Summary
Overview
Work History
Skills
Accomplishments
Timeline
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KRIS CALI

Acworth,GA

Summary

Managing end-to-end RCM operations for practices within a private equity firm. Driving change across multiple practices nationwide to create best outcomes and streamline processes. Responsible for monitoring the largest portion of AR within the company, including separate Biologics RCM management across multiple practices. Successfully decreased AR over 90 by 55% in 2022. Building scalable policies, procedures, and reporting strategies to ensure KPIs are met and best practices followed. Responsible for RCM staff across multiple practices, both remote and in- house. Capable of building strong, fully engaged teams. Results-driven and effective. Focused and organized with demonstrated success in achieving company goals through increased efficiency initiatives illustrated over 35 years of healthcare management success.

Overview

18
18
years of professional experience

Work History

Director of Revenue Cycle

SENTA Partners
11.2021 - Current
  • Monitor end-to-end RCM functions across multiple practices in several states, assuring KPI's are met and working with teams to ensure success
  • Identify areas of risk or loss and presenting plans of action to senior leadership
  • Streamline processes across practices to create unified, engaged workforce of both remote and in-house team members
  • Created new positions and departments including management layers across RCM department for additional support.
  • Key stakeholder in practice's tuck-in model involving merging EMR's and clearinghouses into one workable process
  • Worked with the vice president of RCM and other RCM leaders to create an RCM bonus structure that adds incentives and rewards for achieving company goals.
  • Manage multiple varied projects with changing timelines
  • Implemented patient payment vendor across multiple practices to include initial kick-off training and monitoring with both operations and RCM teams. Worked with other departments including IT to assist with initial set-up and monitoring any post-implementation issues.
  • Coordination with multiple vendors including clearinghouse, EMR, early out payment vendors, AR management and bad debt vendors across many practices to create efficiencies
  • Assist with implementation and training of new EMR across multiple practices
  • Created reports and presented to senior leadership and operations team. Identified and reported on multiple EMR's, analyzing and streamlining presentation of these reports across multiple facilities
  • Worked with operations department to educate and improve denials and time-of-service collections
  • Oversee RCM functions of multiple practices with multiple locations and team members. Direct responsibility for all RCM functions for 31 locations with 32 physicians, mid-levels and 25 direct reports.
  • Worked with RCM leadership team to effectively manage 52 locations across five states

Revenue Cycle Manager

Atlanta Allergy & Asthma
01.2018 - 10.2021
  • Performed a variety of roles with Atlanta Allergy & Asthma since 1987, resulting in RCM management for the largest and oldest allergy practice in the Southeast until partnering with SENTA Partners in 2020.
  • Monitored and recommended improvements to revenue cycle performance and effectiveness while focusing on appeals and denial management.
  • Monitored claims to identify trends within the industry in order to identify areas of loss and implement clinic-wide methods to minimize loss and maximize revenue.
  • Managed and supervised the billing operations portion of revenue cycle, which includes charge capture, submission of claims and aggressive denial management.
  • Identified new revenue streams and key stakeholder in new procedure/CPT implementation
  • Experience managing prepayment review and audits for multi-facility practice.
  • Key role in set up and training for Buy and Bill Biologics program for multi-facility practice.
  • Experience working with up to 19 physicians, 10 mid-levels and 19 locations.

Patient Account Manager

Atlanta Allergy & Asthma
10.2005 - 10.2012
  • Managed front desk staff at multiple locations
  • Reviewed and worked patient accounts.
  • Responsible for hiring, firing and training.
  • Handled escalated claims and appeals.
  • Worked with insurance provider representatives to solve mass claims problems.
  • Focused on denial management and appeals in order to increase revenue.

Skills

  • Revenue performance
  • Revenue metrics analysis
  • Integration of new acquisitions
  • Creating scalable policies and procedures across multi-specialty practices
  • Best practices and standards
  • Strategic goal-setting
  • Streamlining processes
  • Denial Management and appeals
  • Risk management expertise
  • Financial reporting and analysis
  • Profile and revenue-generating strategies
  • Spreadsheet tracking
  • Excellent team leadership
  • Recruitment of well-qualified staff
  • Motivational leadership
  • Training and team development
  • Managing multiple practices across multiple states
  • Change management
  • Multiple vendor,EMR and clearinghouse experience including ECW, Athena, Nextgen and IMS

Accomplishments

ACAAI Practice Management Committee-Appointed to American College of Allergy Asthma and Immunology Practice Management Committee for 2024 and 2025

Public Speaking - conference speaker for Medico Physician Conference, May 2023. topic: ECW Reporting success

Article Contribution -ACAAI Article-College Advantage Newsletter-interviewed and quoted as subject matter expert regarding effective denial management related to escalated denials

Consulting -consulted and assisted various practices with their RCM needs.

Timeline

Director of Revenue Cycle

SENTA Partners
11.2021 - Current

Revenue Cycle Manager

Atlanta Allergy & Asthma
01.2018 - 10.2021

Patient Account Manager

Atlanta Allergy & Asthma
10.2005 - 10.2012

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KRIS CALI