Melissa Polanco
New York,NY
Summary
A passionate, analytical, and intuitive Healthcare Management professional with proven expertise in revenue cycle, reporting and analysis, and practice management. Thorough knowledge of key performance indicators, budgeting, marketing, revenue cycle administration, and financial operations. Talented team leader with expertise to mentor and guide employees to be proactive, analytical, and work autonomously. Dedicated team player with excellent communication skills who strives to optimize patient care with experience in multidisciplinary care.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Accounts Receivable Administrator
Weill Cornell Medicine
New York, New York
06.2021 - Current
- Monitors denial and no activity trends by payer to identify root cause. Ensure timely and complete follow up for the Department of Surgery on unpaid or denied claims to ensure claims are resubmitted and appealed.
- Identifies trends and changes in reimbursement to implement tactics to increase revenue. Develops strategies, provides training, and makes recommendations to Department support staff to improve revenue cycle processes.
- Tracks departmental Key Performance Indicators and completes assessments on a monthly, quarterly, and annually basis to improve revenue cycle metrics.
- Implemented new AR follow up and denial management policy and procedures to increase departmental revenue resulting in overall revenue targets met or exceeded month over month.
- Streamlined operations to achieve new efficiencies and effectiveness resulting in improved Revenue Cycle KPI metrics.
- Serves as a front-line of communication with clinical and administrative leadership to report revenue cycle metrics.
- Work with departmental senior leadership on ad-hoc projects.
- Maintains regular performance appraisals for subordinates through verbal, written and on-going review programs.
- Mentors, guides, and leads a team of five Revenue Cycle Specialists to analyze and execute AR processes through effective communication, outlined expectations, effective and efficient workflows, and giving them full authority and authority over tasks.
Practice Administrator
Weill Cornell Medicine
New York , NY
05.2020 - 06.2021
- Oversaw day-to-day operations for the Division of Colon and Rectal Surgery & Endocrine and Minimally Invasive Surgery, Front-end operations, and department Call Center.
- Developed financial and strategic models for short and long-term planning.
- Managed annual operating budget.
- Implemented strategies to meet Key Performance Indicators (KPI) for providers and staff including e-Competencies and Revenue Targets.
- Ensured maximum exposure, marketability and promotional opportunities for clinical services offered by the practice.
- Oversees and coordinates efficient utilization of OR time and/or clinical space.
- Implemented new hire training to further develop skills and initiate discussions on task prioritization.
- Reviewed staffing model to maintain adequate staffing levels and develops corrective action plans based on analysis of data performance reports.
- Ensured maximum exposure, marketability and promotional opportunities for clinical services offered by the practice.
- Oversaw utilization of clinical and OR schedules in Epic scheduling system and implemented strategies to improve scheduling tactics with support staff.
Practice Supervisor
Weill Cornell Medicine
New York, New York
05.2019 - 06.2021
- Supervise a team of eight Senior Patient Coordinators at three outpatient clinic locations and responsible for the day-to-day operations.
- Collaborate with multi-disciplinary staff to improve overall patient care, wait times and response times to improve overall patient access.
- Implement new hire training to further develop skills and initiate discussions on task prioritization.
- Monitor the levels of quality of service as measured by satisfaction surveys, customer comments, and direct observation.
- Ensure practice compliance with local, state, and federal regulatory requirements.
- Identify and implement policies, procedures, and best practices to ensure optimal practice performance.
- Review and optimize provider schedules. Also, ensure adequate staffing levels to provide optimal support.
- Ensure compliance with regulatory audits/inspections for internal/external reviews.
- Monitor Key Performance Indicators (KPI) to determine and address performance issues of providers and staff.
- Manage the annual budget including capital planning and monitor monthly for variances.
Revenue Data Analyst
Weill Cornell Medical College
New York, NY
03.2019 - 05.2019
- Provide analytical support and data reporting for all clinical divisions with the Department of Surgery.
