Nelson Estrada
NORTH BETHESDA,MD
Summary
Versatile Senior Manager specializing healthcare revenue cycle management and skilled at planning, implementing and overseeing key improvements to drive business growth and efficiency. History of cultivating an open culture with free exchange of information. Pursuing new professional challenges with a growth-oriented company.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Sr. Manager of Patient Health Revenue Cycle
Whitman-Walker Health
01.2020 - 01.2024
- Coordinated and supervised entire patient revenue cycle process for one of the largest Federally Qualified Healthcare Centers in Washington, DC to include billing and collections, contracting, credentialing, auditing, revenue cycle analysis and reporting, launching new EMR system and cross-departmental training and guidance on all billable medical, dental and behavioral health encounters
- Recruited, developed, cross trained and managed a highly efficient and effective team of Revenue Cycle Specialists and an external vendor resulting in 95% average GCR over a 10 year period
- Conceptualized and implemented procedures to ensure maximization of revenue
- Guided and supervised internal staff and external vendor to ensure 100% compliance with the contract management and internal procurement process
- Oversight of billing and collections guidelines for federal and state, and commercial contracts to include VA, MD and DC Medicaid, and Medicare statutes
- Actively and proactively analyzed large data sets to identify areas of exposure to the organization to ensure compliance with federal and state laws in order to mitigate areas of potential fraud, waste and abuse
- Developed custom tracking tools and reports to track and compile areas of concern, and root causes
- Resolved internal and external deficiencies to mitigate negatively impacted revenue, and improve all aspects of the revenue cycle
- Recruited, developed, trained and managed Revenue Cycle Analysts for high-level SQL reporting/analysis of impacted revenue
- Created, trained on, and implemented process redesign procedures and adherence to all internal control for dental, medical and behavioral health departments
- Actively collaborated in various aspects of quarterly, yearly and Ad-Hoc federal and state and funder audits including over utilization audits for dental, medical and behavioral health providers
- Innovated and strengthened provider credentialing procedures to ensure compliance with all internal and external requirements including CAQH, PECOS, NPPES, NCQA Credentialing standards, and PSV (Primary Source Verification) for medical, dental and behavioral health providers
- Analyzed and communicated areas of operational concern that required process improvement, and made recommendations for internal policy changes to improve service delivery, outcomes and revenue maximization
- Initiated, developed and produced high-level scheduled and Ad-Hoc custom financial reports to executive team/senior management
- Provided HIPAA, False Claims Act, and other federal laws training to internal and external Billing team to ensure 100% compliance with CMS, HHS, HRSA and OIG regulatory authority
- Established and maintained relationships with external vendors, third party payor representatives and external stakeholders to ensure positive communication and outcomes to help support overall health center operations.
Manager of Patient Health Revenue Cycle
Whitman-Walker Health
01.2013 - 01.2019
- Coordinated and supervised entire patient revenue cycle process for one of the largest Federally Qualified Healthcare Centers in Washington, DC to include billing and collections, contracting, credentialing, auditing, revenue cycle analysis and reporting, launching new EMR system and cross-departmental training and guidance on all billable medical, dental and behavioral health encounters
- Recruited, developed, cross trained and managed a highly efficient and effective team of Revenue Cycle Specialists and an external vendor resulting in 95% average GCR over a 10 year period
- Conceptualized and implemented procedures to ensure maximization of revenue
- Guided and supervised internal staff and external vendor to ensure 100% compliance with the contract management and internal procurement process
- Oversight of billing and collections guidelines for federal and state, and commercial contracts to include VA, MD and DC Medicaid, and Medicare statutes
- Actively and proactively analyzed large data sets to identify areas of exposure to the organization to ensure compliance with federal and state laws in order to mitigate areas of potential fraud, waste and abuse
- Developed custom tracking tools and reports to track and compile areas of concern, and root causes
- Resolved internal and external deficiencies to mitigate negatively impacted revenue, and improve all aspects of the revenue cycle
- Recruited, developed, trained and managed Revenue Cycle Analysts for high-level SQL reporting/analysis of impacted revenue
- Created, trained on, and implemented process redesign procedures and adherence to all internal control for dental, medical and behavioral health departments
- Actively collaborated in various aspects of quarterly, yearly and Ad-Hoc federal and state and funder audits including over utilization audits for dental, medical and behavioral health providers
- Innovated and strengthened provider credentialing procedures to ensure compliance with all internal and external requirements including CAQH, PECOS, NPPES, NCQA Credentialing standards, and PSV (Primary Source Verification) for medical, dental and behavioral health providers
- Analyzed and communicated areas of operational concern that required process improvement, and made recommendations for internal policy changes to improve service delivery, outcomes and revenue maximization
- Initiated, developed and produced high-level scheduled and Ad-Hoc custom financial reports to executive team/senior management
- Provided HIPAA, False Claims Act, and other federal laws training to internal and external Billing team to ensure 100% compliance with CMS, HHS, HRSA and OIG regulatory authority
- Established and maintained relationships with external vendors, third party payor representatives and external stakeholders to ensure positive communication and outcomes to help support overall health center operations.
