Pamela Ellis
Novi,MI
Summary
Strategic revenue cycle executive with a strong focus on cross-department collaboration, successfully implementing workflow improvements that enhanced audit transparency and reduced denials. Demonstrated ability to align IT and operational teams to optimize revenue cycle processes and drive continuous improvement.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Director, Billing/Denials/Home Care/Hospice/Audits & Appeals/Cash Posting
University of Michigan – Sparrow Health System
Lansing, MI
01.2023 - Current
- Direct multi-department billing operations, denials management, home care and hospice lines and critical access facilities.
- Reduced open denials by 30% through standardized workflows and KPI dashboards (Epic SlicerDicer, Inflow).
- Reduced AR days from 80 to 49 within 8 months; created issue tracker and adjustment process approval along with ongoing meetings with payer reps and JOC meetings.
- Implemented WQ scoring system and productivity metrics, improving follow-up timeliness by 25%.
- Design, RCM workflows and process maps for follow-up, denials, and appeals to maximize revenue and decrease overall adjustments.
- Led ongoing quality reviews and performance tracking for improved revenue cycle efficiency and productivity.
- Collaborated with IT, UR, coding, and ancillary departments to enhance audit transparency and foster cross-department collaboration.
- Coordinated with IT team on EPIC implementation across 4 facilities to address challenges and ensure operational alignment.
Manager Denials/Payment Variance/Audit
Trinity Health
01.2018 - 01.2022
- Developed and maintained key metrics to improve denials management, verification, authorizations, collections, specialty billing, refunds, variance, and audits for the MI, ID, OR, and Fresno market.
- Manage, administer, develop, and maintain key metrics to facilitate continuous improvement, by working with teams to understand root cause analysis.
- Develop best practices to streamline the revenue cycle and establish protocols and policies that minimize risk along with managing project plans and deliverables.
- Establish and implement and develop instructional programs focused on maximizing collections to meet or exceed standards, minimizing patient account write-offs/OWO’s.
- Lean Leadership meetings with C-Suite team weekly to provide revenue cycle metrics.
- Engaged in organizing and implementing system upgrades for billing and patient access area; and developing value stream mapping to present to C-Suite members.
- Ensured effective communication with vendors to optimize outsourced accounts receivable management.
- Manage multiple priorities in consistent monitoring of possible system upgrades for automation.
- Working with EPIC team and project team on the transition of legacy system to EPIC.
Director Revenue & Billing -Contract
Trustbridge Health
01.2015 - 01.2018
- Hospice facilities with physician plans and mid-level providers, supporting over 150 nursing homes, Palliative Care, hospital services, home health Agency and Critical Access.
- Managed and developed key metrics to drive continuous improvement in financial counseling, payment posting, insurance verification/authorizations, billing, collections, refunds, and unapplied credits.
- Contract negotiation with Managed Care Organizations.
- Successful escalation process with payors to resolve outstanding AR.
- Decreased AR Days by 32 for Medicare, 60 for Medicaid, and 80 for Commercial payers.
- Established and implemented instructional programs to maximize collections and minimize patient account write-offs.
- Automation of admission insurance verification to real-time.
- Manage budget for the department, making certain that budget allowances and bad debt are aligned with successful outcome in leading organizational change management.
- Develop best practices to streamline the revenue cycle and establish protocols and policies that minimize risk along with managing project plans and deliverables.
- Manage a team of coders and assist in implementing coding guidelines, clinical staff training and proper processes for billing, PQRS responsibility for providers- PQRS Solutions.
- Successful system implementation and upgrades along with training physicians to utilize EMR systems.
- Comply with all internal controls and governmental regulatory requirements for billing.
- Oversaw documentation compliance and conducted internal audits.
- Assist with selection and implementation of an EMR and act as the coordinator to ensure coding guidelines and requirements were met and the interface was seamless.
- Work with Operations on the proper procedures for the front office staff including medical records.
- Monitor payer billing guidelines through federal and state policies.
- Manage department staff and coordinate efforts within the company, to develop best practice for all areas as they pertain to the revenue cycle.
- Assist to negotiate and administer contractual relationships and ongoing meetings with insurance carriers.
- Manage and oversee the clearinghouse and associated vendor contracts.
- Implement appropriate billing software edits with IT, for efficient claim submission and faster payment turnaround.
