KIMBERLY MILLER
West Memphis,AR
Summary
To obtain a position with your company.
Overview
8
8
years of professional experience
Work History
Director Operational Excellence
Bioventus Inc
01.2022 - Current
- Partners with IT to manage, develop, and launch technology platforms that enable the PARS team to operate with speed and accuracy via process automation
- Oversees and manages the integration of new products and services for the PARS team
- Works closely with the integration management office to ensure that all newly acquired products meet their revenue and profitability targets
- Develops and documents processes for the PARS team and identifies opportunities for continual improvement with an emphasis on compliance and on overall cycle time
- Partners with market access to develop the best reimbursement strategy for assigned product lines
- Reports necessary items to the EXOGEN Governance Committee and makes recommendations
- Budget: Ensures adhering to budget standards and guidelines
- Holds oneself and others accountable to conduct business in a manner compliant with Bioventus’ Code of Compliance, policies and procedures and internal controls applicable to their role
- Attracts, develops and retain talent
- Ensure focus and alignment with functional and company goals
- Provide employees with continuous feedback and coaching using talent-and-performance management tools.
Director Reimbursement Operations
Bioventus LLC
03.2021 - 01.2022
- Prioritizes, plans, and leads the activities of the Systems, Testing & Training team
- Reimbursement projects that drive improved programs, policies and procedures that ensure compliance with all federal (HIPAA), Medicare, and payer requirements
- Programs for in-house training and education courses for Order to Cash (order management, patient financial services, reimbursement services, and operations) employees and sales representatives
- Organizes, plans and tests pilot programs and enhancements to ensure uninterrupted business continuity
- Develops procedures and work instructions for Order Management, Reimbursement Services, and Patient Financial Services
- Prioritizes, plans, and leads the activities of the Claim Support, Appeals & Audit team
- Escalated medical record review and resolution to ensure the reimbursement services team can request assistance in determining medical necessity
- Appeal qualification determination and coordination of pre-authorization denial appeals
- Appeal qualification determination, and coordination of denied claim appeal (level 2 & level 3)
- Periodic / frequent claim audit of commercial & Medicare claims for scorecards, risk, and compliance reporting to provide control evidence on quality claim standards, demonstrating compliance with HIPAA, Medicare, and any other required regulations
- Manages the Medical Authorization floater team across payer lanes to ensure highest possible coverage of claims processing based on changes to volume of claim mix and availability of reimbursement services resources
- Identify & recommends reimbursement policy and procedure changes to the Governance team, providing evidence, data, and solution options
- Supports payer audits and claims appeals in partnership with accounting and claims submission team
- Budget: Ensures adhering to budget standards and guidelines
- Holds oneself and others accountable to conduct business in a manner compliant with Bioventus’ Code of Compliance, policies and procedures and internal controls applicable to their role
- Attract, develop and retain talent
- Ensure focus and alignment with functional and company goals
- Provide employees with continuous feedback and coaching using talent-and-performance management tools
- Collaborates with Audit & Risk Management function to identify business risks, and develop and implement preventive strategies for functional area.
Director Reimbursement Services
Bioventus LLC
01.2016 - 03.2021
- Develops and implements a proactive internal reimbursement strategy to drive and improve favorable reimbursement and payment decisions yielding increased revenue for the organization
- Follows reimbursement trends to identify any potential threats to our current products
- Ensures all processes and procedures are compliant with HIIPA and any other required regulations
- Researches and identifies coverage policies and reimbursement levels for the company’s products
- Customer Focused: Develops and maintains professional business relationships with key contacts and payer decision makers
- E.g
- Customers and stakeholders (such as sales representatives, sales management, physicians, payers) to ensure authorization and reimbursement for product
- Develops and trains sales team on and order processing and prior authorization requirements and procedures
- Negotiations: Reviews and approves pricing for single case negotiations within established guidelines
- Negotiates pricing on a case by case basis working directly with customers and internal employees to help them more successfully collect payments on procedures for products experiencing reimbursement difficulties
- Reporting: Prepares and presents reports and analysis related to payers
- Develops and delivers presentations for in-house training and education programs for staff, sales representatives and distributors
- People Leadership: Coach and manage performance of direct reports, ensure focus on functional and company objectives
- Conduct full performance management cycle
- Budget: Ensures adhering to budget standards and guidelines.
