Kimberly Adame

Interim Director of Billing 08/2022 - 12/2022

Managed and supervised the daily operations and achievements of a multi-functional national durable medical company.

• Developed and inspired a group of 59 employees to exceed and optimize their performance management.
• Strongly improved operations by establishing a robust RCM team structure.
• Developed new and enhanced existing job duties and descriptions.
• Partnered with executives from different departments and cross-functional teams to design and implement a department flow chart, resulting in enhanced lead times.
• Analyzed troubled situations and events for problem-solving and supporting company sustainability and expansion.
• Instituted efficient procedures, policies, and key performance indicators to maximize revenue generation through seamless billing processes.
• Cultivated strong relationships with customers by responding promptly to inquiries or complaints.
• Maintained accurate monthly revenue reports for C-suite executives.

Licensing & Credentialing Manager: 02/2023 - Current

Played a key role in enhancing operations and profitability at a national durable medical company with diverse lines of business:

• Developed and implemented credentialing processes for providers/supplier.
• Reviewed provider applications to ensure accuracy of data and compliance with regulations.
• Ensured compliance with federal, state, and local laws as well as accreditation standards.
• Maintained the credentialing database, ensuring timely updates and accurate records.
• Developed a department flow chart in collaboration with executives and team members from different departments, resulting in improved lead times.
• Analyzed problematic situations and occurrences to provide solutions and facilitate company survival and growth.
• Implemented strategies, KPIs, policies and procedures to optimize provider/supplier credentialing.
• Provided consistent updates to intradepartmental executives.

Maintained efficient performance in overseeing a prominent Pain Management and Chiropractic Care group:

• Implemented CureMD PM+EHR system to optimize workflow and enhance efficiency.
• Streamlined operations by introducing a new organizational structure and implementing effective processes and procedures for the RCM department.
• Developed Key performance indicators (KPIs) for the RCM department.
• Conducted regular 1:1 meetings with CEO, operations manager, practice leaders, team leads, and RCM staff members to discuss metrics and overcome operational challenges. Contributed to the attainment of company KPIs through effective problem-solving.
• Revenue Reporting: insurance & patient collections, aging by plan/patient, service analysis by code (product), & other statics
• Optimized provider licensing and credentialing operations.
• Achieved effective contract rate negotiations with a range of payer entities including Commercial & Federal, Medicare, Medicaid, and Personal Injury.

Enhanced the efficiency of billing, collections, contracting/credentialing and consulting services in a family-owned business:

• Proficient across multiple medical domains spanning Ophthalmology, Family Medicine, Internal Medicine, Dermatology,
  Psychology/Psychiatry,Vascular Surgery and Rheumatology.
• Handled end-to-end responsibilities for internal and client recruiting processes including training programs, performance appraisals, action plan execution and separations within the revenue cycle sector.
• Successfully administered and supervised internal employee Health Coverage & benefits utilizing Paychex
• Provider licensing & credentialing, hospital privileges for all clients.
• Managed contract negotiations with insurance companies, resulting in improved rates and conditions for all clients
• Met goals for proper collections and daily processes by collaborating with clients.

Handled high-volume Medicaid billing for speech therapy, physical therapy, occupational therapy, and private duty nursing services for disabled children:

• Configured and optimized KanTime PM+EMR
• Achieved favorable contract rates through negotiations and effectively managed the credentialing process with insurance companies for a smooth integration into the Star Kids Managed Medicaid program.
• Analyzed payroll data of Field Clinicians against services billed to determine profit and loss on all cases.
• Managed revenue and finance reporting for all lines of business under the COO's supervision to Alleon Capital Healthcare Factoring.
• Partnered with the COO, Administrator, and VP of Operations to optimize operational processes.