Paul Muniz
Summary
Result-oriented professional with 20+ years in the Healthcare Industry with proven ability to drive results in the areas of Revenue Cycle Management, Customer Service, Provider Relations, Budget Management and Leadership. Unique relationship building strategies that enhance collaboration as well as financial success with a focus on securing profitable reimbursement, incorporating efficiencies and solidifying executive level relationships with internal and external customers.
Overview
23
23
years of professional experience
Work History
AR Director
Parallon – CareNow Urgent Care, Revenue Cycle
06.2018 - Current
- Management
- Work closely with Finance, Sales, and Clinic Operations department in order to drive growth initiatives andimprovements within the Revenue Cycle Process
- Responsible for Financial Services, Bad Debt Reduction
- Reimbursement Initiatives and Reduction of A/R for over 197 CareNow urgent care clinics
- Responsible for AR totaling annual revenue ~ $225mil with over 2mil visits
- Manage work from home staff of 4 direct and 70 indirect FTE's – Front End Billing, Claim
- Status, Denials, and Appeals
- Manage offshore staff dedicated on collections of Managed Care and Workers Comp (35 FTE's)
- Claim Status, Denials, and Appeals
- Ensure that third party billing is submitted correctly and that appropriate follow-up is performed
- Assure that denials are corrected and filed
- Assure compliance with self-pay and bad debt policies
- Establish and monitor productivity standards, quality improvement, and assurance and directstaffing meeting departmental goals
- Compile reports at month end and as needed
- Maintain policies and procedures
- Review AR data and develop strategies to improve revenue
- Coordinate with the IS team and financial/business analyst to create the development of follow upcollection work list
- Review collection reports to ascertain status of collections and balances outstanding and evaluateeffectiveness of current collection policy and procedures
- Collaborate with others, including personnel in company branches to exchange information.
Sr Payer Support Analyst
Acumen Global Solutions
07.2017 - 06.2018
- Consulting - Revenue Cycle Management
- Providing practice, process and revenue cycle management expertise to sales, implementation and revenuecycle management teams as well as building client relations for long term success
- Monitored and reviewed variances between budgeted versus actual recoveries and revenues for
- Claims Recovery
- Supported revenue cycle operations
- Performed total dollar recoveries, aging analysis, pay rates, payer margins and A/R analysis tooptimize receivables performance
- Audited follow up process and trained staff on appropriate follow up strategies to maximizeaccount collections., Payer Support & Transactions Standards
- Worked closely with Health Plan Payers in order to reduce A/R > 90 days, Reimbursement issues andbad debt
- Work hand-in-hand with our Sales Account Executives to review sales strategies that wouldincrease Health Plan, Payers and IPA revenues and profitability
- Reduced A/R > 90 Days by 23% in three years
- Reduced Bad Debt by 18% in three years
Sr. Director
Progenity Inc
12.2016 - 07.2017
- Revenue Cycle Management
- Work closely with Managed Care and Finance departments in order to drive growth initiatives andimprovements within the Revenue Cycle Process
- Responsible for all Revenue Cycle aspect, including but notlimited to Financial Services, Front End Operations, Bad Debt Reduction, Reimbursement Initiatives and
- Reduction of A/R > 90 days
- Direct Revenue Cycle team consisting of 65 FTE's across all billing functions
- Established Reporting tools to predictable cash
- Established KPI's for production and quality
- Reduced A/R > 90 Days by 10%
- Increased cash collections by 43.8% from $16 MM per month, to $23 MM per month
- Established monthly meetings between all Sales Regions and Billing Department
- Patient Collection Strategy
- Managed offshore staff for data entry team
Vice President Revenue
Next Health USA
06.2016 - 12.2016
- Cycle Management
- Providing practice, process and revenue cycle management expertise to sales, implementation and revenuecycle management teams as well as building client relations for long term success
- Managed offshore RCM team – Claims Status, Denials, Appeals, and Reporting Analytics
- Managed internal RCM team – Data Entry
- Support Sales
- Assist in evaluation prospective clients current state, potential fit and value for the Company
- Actively participated and supported Sales with client onboarding
- Built strategic relationships with clients
- Evaluate and recommend best practices to ensure outcomes will meet client expectations
- Increase operational margins through best practice implementation
- Handle the highest level RCM process escalations
- Provide leadership that will lead to improved cash flow, increased revenue, overall clientsatisfaction through engagement and referrals.