- Create standardized and ad-hoc reports based on functional needs including daily, weekly, monthly and quarterly related to charges, payments, write-offs WRVUs, referrals and patient volume.
- Assist with the preparation of monthly revenue and WRVU forecast for the Surgery Department by division and physician.
- Assists with contracting new physicians, new rates and new plans.
- Prepare and distribute daily cash reports to monitor daily charges, payments, and other billing indicators.
- Ensure reports are being delivered on a timely basis and escalates any delays or issues.
- Analyze billing trends for providers and departmental divisions as requested.
- Identify opportunities for improvement and make recommendations.
- Identify undervalue contracted rates by analyzing reimbursement pattern.
- Execute analysis on increase trends for denials and provides findings to
management. - Perform audit reporting on charges posted manually by the coding team.
Revenue Cycle Specialist
Weill Cornell Medical College
New York, NY
01.2014 - 03.2019
- Provide analytical support, A/R management, problem solving and communication to the Department of Surgery Colo-rectal and Transplant divisions on all matters pertaining to the revenue cycle.
- Through reporting and analysis, currently responsible for managing 9 million dollars of a 45 million dollar revenue budget.
- Co-authored and implemented the Standard Operating Procedure Policy for the Department of Surgery for front desk staff, which included key points such as Customer Service, Front End Procedures and Payment Collections.
- Manage open invoices in A/R by provider while performing root cause analysis on denials, resubmit claims, document claim status, request medical records, write letters of medical necessity and file appeals and re-determinations.
- Prepare monthly reports by provider or division and meet with physicians and practice managers to go over current A/R, days in A/R, charge lag, A/R trends, payer mix, E-competency, case count volume, charges and payments including trends in WRVU provider productivity.
- Liaise with the Coding Supervisor and Billing Manager on strategic planning to decrease denials and increase collections.
- Successfully and efficiently maintain accounts to ensure adequate reimbursement by verifying insurance companies are paying at the contracted rates, in a timely manner, and by provider payer policy.
Billing Representative
Weill Cornell Medical College
New York, NY
09.2010 - 01.2014
- Assisted with the development and implementation of strategies and procedures that reduced denials, maximized reimbursement and promoted faster payment.
- Assisted in training current and new employees on the use of systems and departmental policies and procedures.
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
- Professionally and courteously scheduled and verified appointments, registered patients, maintained medical records by filing appropriate forms, test results, patient questionnaires and insurance information.
Education
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Hooksett, NHSkills
- Proficient in Cognos reporting tool, FPSC bench-marking and & EPIC
- Extensive knowledge of Government, Managed Care insurance plans, policies and guidelines
- Extensive knowledge of billing, revenue management, and accounts receivables for multi-specialty surgery department
- Knowledgeable in Commercial contract negotiations and credentialing
- Experienced in monitoring and analyzing revenue cycle KPI's such as net collection ratios, days in AR, and % of AR over 90 days
- Budget Expense and Revenue Analysis
- Certified Professional Coder (CPC)
- Certified Physician Practice Manager (CPPM)
- Highly proficient in Microsoft Office Suite
- Experienced in analytical data trending and reporting
Certification
- Certified Professional Coder (CPC). Certified by the AAPC in 2015.
- Certified Physician Practice Manager (CPPM). Certified by the AAPC in 2016.
Timeline
Accounts Receivable Administrator
Weill Cornell Medicine
06.2021 - Current
Practice Administrator
Weill Cornell Medicine
05.2020 - 06.2021
Practice Supervisor
Weill Cornell Medicine
05.2019 - 06.2021
Revenue Data Analyst
Weill Cornell Medical College
03.2019 - 05.2019
Revenue Cycle Specialist
Weill Cornell Medical College
01.2014 - 03.2019
Billing Representative
Weill Cornell Medical College
09.2010 - 01.2014
Bachelor of Science - Healthcare Administration
Southern New Hampshire University