Summary
Overview
Work History
Education
Skills
Timeline
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Mary Elizabeth Hunter

Mary Elizabeth Hunter

Deland,FL

Summary

Experienced Revenue Cycle and Managed Care Sr Director with a strong background in Academic Medical Centers, Ambulatory Surgery, Physician Practice, and Hospital healthcare industries. Skilled in Revenue Cycle Improvement, Account Receivable Management, Business Process Improvement, Denial Prevention, Health Information Administration, and Healthcare Information Technology (HIT). Proven track record of optimizing revenue cycle efficiencies for maximum contractual reimbursement, advanced project management, seasoned network development, and contract negotiations. Excels in strategic planning and execution. Deep expertise in acute care revenue cycle management with a strong focus on back-end operations. Strong data analytics and visualization skills using Excel, SQL, Tableau, Power BI, or similar tools. Proven ability to apply economic value-add (EVA) frameworks to assess financial impact and optimize revenue cycle processes. Sr Leadership expertise in all areas of Managed Care Contract Negotiations including Value-Based, Risk Adjustment, Gain Share, and IPA. Health Plan Network Development and re-procurement experienced. Skilled in strategic planning, team leadership, and operational excellence. Utilizes proven methodologies to drive business growth and enhance organizational performance. Track record of successfully leading diverse teams and managing complex projects. Knowledgeable Sr Director Revenue Cycle Operations and Managed Care with a proven background in senior leadership roles driving strategic initiatives and fostering organizational growth. Successfully led cross-functional teams to achieve key business objectives enhancing operational efficiency and stakeholder satisfaction. Demonstrated expertise in project management and strategic planning.

Overview

37
37
years of professional experience

Work History

Sr. Director, Revenue Cycle

Surgery Partners
07.2019 - Current
  • Revenue Cycle Operations Leader of 65 ASC's that employed 165 Support Team Members, 12 Certified Coders and high-level appeals specialists, Coaching and Development of 8 Directors, 4 Revenue Cycle Trainers and Revenue Cycle Analytics Team
  • Proven Track Record of Identifying and Improving Key Performance Indicators (KPI's) to ensure an increase in ASC profitability
  • Responsible for $34m in expected monthly Cash Collections Goals to ensure financial operational expectation were achieved.
  • Historical performance demonstrates monthly and annual collections expectations were exceeded by 20% annually, $460m annually collections along with an additional $25m stretch goal being achieved.
  • Business growth goals continually achieved, new business development of 12% growth.
  • Creation of several Revenue Cycle departments to ensure a reduction in front end controllable denials that resulted in a decrease in DSO/DAR by 6 days on average. Reduced front end controllable denials by 37% within the first rollout year Reduced the percentage of AR aged >90 days to 13% of total AR. Process improvement initiative successfully completed to streamline workflow and eliminate waste.
  • Provided exceptional leadership with direct oversight of daily, monthly and annual goal achievement for 65 ASC's, 4 ANES and 6 Pain Clinics.
  • Versed in all aspects related to Letter of Protections to include participation in depositions. Advanced knowledge of Neuromodulation, Orthopedics through all areas of Revenue Cycle. Direct oversight of a high-level appeals team to ensure successful erroneous denials were overturned through the appeals process, denial overturn rate improved by 17% during the first year and an average of 6% each additional year.
  • Lead and Conducted provider education to improve provider documentation, coding and billing of services
  • Succession Planning
  • RCM, KPI Improvement Strategic Planning and High Level Reporting
  • Cross Functional RCM Impact Collaboration
  • Waystar Integration Leader
  • Cultivated a culture of innovation by promoting creative thinking and encouraging employees to take calculated risks in pursuit of solutions.
  • Directed design and execution of business transformation initiatives to drive performance, profit optimization and growth opportunities.
  • Fostered work culture of collaboration and inclusion to increase morale and reduce turnover.
  • Developed strong relationships with key industry partners, fostering collaboration and mutual growth opportunities.
  • Created an agile working environment, enabling rapid response to changing business needs without sacrificing quality or performance standards.
  • Established data-driven decision-making processes and implemented best practices in analytics to optimize performance across the organization.
  • Increased employee satisfaction, providing regular coaching and feedback sessions.
  • Managed risk effectively by identifying potential threats, developing contingency plans, and implementing mitigation strategies in line with overall business objectives.
  • Achieved departmental goals by developing and implementing strategic plans and initiatives.
  • Navigated complex regulatory environments to ensure compliance with local laws, standards, and regulations relevant to the business domain.
  • Drove strategic improvements to enhance operational and organizational efficiencies.
  • Revamped operational plans to refocus staff and align processes with business objectives.
  • Optimized project timelines by effectively delegating tasks and prioritizing workload among team members.

