Lisa Schulz
Mansfield ,TX
Summary
24 Years’ Experience plus In Revenue Cycle, Front End to Back End Denials Management to include Service lines of Behavioral Health PCP, Women’s Health (OBGYN) and Surgery Hospice PCP, Facility i.e., SNF and hospital facility and Hospitalists. Accomplished industry leader offering many years of management expertise including staff training and development, performance evaluation, and continuous improvement. Focused and efficient with proficiency in financial reporting and budget adherence. Demonstrated success in evaluating P&L to achieve targets.
Overview
21
21
years of professional experience
Work History
Optimal Practice Insight| Client Success Manager
Optum insight/ Optum Behavioral Care Health
Dallas, TX
09.2021 - Current
- Manage Clients in spaces of Hospitals, Physicians Groups and Mental Health, Women’s Health,& Surgery
- Assisted in various aspects of claims processing and billing, such as Revenue Cycle management, Registration, and coding trends for accurate billing
- Ensure contracts are loaded correctly to payout claims correct rates to the Clients correct
- Fulfill my clients/Providers needs by producing reports needed/ Projects they need done with claims at a mass amount for reprocessing
- Assisted in onboarding new customers, ensuring a smooth transition into the platform.
- Created client success plans tailored to individual needs and goals.
- Maintained comprehensive documentation of all customer interactions and transactions.
- Developed and maintained relationships with clients to ensure customer satisfaction.
- Investigated issues related to incorrect or incomplete EFT payments and transfers.
Revenue Cycle / Credentialing and Contracting Director
Practice Solutions
08.2020 - 01.2021
- Ensures smooth daily operations for acute and post-acute care providers, optimizing revenue and collections.
- Informs senior management of all operational activities and proactively identifies any potential risks that may hinder current strategies and initiatives.
- Effectively established and maintained professional networks for the benefit of the organization's bottom line
- Optimized operational systems, resource allocation, and processes for increased efficiency.
- Supports information management, project coordination, and planning
- Maintain awareness of changes in legislation and industry that impact services
- Monitors customer satisfaction data, collaborating with vendors, employees, and associates to consult on best practices and strategies.
- Maintain an up-to-date knowledge of regulatory requirements, professional standards, industry practices, and potential organizational initiatives affecting current strategies.
- Coordinated the implementation of policies and methods to ensure achievement of operational goals
- Acts as a champion and a change agent to shift focus to performance metrics and quality standards by improving and changing processes, identifying gaps in complex systems and increasing customer satisfaction
- Acts as liaison or represents the organization to outside governmental or other accrediting agencies and vendors
- Analyze trends impacting charges, coding, collection, and accounts receivable and report findings to management
- Ensures that staff training is performed in a timely and efficient manner including annual compliance training
- Ensures that the activities of the billing operations are conducted in a manner that is in compliance with Federal, State, and payer regulations, guidelines, and requirements
- Routinely reviews health insurance fee schedules and contracts to ensure accuracy
- Knowledge and understanding of the credentialing process
- Knowledge and understanding of billing process
- Organized and prioritized work while managing multiple tasks.
- Ability to work independently with minimal supervision
- Maximized productivity through expert use of Microsoft Office applications and internet resources
- Ability to establish and maintain professional working relationships with providers, insurers, medical facility management, staff, and related contacts outside the organization.
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Assessed the achievement of employees against established benchmarks or targets.
- Maintained strict adherence to applicable regulations, policies, and procedures.
- Identified areas for improvement in operational performance metrics.
- Leveraged data analysis to uncover opportunities for improving processes.
- Directed daily operations and ensured compliance with relevant laws and regulations.
- Facilitated collaboration between teams by encouraging open communication channels.
- Developed and delivered informational reports outlining company progress to board of directors.
- Led cross-functional teams to achieve project completion within budget and deadlines.
- Monitored industry trends to identify opportunities for expansion and innovation.
- Implemented new technologies to streamline processes and enhance productivity.
- Analyzed data to inform decision-making and strategic direction.
- Achieved efficient workflow by assigning tasks, setting objectives, and guiding team to achieve goals.
- Prepared staff work schedules and assigned team members to specific duties.
Systems Operations VP of Revenue Cycle
Sundance Healthcare -Behavioral Health
07.2018 - 03.2020
- In charge of overseeing the accuracy of billing and revenue cycle for three hospitals in the DFW market by managing the Central Business Office, HR, and Accounts Payable departments.
- Determined discrepancies within the revenue cycle, leading to the establishment of effective correction measures for CBO
- Reconstructed flow of billing and collecting the AR for efficiency and compliance
- Implemented cost savings measures in ancillary billing and vendor contracts
- Researched and addressed account collection challenges for Disproportionate Share Hospital (charity), ensuring compliance with CMS/State guidelines for reimbursement.
