PAMELA WASHINGTON
Forney,TX
Summary
Detail-oriented and results-oriented Revenue Cycle Operations Manager with 10+ years of experience in healthcare revenue cycle management. Proven ability to improve billing accuracy, reduce denials, and streamline processes. Highly skilled in utilizing various EMR and billing systems.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Billing Supervisor
Med-Metrix
08.2023 - Current
- Review billers' month-to-date productivity for processing claims, comparing it to the per day productivity goal#
Productivity Report-Daily (date) and using the details provided in report detail Productivity retrieve in Xclaims - Import/Exports Report-Supervisor is responsible for recording and uploading daily and monthly import and export numbers on the Teams Site:
retrieve in Xclaims - Unbill/Hold Report-This report identifies claims that are on hold for specific reasons, including the number of impacted accounts, the total dollar amount, and the claims that have not yet been billed retrieve in Xclaims
- Biller-Billing claims
- CCR Report-This report displays claim edits, including the account number and dollar amount impacted by each edit. review these edits for further resolution.
The report also displays the overall CCR percentage.
retrieve in Xclaims - Unbilled-This report identifies claims that are on hold for specific reasons, including the number of impacted accounts, the total dollar amount, and the claims that have not yet been billed
- Rejection Report-Supervisors are responsible for reviewing reports, high-dollar accounts, and common payer rejections. They should be able to explain high-dollar rejections and the actions taken to resolve them. Additionally, they should identify and analyze trends in payer and department-specific issues, such as missing NURSEY NB claims or Fidelis DRG rejections.
- DNFB Meeting-supervisor will update the current hold status numbers/dollar amt. and share
- Salesforce- FinThrive Community Portal-Supervisor is responsible for opening and tracking all cases and checking for notifications and alerts.
Revenue Cycle Operations Manager -Quality Assurance Manager
Steward Healthcare Hospital
09.2018 - 02.2023
- Utilizing Epic and Cerner Revenue Cycle Management System and Power Chart (EMR Systems)
- Conducted JOC meetings with payers to report trends and assign projects per claim rejects
- Introduced new system products and recommended changes to increase revenue
- Developed and implemented revenue cycle strategies
- Improved billing accuracy by 10%
- Reduced denials by 5%
- Providing business support services to cash posting, customer service, billing, and accounts receivable follow up departments as well work all Commercial, Managed Medicaid/Medicare accounts for which I am currently assigned
- Hospital AR/Follow Trainer - Monitors collections staff efficiency through audit processes
- Supported clinical team members with revenue cycle procedures and addressed issues
- Monitored and guided revenue cycle operations
- Recruited, interviewed, hired and trained employees and implemented mentoring program to promote positive feedback and engagement.
Collector SPecialist, Credentaling Specialist, Billing Specialist and Payment Poster
Alliance Family of Companies
10.2016 - 09.2018
- Systems utilized: E-clinical works, Advance MD, Epic, Office ally, Lytec, IM Bills, Nightingale medrium, and centricity
- Verifying the qualifications of healthcare professionals
- Liaison between outsourced third-party billing managers and billed claims to insurances
- Submitted insurance claims / Appealed denials of Insurance claims
- Finding root causes to claims denials, reported trends and reduced claim denials
- Reduced days of account receivable, keeping track of clean claims as well as tracking claim denials
- Answer patient calls, process payments over the phone, prepare payment plans, negotiate discounts per facility policies, send out medical records / interpret medical records for proper diagnosis codes
- Investigated and corrected rejected claims/auditing accounts
- Knowledgeable of Insurance online portals and their LCD's policies
- Kept up with new CMS Rules and Regulations.