Sr. Director Revenue Cycle Operations & Managed Care & Credentialing

USF Health
05.2016 - 06.2019
  • Sr Leader with direct Revenue Cycle Operations, Managed Care and Credentialing oversight that included operations, full administration, and development of programs and services that support revenue cycle initiatives; scheduling, registration, financial counseling, POS collections efforts, technical and professional billings, denials management, charge master maintenance, patient accounting and eligibility systems. Responsible for oversight and direction of a 150 department Revenue Cycle Team to ensure a timely, accurate billing with collections of $42m in NET Collection within 28 DAR monthly. Effective development, implementation, monitoring and communications of goals, objectives, budgets and expected KPI performance.
  • Analyzed critical operations on an ongoing basis and developed reporting that evaluated and demonstrated productivity and performance gains. Lead Revenue Cycle Operations, Managed Care Contracting and Credentialing for all USF Health Physician Clinics (multispecialty), Ambulatory Surgery Centers and Pain Practices. Expert in Hospital, Ambulatory Surgery, Professional Revenue Cycle Operations. Contract re-negotiations resulted in $9m increase in revenue (utilization compare year over year)
  • Reduced frontend controllable denials by 27%, Clean claim rate of 97%, Improved Average DAR 28 days
  • Succession Planning
  • EPIC Integration Leader
  • HST Integration Leader
  • Experienced Contract Management Integration Leader (Experian)
  • Optimized project timelines by effectively delegating tasks and prioritizing workload among team members.
  • Streamlined operations for increased efficiency with process improvements and automation.
  • Championed continuous improvement initiatives to drive operational excellence within the organization.
  • Led cross-functional teams to successfully launch new products, meeting deadlines and budgets.
  • Facilitated seamless business transitions during mergers or acquisitions, ensuring minimal disruption to ongoing operations while integrating teams effectively.
  • Implemented cost-saving measures through effective resource allocation and budget management.
  • Instituted formal operating procedures and enforced adherence to policies and regulations that impacted bottom-line.
  • Led development of business operation processes and policies.
  • Cultivated a culture of innovation by promoting creative thinking and encouraging employees to take calculated risks in pursuit of solutions.

Director, Provider Relations and Network Development

Amerigroup Florida
08.2011 - 05.2016
  • Lead all aspects of Provider Network Management to include provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, product and market expansion.
  • Lead a team of 6 Managers and 4 Supervisors with a dotted line to 150 Support Team Members
  • Responsibilities included strategic analysis and negotiations for network management, including organizational management, complex contracting, and contracting efforts to support Florida Healthy Kids, Medicaid and CMS requirements. Risk and Gainshare contracting with IPA Groups.
  • Successful Network builds which resulted in a financially secure and viable network, resulting in both the FHK and SMMC-MMA regional contract awards.
  • Works closely with regulatory partners to achieve a high level of compliance and customer satisfaction.
  • Executes and leads strategic network initiatives, in line with corporate strategy, throughout the department. Develops new and revised workflow, structure, policies and procedures as necessary to ensure departmental activities are consistent with corporate strategy and business development initiatives, develops an annual budget for salaries and all other operational areas and administers it throughout the year to ensure compliance. Hospital contract negotiations. Responsible for hiring, developing, training and retaining high-quality, productive employees.
  • Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
  • Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
  • Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
  • Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.