- Established and fostered partnerships with multiple insurance companies
- Successfully updated and negotiated contracted rates to align with the prevailing industry standards after determining no revisions had taken place in the past 4 years, resulting in a increase of 30%
- Ensured proper coding and adherence to CMS guidelines by researching CPT codes in medical records, collaborating with Novitas (MAC) and Texas Medicaid, along with 32 additional state Medicaid programs.
- Met requirements for timely completion of clinical documentation and secured doctor's signature on charts, whether through manual signing or electronic means (if authorized via CMS registration).
- Managed billing process by staying current with CPT codes, modifiers, DRG's and RUG to optimize reimbursement
- Provided leadership during times of organizational change by managing transitions effectively.
- Designed effective organizational structures that aligned with corporate mission and values.
- Identified opportunities for process automation that increased productivity levels.
- Negotiated contracts with suppliers to secure favorable terms for the organization.
- Managed a team of 15 professionals, providing guidance and direction to ensure successful execution of projects.
- Resolved conflicts between employees in a timely manner while fostering an atmosphere of collaboration.
- Hired, trained, and mentored staff members to maximize productivity.
AR Director of Revenue Cycle
Schumacher Clinical Partners / Service lines: ED, PCP and Hospitalist
05.2015 - 05.2018
- Successfully supervised the daily activities of a 40-member staff and two supervisors in charge of Revenue Cycle Improvement and Billing operations
- Monitored PAS, Charge Capture, DFNB, Edits, Coding, HIM to Denied Claims for accuracy in 32 states and 800 physicians. Collaborated with Payer Behaviors metrics and ensured accurate billing for ED and HM service lines in hospitals.
- Maximized ROI by conducting QA audits and ensuring compliance with Best Practice standards.
- Demonstrated expertise in crafting persuasive appeal letters that effectively challenged denials endorsed by EMTALA, ACEP, and CMS guidelines.
- Established clear benchmarks for department success and implemented effective policies and procedures to improve overall performance.
- Recognized coding potential for increased financial success.
- Maintained accurate billing practices by researching CPT codes, ensuring compliance with CMS guidelines, and adhering to Medicaid regulations in various states.
- Implemented efficient protocols for clinical documentation, prioritizing adherence to guidelines and facilitating doctor's signatures either manually or electronically as per CMS registration.
- Maintained up-to-date knowledge of CPT codes, modifiers, DRGs, and WRVUs to ensure timely and maximum reimbursements for companies.
- Developed strategies to enhance billing process efficiency in multiple departments.
Divisional Director of Revenue Cycle
Texas General Hospital – Outpatient Surgery/ Ambulatory and ED Hospitalist
06.2014 - 05.2015
- Managed and supervised a team of 26 staff members consisting of CBO, HR staff, Denials Management, Coding Specialists, and Director of Coding across 2 hospital locations and the ACO.
- Reduced the percentage of denied claims by providing comprehensive training to staff in revenue cycle
- Optimized coding practices to align with ACEP-CMS guidelines, ensuring accurate and ethical billing
- Reduced claim denials by effectively managing CBO operations across all departments at the facility level
- Leveraged negotiation skills to maximize reimbursement rates from insurance providers.
- Collaborated with senior management to devise strategies for the mutual benefit of internal teams and customers.
- Facilitated clear and effective communication between various teams within the company.
- Successfully on-boarded and coached new team members in various positions.
- Identified areas of improvement in the division through comprehensive data trend analysis.
- Managed daily operations to ensure staff members met quality standards.
- Negotiated contracts with external vendors on behalf of the division.
- Implemented new processes and procedures to streamline workflow across teams.
- Communicated regularly with stakeholders regarding progress updates on projects and initiatives taken up by the division.
- Organized training sessions for employees in order to improve their skillsets related to their roles within the organization.
- Made sure clinical documentation was done timely to guidelines and charts signed by doctor either by hand or electronic if registered with CMS to do so
Operations Regional Revenue Cycle - Post Acute Care- SNF/NF/Assisted Living
Cathedral Rock/Preferred Healthcare
11.2010 - 04.2014
- Managed operations for 12 Nursing/Skilled Nursing Facilities across New Mexico and Texas.
- Provided education and training to business office managers regarding daily tasks
- Ensured accurate and efficient booking of revenue at the highest level
- Ensured building operations followed state and federal guideline
- Ensured timely completion of clinical documentation according to guidelines, with appropriate verification by doctors or nurses, whether through manual or electronic means if registered with CMS.
- Created detailed reports summarizing the status of accounts receivable balances at any given time.
- Responded to customer inquiries regarding their bills or payment plans in a professional manner.
