LEGACY THOMAS
Lignum,VA
Summary
Senior Revenue Cycle Specialist with 5+ years of healthcare revenue cycle experience managing Medicaid, Medicare, and commercial payer accounts in high-volume healthcare environments. Experienced in end-to-end revenue cycle operations including insurance verification, benefits review, claims submission, denial management, appeals, accounts receivable, payment posting, reimbursement reconciliation, and month-end balancing. Proven track record of reducing aged receivables, improving collections, recovering lost revenue, and optimizing billing workflows through data-driven analysis and process improvement initiatives.
Overview
6
6
years of professional experience
Work History
Revenue Cycle Specialist
Rite of Passage
01.2024 - Current
- Manage the complete revenue cycle for 58+ behavioral health accounts across Medicaid, Medicare, and commercial payers.
- Personally manage and resolve 100+ claims weekly through claim submission, follow-up, denial resolution, payment posting, and reimbursement reconciliation.
- Investigate, appeal, and resolve denied claims, underpayments, and reimbursement discrepancies to maximize revenue recovery.
- Verify insurance eligibility, benefits, coverage requirements, and payer-specific billing requirements prior to claim submission.
- Maintain a 99% on-time invoicing rate while ensuring billing accuracy and payer compliance.
- Reduced aged accounts receivable balances by 97% through proactive denial management and payer follow-up strategies.
- Audited claim and reimbursement data, preventing approximately $2.4 million in potential revenue loss.
- Perform month-end balancing and revenue reconciliation to support accounting and financial close processes.
- Analyze denial trends, reimbursement performance, collection metrics, and aging reports to identify opportunities for improvement.
- Prepare KPI reporting for leadership regarding collections, denials, reimbursement timelines, and account performance.
- Partner with leadership to evaluate workflow improvements and recommend system enhancements supporting departmental efficiency.
- Collaborate with admissions, clinical, utilization review, and finance teams to improve reimbursement outcomes and reduce billing delays.
Claims Analyst
NALC Health Benefit Plan
01.2020 - 01.2024
- Reviewed and adjudicated claims involving Medicare, Medicaid, and commercial insurance plans.
- Processed high-volume medical claims while maintaining reimbursement accuracy and compliance with federal regulations and payer guidelines.
- Applied CPT, ICD-10, and HCPCS coding knowledge to support accurate claim processing and reimbursement.
- Managed claim corrections, appeals, and provider inquiries to ensure timely resolution and compliance.
- Conducted trend analysis to identify billing irregularities and mitigate potential fraudulent activity.
- Coordinated with providers, members, and payers to resolve claim discrepancies and payment issues.
- Coordinated with providers, members, and payers to resolve claim discrepancies, enhancing overall claims accuracy.
- Supported audit readiness through documentation review and compliance monitoring.
Education
Bachelor of Science - Human Resource Management
Western Governors University
Lignum, VA 06.2026 - 06.2026
Skills
- Claims Submission
- Insurance Verification
- Benefits Verification
- Medicaid Billing
- Medicare Billing
- Commercial billing
- Denial Management
- Appeals management
- Revenue Recovery
- Payment Posting
- Revenue Reconciliation
- Revenue management
- Month-end close
- CPT
- ICD-10
- HCPCS
- KPI Reporting
- Revenue Analysis
- Excel Reporting
- Workflow Optimization
- Behavioral billing
- Workflow Optimization
Personal Information
Title: SENIOR REVENUE CYCLE SPECIALIST
Professional Development
- Payroll Administration Coursework, In Progress
- Bookkeeping Coursework, In Progress
Timeline
Bachelor of Science - Human Resource Management
Western Governors University
06.2026 - 06.2026
Revenue Cycle Specialist
Rite of Passage
01.2024 - Current
Claims Analyst
NALC Health Benefit Plan
01.2020 - 01.2024