risks
  • Develop and implement policies and procedures for provider credentialing, privileging, and enrollment
  • Oversee the management and administration of the CAQH database, ensuring accurate and up-to-date provider information for credentialing and contracting purposes
  • Conducted thorough verification of provider credentials, licenses, certifications, and professional references

RCM SME - Product Manager

TEBRA (Kareo)
03.2022 - 12.2022
  • Expert Knowledge of the healthcare revenue cycle, including billing, coding, reimbursement, compliance, and regulatory requirements
  • You stay updated on industry trends, best practices, and emerging technologies related to RCM
  • Develop and execute the product vision, strategy, and roadmap based on market research, customer feedback, and business objectives
  • You analyze market trends, competition, and customer needs to identify opportunities and define product requirements
  • Own and Improve key performance indicators (KPIs)
  • Provides training and education to staff members on RCM best practices, coding updates, documentation requirements, and revenue optimization strategies
  • Develop educational materials, conduct workshops, or deliver presentations to enhance staff competence and knowledge
  • Compliance and Regulatory Adherence: Ensuring billing processes and practices comply with industry regulations, coding standards, billing guidelines, and legal requirements, such as HIPAA and Medicare regulations

VP of RCM & Credentialing (Operations Manager)

PBS Billing Services
09.2011 - 07.2019
  • Overseeing Billing Operations: Managing and directing the day-to-day operations of the billing department, ensuring accuracy, efficiency, and timely processing of invoices, claims, and payments
  • Staff Management and Development: Leading and supervising the billing team, including hiring, training, and evaluating staff
  • Providing guidance, coaching, and mentoring to team members to ensure optimal performance and professional growth
  • Billing System Management: Overseeing and maintaining billing systems, software, and tools, ensuring they are up to date, functioning properly, and aligned with business needs and regulatory requirements
  • Lead and manage overall operations for medical billing & credentialing, overseeing a team of five in house employees with ten offshore employees & ensuring smooth day-to-day operations
  • Implemented electronic health record (EHR) & EDI systems and other technology solutions to support efficient and effective clinic operations
  • Analyze operational data, key performance indicators (KPIs), and financial metrics to identify areas for improvement and implement action plans to drive performance enhancements
  • Develop and manage operational budgets, control costs, and identify opportunities for cost savings and process optimization

Consultant/Project Manager

Idilus
Wheaton, IL
08.2007 - 05.2010
  • Facilitated training sessions for team members on various topics relevant to the job role.
  • Developed project plans, budgets, and timelines to ensure successful completion of projects.
  • Built and established strong partnerships with teams, vendors and contractors.
  • Modified project plans when needed to better align with organizational objectives.
  • Identified potential problems before they arose by proactively analyzing data from previous projects.
  • Determined project staffing needs and led resource management.
  • Conducted regular meetings with team members to review progress and discuss upcoming tasks.
  • Negotiated with project stakeholders or suppliers to obtain resources or materials.
  • Created detailed reports outlining progress and any issues encountered during a project.
  • Exceeded customer satisfaction by finding creative solutions to problems.
  • Utilized various software and tools to streamline processes and optimize performance.
  • Served as primary liaison for clients, political stakeholders, providers and public policy associations, lobbyists and partners.
  • Reviewed non-contracted instrumentation for spine surgeries and initiated vendor contract evaluations in conjunction with operations staff and orthopedic spine and neurological spine specialists.
  • Facilitated collaboration between various stakeholders such as hospital leadership, clinicians, IT personnel, vendors.
  • Recruited, hired and trained new medical and facility staff.

RCM Director

Weil Foot and Ankle Institute
Des Plaines, Illinois
10.1999 - 08.2007
  • Ensured compliance with all relevant regulations, policies and procedures.
  • Delegated work to staff, setting priorities and goals.
  • Oversaw the preparation of monthly billing reports and analysis to track billing efficiency and accuracy.
  • Maintained accurate records of all billing transactions.
  • Conducted regular audits of billing activities to ensure compliance with company policies and regulatory standards.
  • Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
  • Negotiated with software providers to enhance billing system functionalities according to company needs.
  • Implemented new billing system software, resulting in an increase in productivity.
  • Trained staff in billing systems and procedures to ensure compliance with standards.
  • Managed billing calendar and scheduled claims for payments.
  • Completed day-to-day duties accurately and efficiently.
  • Reviewed appeals processes and assisted in preparing appeal letters when necessary.
  • Managed the setup and billing of complex client accounts, ensuring compliance with contractual agreements.
  • Communicated with stockholders or other investors to provide information or raise capital.
  • Oversaw daily activities related to the processing of electronic claims submissions.
  • Streamlined billing processes through the introduction of automated systems, reducing manual errors.
  • Established clear billing policies and procedures, ensuring consistent application across all client accounts.
  • Assisted in developing policies and procedures related to medical billing operations.
  • Maintained detailed records of all payments received from patients or third-party payers.

Education

National Louis University/University of Phoenix
Lisle, IL

Skills

  • Marketing
  • Key performance indicators
  • Policy and procedure development
  • Customer relationship management (CRM)
  • Employee onboarding
  • Staff development
  • Product management
  • Staff management
  • Customer service
  • Policy implementation
  • Business development
  • Regulatory compliance
  • Staff training and development
  • Clear communication
  • Operations management
  • Business administration
  • Complex Problem-solving
  • Networking strategies
  • Risk management
  • Revenue management
  • Strategic planning
  • Relationship building
  • Time management
  • Project planning
  • Performance evaluations
  • Project management
  • Stakeholder management
  • Data analysis
  • Workforce management

Locations

  • Bloomingdale, IL

References

References available upon request.

Timeline

RCM SME - Product Manager

TEBRA (Kareo)
03.2022 - 12.2022

Manager of Credentialing & Contracting - Compliance - Provider Network

Doctors of Physical Therapy
03.2020 - Current

VP of RCM & Credentialing (Operations Manager)

PBS Billing Services
09.2011 - 07.2019

Consultant/Project Manager

Idilus
08.2007 - 05.2010

RCM Director

Weil Foot and Ankle Institute
10.1999 - 08.2007

National Louis University/University of Phoenix

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Keisha Murray