- Worked collaboratively with other departments such as clinical staff to ensure accurate coding of services provided.
- Evaluated existing billing systems for potential improvements or changes necessary due to industry updates or changes in regulation.
- Researched and resolved complex claim issues with insurance companies.
- Monitored payment postings to ensure accurate financial records.
- Processed credit card payments from customers utilizing established protocols for secure transactions.
- Assisted in the development of internal procedures for processing insurance claims.
- Developed, implemented, and monitored processes for billing and collections activities.
- Performed data entry tasks such as entering patient demographics into the system.
- Reviewed and analyzed patient accounts to ensure accuracy of information and timely payments.
- Provided customer service assistance in resolving billing disputes with insurance companies or other third parties.
- Maintained current knowledge of health care reimbursement laws and regulations impacting billing practices.
- Identified solutions to improve revenue cycle operations efficiency and effectiveness.
- Analyzed daily cash receipts from patients and third-party payers to identify discrepancies or trends that may require follow-up actions.
- Prepared monthly reports on account receivable aging analysis, denied claims analysis, collection performance metrics.
- Reconciled accounts receivable ledgers against general ledger entries on a regular basis.
- Participated in meetings with external auditors as needed to provide support documentation related to revenue cycle operations.
- Participated in revenue cycle processes, working to maximize profitability and increase revenue.
- Evaluated revenue cycle processes and established actionable methods to increase productivity and efficiency.
- Oversaw complete lifecycle of revenue operations.
- Provided revenue cycle process support to all clinical personnel, including resolving procedure challenges.
- Analyzed and reported on billing cycle data to inform management.
- Delegated work to staff, setting priorities and goals.
- Developed work schedules according to budgets and workloads, covering priority tasks.
Regional Business Office Manager
Long Term Care Home /SNF
07.2003 - 07.2011
- Implemented effective account management strategies for residents in a Long Term Care Home
- Efficiently oversaw resident accounts and resolved outstanding debts
- Ensured timely and accurate billing for all accounts.
- Contributed to the analysis of financial data, labor expenditure optimization, and P&L execution
- Managed responsibilities related to accounts payable and payroll.
- Conducted regular assessments of patient accounts for the purpose of ensuring accurate billing practices.
- Prepared monthly reports summarizing accounts receivable aging information for executive review.
- Utilized financial data analysis to identify patterns and inconsistencies within accounts receivable activity.
- Developed and enforced operational guidelines for the regional business office.
- Managed various tasks including accounts receivable coordination, collections management, billing processes, and coding.
- Managed team of five employees in regional business office, responsible for hiring, training, and conducting performance evaluations.
- Maintained confidentiality of all patient records in accordance with applicable laws.
- Collaborated with other departments to develop strategies to optimize operational efficiency.
- Monitored cash flow projections for the regional business office on a weekly basis.
- Ensured timely follow-up on delinquent accounts through collection efforts.
- Ensured compliance with legal and regulatory requirements affecting the business office.
Education
B.A - Healthcare Management/Administration
National American University
Kansas City, MOSkills
- Revenue Cycle Management
- Claims Processing/Billing/ERA /EFT/ Cash Posting operations
- Project Management
- Professional Relationships
- Accounts Management
- Bad Debt Management
- Financials
- Labor Costs
- P&L Analysis
- Data Analytics
- Staff Training
- Proficient in [Software]
- Business Analytics
- Reporting
- Performance Goals
- Telephone Etiquette
- Materials and documentation
- ROI understanding
- Business operations knowledge
- Stakeholder relationships
- Client Education
- Deadline-oriented
- Client Engagement
- Customer service and support
- Client Relationship Management
- Account oversight
- Client liaison and advocacy
- Best Practices
- Revenue Generation
- Risk Mitigation
- Key Performance Indicators
References
References available upon request.
Timeline
Optimal Practice Insight| Client Success Manager
Optum insight/ Optum Behavioral Care Health
09.2021 - Current
Revenue Cycle / Credentialing and Contracting Director
Practice Solutions
08.2020 - 01.2021
Systems Operations VP of Revenue Cycle
Sundance Healthcare -Behavioral Health
07.2018 - 03.2020
AR Director of Revenue Cycle
Schumacher Clinical Partners / Service lines: ED, PCP and Hospitalist
05.2015 - 05.2018
Divisional Director of Revenue Cycle
Texas General Hospital – Outpatient Surgery/ Ambulatory and ED Hospitalist
06.2014 - 05.2015
Operations Regional Revenue Cycle - Post Acute Care- SNF/NF/Assisted Living
Cathedral Rock/Preferred Healthcare
11.2010 - 04.2014
Regional Business Office Manager
Long Term Care Home /SNF
07.2003 - 07.2011
B.A - Healthcare Management/Administration
National American University
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