Group Manager Reimbursement Services
Smith & Nephew, Inc. / Bioventus LLC
- Manages supervisors who hire, and train Internal Reimbursement, Patient Advocate, Order Entry, and Appeals personnel
- Implements processes and organizational changes to drive and improve favorable reimbursement and payment decisions yielding increased revenue for the organization
- Acts as the Privacy Officer for the GBU Identifies and develops privacy policies for the GBU and facilitates GBU wide assessments
- Ensures privacy and security of data as it relates to HIPAA
- Researches and identifies the coverage policies and reimbursement levels for the product lines of Smith & Nephew, Inc
- Reviews and approves pricing for single case negotiations within established guidelines
- Develops and implements in-house reimbursement programs, policies and procedures
- Implements a proactive reimbursement strategy
- Follows reimbursement trends to identify any potential threats to our current products
- Develops and maintains professional business relationships with key contacts, and payor decision makers
- E.g
- Customers and stakeholders (such as sales representatives, sales management, physicians, payors)
- Negotiates pricing on a case by case basis working directly with customers and Smith & Nephew personnel to help them more successfully collect payments on procedures for products experiencing reimbursement difficulties
- Establishes relationships with our customers and payors to ensure authorization and reimbursement for product (includes)
- Prepares and presents reports and analysis
- Assists insurance reimbursement specialist in finding alternate sources for authorization and reimbursement
- Provides dedicated resources to assist and educate sales representatives, distributors, patients, and physicians’ staff to understand what is needed to deem medical necessity and warrant authorization and reimbursement for the product
- Educates sales and marketing on the reimbursement for products
- Educates the payor community of the benefits of our product to establish/expand coverage policy and reimbursement
- Identifies referrals for in-services and preferred provider contracting
- Partners with Financial Services to identify carriers trends
- Influences payors to adopt coverage decisions and reimbursement mechanisms that will encourage the use of Smith & Nephew products
- Develops and delivers presentations for in-house training and education programs for staff, sales representatives and distributors
- Responsible for direct reports and contract employees adhering to the general HSE responsibilities: Ensures HSE procedures are followed
- Informs HSE Managers on HSE performance within areas of responsibilities
- Addresses HSE action items (non-conformances) within areas of responsibilities.
Manager Reimbursement Services
Smith & Nephew, Inc. / Bioventus LLC
- Works in collaboration with Order Management, Patient Financial Services, Sales, and Finance to ensure that patients have a best in class experience throughout the reimbursement process when EXOGEN is prescribed
- Proactively identifies opportunities for improved processes, performance, and metrics
- Resolves issues; gathers, analyzes and interprets data to determine root cause of errors and implement appropriate correction actions / issue resolution
- Develops and maintains professional business relationships with key contacts, payer decision makers, customers, and stakeholders
- Attract, develop and retain top talent through active coaching, development plans and regular performance feedback, using talent and performance management tools, to ensure focus and alignment with functional and company goals
- Monitors key performance indicators daily, weekly and monthly to ensure consistent and effective operations for each team member
- Holds oneself and others accountable to conduct business in a manner compliant with Bioventus’ Code of Compliance, policies and procedures and internal controls applicable to their role
- Complies with all health, safety and environmental policies, procedures and job hazard analyses applicable to specified job activities; including medical evaluations as required by job function.
Skills
- Quality Control Processes
- Employee Training
- Specification Review
- Customer Service
- Complex Problem Solving
- Performance Monitoring
- Team Collaboration
- Complaint Resolution
- MS Office
- SAP
- Five9
- Brightree
- DocuSign
- Workday
- Medical Manager
- Power BI
- JIRA
- Smart Sheet
- Microsoft Forms
- Share Point
- Staff Supervision
- Team Support and Oversight
- Coaching and Mentoring
- Statistical Analysis
- Attention to Detail
- Critical Thinking
- Time Management
- Effective Multitasking
- Business Administration
- Strong Work Ethic
- Excellent Researching Skills
- Project Management
- Medicare Policy
- Insurance Reimbursement Processes
References
References Furnished upon request
Timeline
Director Operational Excellence
Bioventus Inc
01.2022 - Current
Director Reimbursement Operations
Bioventus LLC
03.2021 - 01.2022
Director Reimbursement Services
Bioventus LLC
01.2016 - 03.2021
Group Manager Reimbursement Services
Smith & Nephew, Inc. / Bioventus LLC
Manager Reimbursement Services
Smith & Nephew, Inc. / Bioventus LLC
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