Regional Revenue Cycle Manager
Quest Diagnostics Inc
02.2008 - 06.2016
- Southwest Business Unit
- Work closely with the Southwest BU leadership in order to facilitate growth by supporting Sales Organizationwith all billing needs
- Responsible for Billing Front End Operations, Bad Debt Reduction, and Client
- Education
- Review AR data and develop strategies to improve revenue
- Held monthly meetings with Sales team to over any billing issues
- Optimize Productivity - Increased Productivity by 33% since 2010
- Lead Easy Pay Process for Southwest BU – Highest Capture Rate in the country
- Reduce Bad Debt Write Offs
- Reduce MLCP Write Offs – Reduced by $1 MM
- Managed a team of 6 direct reports and 60 indirect FTE's
- Improved Employee Engagement by 28%
- Manager, Specimen Management Mid-Atlantic Region
- Worked closely with Sales Organization, Billing, Technical, and Logistics to meet turnaround time and clientretention
- Created efficiency by reducing manual processing and increasing electronic processing
- Manage a team of 5 Supervisors and 110 indirect reports
- Managed Specimen Processing and Imaging functions which included budget, training,technology requirements and management of special handling accounts
- Designed and implemented process improvements
- Reduced quality error rate by 50%
- Increased production and reduced FTE count by 2 (cost savings of $55K)
- Implemented process improvements in the Imaging area that lead to an increase in production andreduction in FTE count by 3, (cost savings of over $75K).
Manager, Claims
Health Partners Plans of Philadelphia
01.2006 - 02.2008
- Worked closely with Providers, Managed Care, Sales, and IT to meet turnaround time and Provider/Clientretention
- Created efficiency by reducing manual processing and increasing electronic processing of claims
- Managed, developed, and implemented a new team of claims processors and three supervisors
- Hiring responsibility for operations associates and provided career/professional development tonew and existing team members
- Identify and resolve operational issues using well-defined/documented processes, expertise andjudgment
- Perform mid and year-end performance evaluations
- Monitor production and quality metric and assisted in staff training
- Successfully in-sourced claims department
- Involved in successful implementation of Optical Character Recognition software, OCR, to assistin electronic processing of claims
- Managed Service Level Agreements, SLA, to create communication, collaboration andaccountability
- Held monthly meetings with area hospital groups and physician groups to discuss claimsissues/discrepancies, build working relations, communications and collaboration.
Supervisor, Front-end Billing
Quest Diagnostics Inc
07.2000 - 01.2006
- Provided motivation, guidance and leadership to a team of 25 Front-end members
- Oversaw manual andelectronic data entry process
- Monitor team's production as well as to implement KPI's that would increaseproduction
- Managed a team of 25 employees
- Trained and lead team members on relevant systems, standards & procedures in their functionalareas
- Analyzed & interpreted reports on metrics associated with goals & objectives
- Ensured adherence to all Compliance policies & guidelines
- Perform Mid-Year and Annual
- Performance Reviews
- Lead aggressive and motivated teams by giving them ownership of process and how theircontribution impacts to organization
- Reduced Medicare write-off by $1.3mm, (27.6%)
- Reduced Missing Information inflow by $2.9mm
- Reduced backlog by 47%
- Successfully met production at or above departmental standards 12 out of 12 months
Education
MBA - Health Administration
Baylor University
Waco, TX12.2024
Bachelor of Science - Business Management
Peirce College
Philadelphia, PA05.2008
Skills
- People Management
- Financial Reporting
- Verbal and Written Communication
- Recruiting and Hiring
- Strategic Planning
- Coordinate Projects
- Negotiation
Timeline
AR Director
Parallon – CareNow Urgent Care, Revenue Cycle
06.2018 - Current
Sr Payer Support Analyst
Acumen Global Solutions
07.2017 - 06.2018
Sr. Director
Progenity Inc
12.2016 - 07.2017
Vice President Revenue
Next Health USA
06.2016 - 12.2016
Regional Revenue Cycle Manager
Quest Diagnostics Inc
02.2008 - 06.2016
Manager, Claims
Health Partners Plans of Philadelphia
01.2006 - 02.2008
Supervisor, Front-end Billing
Quest Diagnostics Inc
07.2000 - 01.2006
MBA - Health Administration
Baylor University
Bachelor of Science - Business Management
Peirce College
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