Supervisor of Managed Care
Whitman-Walker Health
01.2009 - 01.2013
- Coordinated and supervised entire patient revenue cycle process for one of the largest Federally Qualified Healthcare Centers in Washington, DC to include billing and collections, contracting, credentialing, auditing, revenue cycle analysis and reporting, launching new EMR system and cross-departmental training and guidance on all billable medical, dental and behavioral health encounters
- Recruited, developed, cross trained and managed a highly efficient and effective team of Revenue Cycle Specialists and an external vendor resulting in 95% average GCR over a 10 year period
- Conceptualized and implemented procedures to ensure maximization of revenue
- Guided and supervised internal staff and external vendor to ensure 100% compliance with the contract management and internal procurement process
- Oversight of billing and collections guidelines for federal and state, and commercial contracts to include VA, MD and DC Medicaid, and Medicare statutes
- Actively and proactively analyzed large data sets to identify areas of exposure to the organization to ensure compliance with federal and state laws in order to mitigate areas of potential fraud, waste and abuse
- Developed custom tracking tools and reports to track and compile areas of concern, and root causes
- Resolved internal and external deficiencies to mitigate negatively impacted revenue, and improve all aspects of the revenue cycle
- Recruited, developed, trained and managed Revenue Cycle Analysts for high-level SQL reporting/analysis of impacted revenue
- Created, trained on, and implemented process redesign procedures and adherence to all internal control for dental, medical and behavioral health departments
- Actively collaborated in various aspects of quarterly, yearly and Ad-Hoc federal and state and funder audits including over utilization audits for dental, medical and behavioral health providers
- Innovated and strengthened provider credentialing procedures to ensure compliance with all internal and external requirements including CAQH, PECOS, NPPES, NCQA Credentialing standards, and PSV (Primary Source Verification) for medical, dental and behavioral health providers
- Analyzed and communicated areas of operational concern that required process improvement, and made recommendations for internal policy changes to improve service delivery, outcomes and revenue maximization
- Initiated, developed and produced high-level scheduled and Ad-Hoc custom financial reports to executive team/senior management
- Provided HIPAA, False Claims Act, and other federal laws training to internal and external Billing team to ensure 100% compliance with CMS, HHS, HRSA and OIG regulatory authority
- Established and maintained relationships with external vendors, third party payor representatives and external stakeholders to ensure positive communication and outcomes to help support overall health center operations.
Director of Business Development and Regulatory Compliance
The Lohman Group
03.2003 - 05.2009
- Responsible for identifying and developing business opportunities within the healthcare industry
- Managed client base effectively and utilized creative techniques to cultivate new opportunities that resulted in new business
- Management and oversight of start-up and turn-key operations of dental providers and mental health programs for organizations providing and/or expanding care to underserved populations in Washington, DC, California, Florida and Michigan
- Provided oversight of clients contracted with DC Department of Health, Medicare, and other governing organizations
- Developed Policies and Procedures for Free Standing Mental Health Clinics and dental practices
- Managed deliverables and tasks for all clients to include contracts, credentialing/enrollment applications, hiring and training of new staff to ensure compliance with federal, state and private contracts
- Developed financial forecasting reports for clients related their mental health programs
- Established written Policies and Procedures for clients that met all contractual standards with state and federal credentialing/enrollment for providing mental health programs
- Developed internal processes related identification and management of responsibilities for fraud, waste and abuse for dental, medical and behavioral health providers.
External Consultant
01.2007 - 01.2009
Education
Business Administration -
Heald College
06.2002
Skills
- Contract Review and Negotiations
- Revenue Cycle Management
- Conflict Resolution
- Deadline-Oriented
- Quality Internal Control
- Mitigation of Fraud, Waste and Abuse
- Regulatory Compliance
- Long-Term Business Planning and Execution
- Team-Oriented
- Data Analytics
- Effective Leader
- Recruitment and Talent Development
- Problem Solving
- Process Redesign
- Exceptional Interpersonal Communication
- Project Management
- Extensive Medical, Dental and Behavioral Health Credentialing Experience
- Strategic Planning
- Cross-Functional Collaboration
- Operations Management
- Cross-functional Team Coordination
Certification
- Certified Revenue Cycle Professional (AAHAM), 06/01/2019, True
- Certified Revenue Cycle Specialist (AAHAM), 06/01/2019, True
Assessments
- Management & Leadership Skills: Impact & Influence, Highly Proficient, 12/01/2020
- Spreadsheets with Microsoft Excel, Proficient, 12/01/2020
- Analyzing Data, Proficient, 03/01/2021
- Medical Billing, Proficient, 05/01/2024
- Protecting Patient Privacy, Proficient, 03/01/2023
- Verbal Communication, Highly Proficient, 03/01/2021
- General Manager, Proficient, 03/01/2021
- Recruiting, Proficient, 03/01/2021
- Technical Support, Proficient, 04/01/2024
Military Service
- U.S Army (Regular / Active Duty), United States, Specialist - Promotable to Sergeant, 10/01/1994, 11/01/1997
- U.S Army (National Guard), California and Virginia, Sergeant, 11/01/1997, 10/01/2003
Languages
Spanish
Native or Bilingual
Timeline
Sr. Manager of Patient Health Revenue Cycle
Whitman-Walker Health
01.2020 - 01.2024
Manager of Patient Health Revenue Cycle
Whitman-Walker Health
01.2013 - 01.2019
Supervisor of Managed Care
Whitman-Walker Health
01.2009 - 01.2013
External Consultant
01.2007 - 01.2009
Director of Business Development and Regulatory Compliance
The Lohman Group
03.2003 - 05.2009
Business Administration -
Heald College
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