Director, Provider Relations & Network Development

Comprehensive Care Management
05.2009 - 07.2011
  • Lead all aspects of Provider Network Management to include provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansion.
  • Responsibilities included strategic analysis and negotiations for network management, including organizational management, complex contracting, and contracting efforts to support HPN, HSD and CMS requirements. Worked closely with regulatory partners to achieve a high level of compliance and customer satisfaction for the largest PACE Program in the county.
  • Executes and leads strategic network initiatives, in line with corporate strategy, throughout the department. Develops new and revised workflow, structure, policies and procedures as necessary to ensure departmental activities are consistent with corporate strategy and business development initiatives, develops an annual budget for salaries and all other operational areas and administers it throughout the year to ensure compliance. Hospital contract negotiations. Responsible for hiring, developing, training and retaining high quality, productive employees.
  • Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
  • Enhanced team collaboration through regular communication, goal setting, and performance evaluations.

Manager, Provider Relations

WellCare of New York
03.2006 - 05.2009
  • This position manages the profitability of the Hudson Valley and Capital District network for all lines of business including Medicaid, Child Health Plus, Family Health Plus and Medicare. Responsibilities include Ensure that providers are configured in accordance with their contracts to allow for clean claim pass through rate, Development of provider network into expansion counties. Ongoing analysis of provider network in accordance with HSD/HPN requirements/regulations Provider contracting with multiple reimbursement models, Gain Share, Risk Adjustment, Value-Based Care.
  • Review utilization trends for partner practices to ensure profitability Successfully engage practices in managing costs and profitability.
  • Managed and motivated employees to be productive and engaged in work.
  • Accomplished multiple tasks within established timeframes.
  • Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.

Director, Community Relations

Family Care Certified Services/DATAHR
03.2003 - 03.2006
  • Healthcare sales and marketing position responsible for: Developed network of referral sources for Certified Home Health Care in Westchester, Putnam, Dutchess Nassau and the Bronx counties Assisted in the development of the referral sources in the Lombardi Program in the Bronx Maintained network of referral sources in Westchester, Putnam, Dutchess and Nassau counties Developed and promoted community-based events to attract referral sources and raise awareness of services available
  • Successfully penetrated new markets and establishing genuine rapport with provider community Worked with Community organizations

Medical Laboratory Technician

Orange Regional Medical Center
01.1988 - 01.2003
  • Third shift (11pm -8:30 AM) Medical Laboratory Technician, team of two staff members. Collection of all patients' specimens both inpatient and emergency room patients. Specimen testing, analysis and reporting. Phlebotomy.

Education

Associate of Science - Science, Laboratory Science

Orange County Community College
01.1985

Skills

  • Lean and Six Sigma
  • Power BI,SharePoint
  • EPIC, MODMED,HST,
  • Waystar,TrueBridge
  • Microsoft Excel/Word
  • Succession Planning
  • Leadership Development
  • Organizational development
  • Data analytics
  • Policy implementation
  • Stakeholder relations
  • Strategic planning
  • Verbal and written communication
  • Contract and vendor management
  • Legal and regulatory compliance

Timeline

Sr. Director, Revenue Cycle

Surgery Partners
07.2019 - Current

Sr. Director Revenue Cycle Operations & Managed Care & Credentialing

USF Health
05.2016 - 06.2019

Director, Provider Relations and Network Development

Amerigroup Florida
08.2011 - 05.2016

Director, Provider Relations & Network Development

Comprehensive Care Management
05.2009 - 07.2011

Manager, Provider Relations

WellCare of New York
03.2006 - 05.2009

Director, Community Relations

Family Care Certified Services/DATAHR
03.2003 - 03.2006

Medical Laboratory Technician

Orange Regional Medical Center
01.1988 - 01.2003

Associate of Science - Science, Laboratory Science

Orange County Community College

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