Percy Clocuh
Clayton
Summary
Dynamic revenue cycle management professional with extensive experience at Bayhealth Medical Center. Proven track record in Government Payor billing and compliance monitoring, leading teams to enhance accounts receivable performance. Skilled in data analysis and process improvement, fostering a culture of excellence and accountability within the organization.
Overview
26
26
years of professional experience
1
1
Certification
Work History
PFS Government Payer Manager
Bayhealth Medical Center
08.2019 - Current
- Manage the billing functions for Medicare, Managed Medicare, Medicaid and Military plans and third-party payor’s requirements for payment.
- Tracked government payer credit balances and submitted quarterly reports for Medicare and Medicaid to ensure compliance and accuracy in financial reporting.
- Implements and adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
- Oversaw revenue cycle management, focusing on accounts receivable quality, service levels, and performance metrics.
- Manages Cash Applications functions for all payors, Non-AR payments and Physician revenue.
- Facilitated EDI operations, enrollment processes, and clearinghouse communications to streamline transactions and enhance efficiency in the Patient Financial department.
- Supervises a team of 22 employees – 2 supervisors, 2 direct support staff, and 18 staff.
Government A/R Supervisor
Bayhealth Medical Center
02.2015 - 04.2019
- Oversaw Government payer accounts to ensure compliance and timely processing.
- Managed outstanding A/R to keep accounts over 90 days within HFMA’s benchmark.
- Monitored failed claims to maintain A/R under 1 day; reviewed detailed reports of unbilled and hold accounts.
- Managed daily billing activities, resolving clearinghouse issues.
- Oversaw management of outstanding accounts receivable to maintain cash flow.
- Manages day-to-day operations and coordinates the daily activities of staff.
- Assisted in monitoring credit balances in A/R.
- Supervised a team of 10 employees.
Revenue Integrity Analyst
Beebe Medical Center
11.2011 - 02.2015
- Reviewed claims through Bill Analyzer, identifying billing and compliance issues to support accurate revenue cycle management.
- Monitored reimbursement problem areas, assisting staff in resolving billing issues related to ICD-9, CPT codes, and Medicare, Medicaid, and third-party payment methodologies to reduce claim denials.
- Assisted in resolving third party billing and claims denial issues.
- Monitored regulatory issues that affected billing and compliance related to changes in coding and billing regulations.
- Enhanced Bill Analyzer by developing and maintaining features that improved functionality and user experience.
- Provided cost estimates to patients.
Contract Management Specialist
Beebe Medical Center
01.2007 - 11.2011
- Managed Contract Management database to ensure data accuracy and accessibility.
- Ensured reimbursement follows agreed contract terms.
- Worked with Commercial insurance companies to correct payments discrepancies.
- Analyzed discrepancies between expected and actual commercial reimbursements to identify trends.
- Engaged with payors monthly to discuss and resolve issues related to contract and reimbursement.
- Generated reports using contract management database and crystal report to support decision-making.
- Assisted in resolving third party billing and claims denial issues.
- Explained contract terms to staff members.
- Managed special projects focusing on improving operational efficiency.
Patient Account Representative III
Brandywine Medical Management Services
03.2006 - 12.2006
- Analyzed and investigated patient accounts daily.
- Billed and followed up on claims, ensuring timely processing and resolution.
- Performed billing reconciliation to maintain accuracy and resolve discrepancies.
- Managed third party billing and reconciliation processes, enhancing collaboration and compliance.
- Ensured reimbursed claims are in compliance with the agreed contract.
Patient Account Representative III
Siemens Medical Services
Malvern
08.2003 - 03.2006
- Reviewed and approved medical claims prior to submission, ensuring compliance with regulations.
- Facilitated accurate Medicare and Medicaid billing to maintain financial integrity.
- Performed regular billing reconciliation for third-party payors, facilitating timely payments and reducing errors.
- Analyzed and investigated discrepancies in patient accounts to ensure accurate billing and resolution.
- Reported payment discrepancies on a weekly basis to management.
Billing Representative
DaVita, Inc
Berwyn
02.2000 - 07.2003
- Monitored adherence to billing policies and guidelines to maintain compliance.
- Applied and monitored statutory and corporate compliance policies.
- Corrected and resubmitted rejections promptly to minimize processing delays.
- Reconciled account discrepancies and adjustments.
- Documented and communicated payment discrepancies and policy changes to management for resolution.
- Ensured accurate record-keeping for accounts.
Education
MBA - Healthcare Management
Wilmington University
Dover, DEB.S. - Organizational Management
Wilmington University
Dover, DESkills
- Revenue cycle management
- Medicare billing
- Claims processing
- Accounts receivable management
- Compliance monitoring
- Data analysis
- Process improvement
Certification
Certified Healthcare Financial Professional (CHFP), Healthcare Financial Management Association
Timeline
PFS Government Payer Manager
Bayhealth Medical Center
08.2019 - Current
Government A/R Supervisor
Bayhealth Medical Center
02.2015 - 04.2019
Revenue Integrity Analyst
Beebe Medical Center
11.2011 - 02.2015
Contract Management Specialist
Beebe Medical Center
01.2007 - 11.2011
Patient Account Representative III
Brandywine Medical Management Services
03.2006 - 12.2006
Patient Account Representative III
Siemens Medical Services
08.2003 - 03.2006
Billing Representative
DaVita, Inc
02.2000 - 07.2003
MBA - Healthcare Management
Wilmington University
B.S. - Organizational Management
Wilmington University