Monique Carter
Las Vegas,NV
Summary
Revenue cycle leader with extensive experience in billing and collections management at Aveanna Healthcare. Achieved significant reductions in denials and optimized accounts receivable through strategic policy development and effective staff training. Proficient in Excel and skilled in fostering team collaboration to drive operational excellence.
Overview
28
28
years of professional experience
Work History
Director of Revenue Cycle Management
Prime Providers
Long Beach, CA
04.2024 - Current
- Oversee billing, collection, and authorization of Private Duty Nursing, Home Care and Behavioral Health Division
- Responsible for all aspects of patient access to service, authorization, charge capture, payor contracting financial support and billing and collection activities on a daily basis.
- Oversee the planning, organization, implementation, direction and schedules of all authorization, claims management processes and controls to ensure the accuracy and timeliness of claim submissions, collections effort and payment distribution in compliance with contractual, state and federal regulations.
- Develop, implement, and maintain all related policies and procedures.
- Responsible for the directing and supervising of staff and all technical and clerical aspects of patient billing and collection, including service, patient satisfaction and problematic issues as they arise.
- Monitor denials management and determine corrective action plans.
- Use routine monitoring reports to oversee the operational functions, ensuring that billing and collection goals for the department and each individual employee within the department are met.
- Develop and maintain trending models, projections and performance benchmarking analyses.
- Supervise patient billing and collections staff daily, including hiring, monitoring productivity standards and departmental training.
- Oversee functions of key front office staff as it relates to the revenue cycle process.
Director of Billing and Accounts Receivable
Aveanna Healthcare
Seal Beach, CA
07.2018 - 04.2024
- Oversee billing, collection, and authorization operations for western regional offices with weekly billing revenue of $300+ million.
- Work closely with west region president and CFO by keeping them informed of departmental updates.
- Responsible for training, supervising, and evaluating managers to ensure smooth and efficient operations across 23 locations in California, Nevada, Arizona, and Washington State.
- Responsible for conducting employee audits to ensure compliance with internal policies and procedures, health care regulations, and state and federal laws are followed.
- Serves as the company’s main point of contact for billing and collection issues, including producing and monitoring reports to identify trends and problems in charges, claims/EDT files, denials, payments, and other transactions impacting the revenue cycle.
- Responsible for keeping unbilled under 3 DOS days.
- Ensures documents are accurate and correspond with policies for approved charge corrections, refunds, and adjustments.
- Responsible for monitoring AR to identify collection and billing issues focusing on keep AR under 90days.
- Manage communications with, insurance companies, and other parties in relation to billing, payment, and coding requirements and regulations.
- Responsible for managing projects and performing monthly revenue reports across locations.
- Negotiate payer contracts and account adjustments.
- Stays abreast of industry trends and best practices in order to design policies for best billing processes.
- Conduct monthly status meeting with each staff and locations in my region.
- Run and review month end reports for each location.
- Keep staff updated on payer policies and procedures in order to facilitate proper billing with minimal denials.
- Work closely with locations clinical directors to resolve denied authorizations for medical justification.
- Implement payor projects when needed.
Manager of Billing and Prior Authorization
Aveanna HealthCare
Seal Beach, CA
03.2010 - 07.2018
- Managed all aspects of the billing process from electronic and manual submissions of charges to collections and charge write offs.
- Responsible for recruiting, developing, mentoring, and coaching staff.
- Training of staff in the use of billing software.
- Developed and analyzed reports to identify strategies and design new policies for improving billing processes.
- Ensured that accounts were billed properly, and payments and adjustments were applied to accounts correctly.
- Managed insurance relationships with Commercial, Manage Care and State Programs to reduce denials and improve A/R.
- Monitor timely authorization submission and follow-up.
- Assisted in Integration processes in the lines of system payor set-up to ensure accuracy of active contracts.
- Conducted random work list audits for the purposes of assessing and improving employee performance.
- Responsible for conducting monthly Aging meeting to address payment delays and payor issues.
Lead Medicare and Medi-Cal Biller Collector
Kindred Healthcare CBO
La Mirada, CA
06.2008 - 03.2010
- Managed, trained, and coached billing and collection specialists.
- Communicated with insurance companies, patients and providers.
- Determined and explained insurance benefits to patients and handled all in-house billing for Medicare, Commercial insurances and Medi-Cal/MCO patients, including working with patients to resolve complaints and problems quickly.
- Researched all overpaid, underpaid, and denied claims to determine if billing or balance adjustments were accurate and needed.
- Prepared and performed billing and re-billing functions.
- Monitored all remaining weekly Medicare days for all in-house patients.
- Ensured denied claims were researched and appealed if needed.
- Assist in Insurance verification and authorization submission.
- Resolved posting issues to ensure accurate account balances.
Government Billing/Collections Team Lead
Daniel Freeman Memorial Hospital
Inglewood, CA
04.1999 - 05.2008
- Responsible for training new hires on policies, procedures, billing and accounting software.
- Worked directly with physicians and staff on payable diagnosis and insurance verification.
- Created weekly run error reports, made sure claims were billed correctly and daily, and oversaw the application of credits and adjustments.
- Reviewed EOBs and RAs to determine correct code of payment.
- Posted payments and correct contractual agreements.
Admissions Representative
Daniel Freeman Memorial Hospital
Inglewood, CA
02.1998 - 04.1999
- Facilitated the arrival process for patients, from intake and setting up accounts to ensuring timely care.
- Determined and explained insurance benefits to patients.
- Collection of co-payments, co-insurance and deductibles base on insurance plan.
- Creates accounts for initial intake upon presentation to the check-in area.
- Continued to monitor patient queues to ensure timely registration.
- Followed established HIPPA protocol for proper patient look-up.
- Met daily productivity expectations in accordance with department standards.
- Confirms and communicates patient registration status, In/Out of network status and maintained service level to avoid delays.
Education
Associate of Arts - Respiratory Technologist
Long Beach City College
Long Beach, California09.1995
Skills
- Microsoft Office
- Excel
- Word
- PowerPoint
- Outlook
- G-Suite
- Windows
- IOS
- P-Bar
- E-Premis
- Emdeon
- SMS
- HBOC
- Meditech AS400
- DDE
- Continulink
- KenTime
- Allscripts
- Waystar
- Complink
- HealthTrust/GLS
Community Service
Los Angeles County Fire Department, Inglewood, CA, Assist in charity events within Los Angeles County.
Timeline
Director of Revenue Cycle Management
Prime Providers
04.2024 - Current
Director of Billing and Accounts Receivable
Aveanna Healthcare
07.2018 - 04.2024
Manager of Billing and Prior Authorization
Aveanna HealthCare
03.2010 - 07.2018
Lead Medicare and Medi-Cal Biller Collector
Kindred Healthcare CBO
06.2008 - 03.2010
Government Billing/Collections Team Lead
Daniel Freeman Memorial Hospital
04.1999 - 05.2008
Admissions Representative
Daniel Freeman Memorial Hospital
02.1998 - 04.1999
Associate of Arts - Respiratory Technologist
Long Beach City College