- Ongoing Lean Projects, eliminating waste, writing, and updating standard work for ongoing meeting and processes improvement to reduce Unbilled AR.
- Assist with notification and processes for all department staff that work within the practice management software.
Consultant/Contracted Roles/Achievements
01.2009 - 01.2015
- Provided interim management and consulting for acute care hospital, academic facilities and physicians groups.
- Led system conversions, work with testing team with process flows validation.
- ICD-10 assessments and process improvements.
- Supported EMR/EPM implementations and trained staff on system upgrades.
- Delivered revenue cycle, measurable performance improvements.
- Assessed denials and tracked deficiencies within revenue cycle and patient access departments.
- Assessment/Integration of NextGen, Cerner and EPIC system with customization and upgrades for maximum performance.
- Worked with physician practice comprised of 1000+ physicians and mid-level providers with over 159 clinics with all specialties.
- Increased cash collections (self-pay) by 6% per month and reduced days in AR by deploying onsite billing staff to clinics.
- Increased cash collections (patient pay) by 6% per month and reduced days in AR by deploying onsite.
- Provided direction and leadership to 132 professionals involved in verifications, registration, financial counseling, collections, charge entry and billing, physician credentialing.
- Participated and provided departmental education on billing, system upgrade with training, point of service collections, call center, denial trending/tracking and reevaluation of charge master.
- Boosted monthly insurance billing by establishing a financial counseling department to process Medicaid applications and approvals.
- Review dashboard and revenue cycle reports with the providers and CFO.
- Maximize use of the EPM system (IDX-GE, NextGen).
- Provided direction and planning for migration of centralized scheduling department for outpatient and clinic facilities.
- Increased authorization by 35% by creating processes and ongoing revenue development training with third party payers.
- Revenue increase within the surgery department of $400,000 monthly by process improvement and training within charge capture.
- Increased revenue by reviewing unbilled physician service reports.
- Provided objected analysis review of revenue cycle and front-end process to deliver industry standards.
- Developed process and increased revenue from $650,000 to 1.3 million in 90-day timeframe.
- Completed a comprehensive review of denials (Acute Care facilities) for appeals to ensure account deficiencies and timely billings resolutions which increased revenues 6.5 million within 3 months.
- HIM chart auditing, review, and work with staff/departments on DFNB reports.
- Monitor and track the project milestones and deliverables in project management.
- Strategic planning with managers/supervisors for all revenue cycle goals.
- A global management consulting, technology service and outsourcing company helping clients become high-performance businesses. Specializing in revenue cycle, patient access, systems conversions, ICD-10 assessments and interim management for acute care hospitals, academic facilities, and physician groups.
Adjunct Instructor
01.2001 - 01.2013
- Baker College
- Davenport University
- University of Phoenix
- Dorsey Schools
Education
MSA - Information System Resource Management
Central Michigan University
Mt. Pleasant, MIPublic Administration Certificate -
Central Michigan University
Mt. Pleasant, MIBS - Organizational Administration
Central Michigan University
Mt. Pleasant, MISkills
- Soarian financials
- Epic and Cerner systems
- ECW and NextGen
- Zirmed and Emdeon
- Cirius and ePremis
- IDX and Siemens
- Optum healthcare solutions
- McKesson solutions
- Data analytics
- Tableau analytics
- Microsoft Office suite
- CareCentrix services
Certification
- Effective Facilitator, Leadership Strategies, Troy, MI
- Lean Six Sigma Black Belt, Lawrence Technical University, Southfield, MI
- Lean Six Sigma Greenbelt, Lawrence Technical University, Southfield, MI
- HIT PRO, AHIMA, 12/01/12
Phone
cell, 313-550-6436
Timeline
Director, Billing/Denials/Home Care/Hospice/Audits & Appeals/Cash Posting
University of Michigan – Sparrow Health System
01.2023 - Current
Manager Denials/Payment Variance/Audit
Trinity Health
01.2018 - 01.2022
Director Revenue & Billing -Contract
Trustbridge Health
01.2015 - 01.2018
Consultant/Contracted Roles/Achievements
01.2009 - 01.2015
Adjunct Instructor
01.2001 - 01.2013
MSA - Information System Resource Management
Central Michigan University
Public Administration Certificate -
Central Michigan University
BS - Organizational Administration
Central Michigan University