Work Preference
Summary
Overview
Work History
Education
Skills
Websites
Certification
Timeline
Generic
Open To Work

Lori Borgerding

Wayland,MI

Work Preference

Job Search Status

Open to work
Desired start date: Immediately

Desired Job Title

Director, Revenue Cycle, Patient AccessVice President, Operations Senior ManagerDirector, Revenue Cycle

Work Type

Full Time

Location Preference

RemoteHybrid
Location: Wayland, MichiganGrand Rapids, MI
Open to relocation: No

Salary Range

$150000/yr - $200000/yr

Important To Me

Work-life balanceFlexible work hoursWork from home optionHealthcare benefitsPaid time offCompany Culture401k matchStock Options / Equity / Profit SharingTeam Building / Company Retreats

Summary

Dynamic leader with extensive experience in revenue cycle management at OneOncology, driving process improvements and achieving a 711% reduction in enrollment cycle time. Proven expertise in financial analysis and team leadership, leveraging strategic planning to enhance operational efficiency and compliance. Committed to optimizing workflows and fostering high-performing teams.

Overview

25
25
years of professional experience
1
1
Certification

Work History

Director, Revenue Cycle, Patient Access

OneOncology
Nashville
09.2022 - 09.2025
  • Patients are our number one priority
  • Build and manage high performing teams, including but not limited to, insurance verifications, authorizations for chemo treatment and radiology, upfront collections, financial counseling with patient assistance, coding and compliance including audits and education billing, cash posting, and AR management for both onshore and offshore teams.
  • Direct management of Research coding & billing team – Billing for Phase 1 Clinical trials for START Midwest, Phase II and Phase III clinical trials billing through CHC
  • Manage teams to obtain patient financial assistance through foundations and copay cards to reduce patient financial responsibility to let patients focus on improving their health
  • Leverage technology to optimize workflows that drive efficiency, quality and accuracy using automation and AI tools – wrote over 200 rules to automate claims processing
  • Claim denial management and analytics to reduce rejection rate/payer management – largest monthly receivables - August, 2025
  • Launched AI program for prior authorizations to streamline mundane human processes with 99% accuracy.
  • Key project coordinator for data conversion and execution of new practices in growing clinic
  • Instrumental in launch of new payment management system – Candid Health
  • Create strategies to identify root cause billing and coding issues to reduce claim denials.
  • Optimize workflows to address issues through continuous process improvement.
  • Administrator for PolicyStat, HealthStream and InstaMed software programs
  • Report creation and maintenance through PowerBI and Informatics
  • Compliance Officer - Oversee the compliance program which includes HIPAA, provider documentation, auditing, education, and HCC coding
  • Work for Corporate OneOncology at the Cancer & Hematology Centers, Grand Rapids, MI

Vice President, Operations Senior Manager

PNC Bank / PNC Healthcare
Kalamazoo
12.2017 - 09.2022
  • Manage team of Project Managers for new provider onboarding using Agile approach.
  • Lead negotiations with payers to enroll for direct connections with PNC Clearinghouse
  • Direct and support the enrollment of providers with payers for 835, 837 and EFT EDI submissions
  • Received 2020 Celent Model Bank Award for technology – automating enrollment processes
  • Reduced cycle time from 32 days to 4.5 days – 711% improvement
  • FTE reduction of 57% in growing area of business
  • Managed capital project from manual preparation to an automated enrollment process improving quality, cycle time and reduced FTE count.
  • Coordinate and troubleshoot status meetings with payers and providers to mitigate problems or delays related to provider onboarding and enrollments.
  • Build reporting to establish metrics to hold staff accountable for productivity and quality while providing staffing analysis for rapidly growing business needs.
  • Administrator for Healthcare division SharePoint site.
  • Monitor team performance using strategic plan and established KPI’s.
  • Highest Employee Satisfaction (eNPS) scores for Healthcare Division
  • PNC Healthcare is a clearinghouse for 835, 837 and EFT EDI transmissions, lockbox, Intelligent Optical Character Recognition (IOCR) and other products to support healthcare operations

Director, Revenue Cycle

Spectrum Health/Priority Health MANAGED BENEFITS
Grand Rapids
06.2000 - 11.2017
  • Lead multiple cross-functional operation teams including managers and supervisors for effective service to meet and exceed customer needs and objectives.
  • Direct the leadership of health insurance Revenue Cycle to complete timely enrollment and billing of plan’s groups and members through electronic (EDI) and paper processes.
  • Managed Claims Third Party Liability Claim department and increased savings from $10M to > $22M in 4 years.
  • Primary responsibility for >$4M budget for several cost centers preparing annual financial budget and targets, reconciliation of monthly variances, preparation for monthly accruals for accurate cost reporting.
  • Identified opportunity through Rapid Improvement Event, implemented the movement of member material mailings to online delivery to save >$1M annually in printing and postage.
  • Inaugurated a new identification card vendor improving delivery time to members from 2 weeks to 2 days and dramatically decreasing call volume to Customer Service, Sales and external agents.
  • Project management and leadership. Several successful project implementations.
  • Executed project for multi-phase certification of CORE compliance, coordinated with Information Systems and outside consultants for certification achievement.
  • Control Objective owner for SOC1 and MAR audit; create, maintain, and analyze statistical reports to support audit controls.
  • Complex regulation monitoring for compliance including Affordable Care Act(ACA), Center for Medicaid and Medicare Services(CMS), CAQH Committee for Operating Rules for information Exchange(CORE), Workgroup for Electronic Data Interchange(WEDI), Service Organization Control (SOC1), Model Audit Rule(MAR) and Health Insurance Portability and Accountability Act (HIPAA).
  • Manage several vendor relationships.
  • Process Improvement professional. Bronze certified. Toyota Production System, Kaizen culture, A3, PDSA. Lean Process principals coach.
  • Developed, implemented and directed alliance of multi department senior leadership members to remove silo mentality and build effective relationships to unite as cohesive team.
  • Strong Gallup Scores; 2015-Most improved team Gallup scores across Priority Health and Spectrum Health system.
  • Implemented new team for workflow development using OnBase Workflow to process paper electronically through the organization to save administrative costs while establishing and exceeding strategic and operational goals.
  • Directed team to develop automated processes including provider claim and reimbursement reporting, health care cost reports, financial analysis, and cost trending reports to enhance efficiency and timeliness.
  • Manage and prepare health care claim cost and other analysis as requested to provide inherent details for mitigating loss potential.
  • Staffing analysis to forecast and provide appropriate coverage during peak periods.

Education

Master of Business Administration -

Cornerstone University
Grand Rapids, Michigan

Bachelor of Applied Science with Honor - Accounting

Davenport University
Grand Rapids, Michigan

Skills

  • Revenue cycle management
  • Financial analysis
  • Team leadership
  • Strategic planning
  • Analytical thinking
  • Process improvement
  • Project management
  • Provider enrollment

Websites

Certification

Spectrum Health – Bronze Certified - Performance Improvement Systems

Timeline

Director, Revenue Cycle, Patient Access

OneOncology
09.2022 - 09.2025

Vice President, Operations Senior Manager

PNC Bank / PNC Healthcare
12.2017 - 09.2022

Director, Revenue Cycle

Spectrum Health/Priority Health MANAGED BENEFITS
06.2000 - 11.2017

Master of Business Administration -

Cornerstone University

Bachelor of Applied Science with Honor - Accounting

Davenport University

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Lori Borgerding