Scheduler /Healthcare Recruiter
Pediatric Home Healthcare
08.2015 - 07.2016
- Managed and supervised 20 family members in home healthcare setting for disability children
- Hired Registered Nurses as well as LVNs for patient's homes
- Pre-screened resumes prior to sending to corporate hiring managers for consideration
- Communicated with patient's families, handle concerns, problem solving/ (on call duty)
- Reviewed and analyzed resumes using our in-house ATS software program
- Introduced new hires to company and walked them through hiring and training process
- Served as employee advocate for new hires as well as established employees
- Worked with quality assurance department and Director of Nurses' department
- Completed human resource operational requirements by scheduling and assigning employees.
Patient Access Manager
First Choice Emergency Room
10.2013 - 04.2016
- Managed and supervised 20 employees in a medical office setting, for a free-standing emergency room setting
- Supervision of patient scheduling, registration, financial counseling, medical records, ER billing and collections, data entry and processing, and cash posting
- Observed all facility rules and regulations regarding patient data to promote confidentiality and integrity
- Educated all registration staff personnel regarding updates and changes to job positions
- Trained and mentored new employees in the registration department, answered questions and provided insight on patient services
- Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.
Medical Billing and Coding Instructor/Account Representative
Everest College
01.2013 - 08.2015
- Taught theory and fundamentals of ICD 9 and HCPCS coding
- Trained students in technical skills such as billing, coding, software management, and the patient's EMR systems
- Taught confidentiality and medical laws /prepared students for employment for entry level position
- Executed billing tasks and recorded information in company databases
- Handled account payments and provided information regarding outstanding balances
- Monitored outstanding invoices and performed collections duties
- Processed payment via telephone and in person with focus on accuracy and efficiency
- Improved accounts payable processes and achieved 98% reduction in late fees.
Collections Specialist/Coder Anesthesiologist
Forest Park Medical Center, Apple One Temp Services
01.2013 - 05.2013
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others
- Resourcefully used various coding books, procedure manuals and on-line encoders
- Reviewed patient charts to better understand health histories, diagnoses, and treatments
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Hospital Biller/ Hospitalist Doctors
Texas Health Medsynergies, Arlington Memorial Hospital
09.2009 - 05.2013
- AR/Follow Up Rep/ Hospital Biller
- Utilized IM Bills Coding System, Epic EMR system, and Centricity Billing System
- Managed multi-physician office for twelve hospitalist doctors in hospital setting
- Hospital AR follow up specialist- Identified root causes of insurance denials, sent appeals to payors, and strived to minimize lost revenue-for commercial and government insurances / Establish and maintain relationships with individual payer provider relations representatives to resolve collection issues with patient accounts
- Triaged and assessed phone calls from facilities, physicians, and patients to prioritize care and quickly handle urgent issues
- Investigated patient medical coverage to determine coverage eligibility.
Education
Certified Professional Biller -
AAPC
07.2023
Bachelor of Science, Technical Management, Human Resources -
DeVry University
01.2009
Skills
- Team Development
- Reporting skills
- Strategic Decision-Making
- Technical knowledge
Certification
Certified Professional Biller, AAPC, 2023
Timeline
Billing Supervisor
Med-Metrix
08.2023 - Current
Revenue Cycle Operations Manager -Quality Assurance Manager
Steward Healthcare Hospital
09.2018 - 02.2023
Collector SPecialist, Credentaling Specialist, Billing Specialist and Payment Poster
Alliance Family of Companies
10.2016 - 09.2018
Scheduler /Healthcare Recruiter
Pediatric Home Healthcare
08.2015 - 07.2016
Patient Access Manager
First Choice Emergency Room
10.2013 - 04.2016
Medical Billing and Coding Instructor/Account Representative
Everest College
01.2013 - 08.2015
Collections Specialist/Coder Anesthesiologist
Forest Park Medical Center, Apple One Temp Services
01.2013 - 05.2013
Hospital Biller/ Hospitalist Doctors
Texas Health Medsynergies, Arlington Memorial Hospital
09.2009 - 05.2013
Certified Professional Biller -
AAPC
Bachelor of Science, Technical Management, Human Resources -
DeVry University
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