Rita Rox
Pinson,AL
Summary
Dynamic individual with hands-on experience in Revenue Cycle Management and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Revenue Cycle Manager
DocStation
01.2024 - Current
- Lead strategic billing operations for national pharmacy clients, focusing on services billed under medical benefits.
- Designed and implemented scalable workflows for electronic data interchange (EDI) to streamline claims, and ensure compliance.
- Built and managed a specialized team addressing denials for pharmacy-based services.
- Developed comprehensive billing guidelines for BGM, CGM, DSMT, and medication therapy services.
- Conducted educational webinars and trained pharmacists to navigate Medicare Administrative Contractor (MAC) portals, significantly increasing first-pass claim acceptance.
- Positioned the company as a trusted resource in medical billing education within the pharmacy space.
- Streamlined revenue cycle processes, enhancing operational efficiency and reducing billing discrepancies.
Revenue Cycle Manager
Pathway Healthcare
12.2019 - 02.2023
- Directed a 23-person cross-functional revenue cycle team for a multi-site addiction and behavioral health provider.
- Oversaw payer relationships, claims submission, denial resolution, and monthly closeouts.
- Optimized workflows using Trizetto and internal A/R dashboards, reducing days in A/R, and improving net collections.
- Built staff training programs to increase billing accuracy and compliance with payer policy.
- Partnered with clinical, IT, and leadership teams to align financial performance with patient care delivery.
- Completed financial reporting and analysis for billing revenue cycle.
- Streamlined workflows to minimize claim rejections and maximize reimbursement rates from insurance providers.
- Analyzed complex data sets to derive actionable insights for improving internal processes related to revenue cycle management.
- Supported payer contract negotiations by analyzing and interpreting billing requirements, and implemented corresponding EHR configurations, including place of service, tax ID, specialty/taxonomy codes, billing location details, and payer-specific claim rules.
Director of Operations / Owner
Benchmark Stat LLC
10.2012 - 11.2019
- Founded and managed a healthcare revenue cycle consulting firm, delivering end-to-end billing, coding, A/R recovery, and credentialing services for several providers across multiple specialties.
- Designed custom training programs and hosted state Medicaid EHR/AIU, and Meaningful Use workshops.
- Developed a certified billing training curriculum in partnership with AMBA, and served on the Fortis Institute advisory board.
- Established a fully operational billing clinic within the Jefferson County Sheriff's Office.
- Negotiated client contracts, led recovery projects, and drove measurable revenue improvements.
- Analyzed operational data, identifying trends and recommending actionable solutions.
- Developed and executed strategic plans to achieve organizational goals and drive sustainable growth.
- Identified opportunities for cost reduction and process improvement, implementing changes that resulted in significant savings.
- Trained and guided team members to maintain high productivity and performance metrics.
- Developed and maintained strong relationships with clients, resulting in repeat business and referrals.
Medical Billing Coordinator
National Billing and Associates
12.2007 - 02.2011
- Managed full-cycle dialysis billing across multiple state Medicaid programs and commercial carriers.
- Led payer contract negotiations and built custom fee tables to improve reimbursement and reduce write-offs.
- Verified accuracy of accounts payable payments, resulting in 77% reduction in payment errors and check reissues.
Medical Billing Specialist
American Home Patient / Vital Med Anesthesia
01.2002 - 01.2007
- DME, anesthesia, and therapy billing across Medicare, Medicaid, and commercial carriers.
- Payment posting, insurance verification, authorizations, and credentialing.
- Reviewed billing discrepancies, resolving issues to enhance revenue cycle efficiency.
Education
Associate in Applied Science (A.A.S.) - Healthcare Administration
Southern Junior College
Birmingham, Alabama05.1989
Skills
- Strategic executive leadership
- Operational efficiency development
- Comprehensive revenue cycle management
- Pharmacy and billing systems integration
- Revenue performance analysis
- Proficient in billing cycle optimization
- Claims evaluation proficiency
- Appeals and denial evaluation
- Medicare expertise
- Proficient in MAC navigation
- Credentialing expertise
- Compliance management
- Healthcare provider education
- Payer collaboration
- EDI process optimization
- Workflow optimization
- Accounts receivable recovery
- Financial analysis and reporting
- Team coaching
- Software development
- Building professional relationships
- Cross-functional teamwork
- Responsive to shifting priorities
Affiliations
American Association of Healthcare Administrative Management
Certification
- Certified Revenue Cycle Executive
- Certified Medical Billing Trainer - American Medical Billing Association
- Medicaid Meaningful Use Partner & Workshop Facilitator
- Six Sigma Yellow Belt (in progress)
Timeline
Revenue Cycle Manager
DocStation
01.2024 - Current
Revenue Cycle Manager
Pathway Healthcare
12.2019 - 02.2023
Director of Operations / Owner
Benchmark Stat LLC
10.2012 - 11.2019
Medical Billing Coordinator
National Billing and Associates
12.2007 - 02.2011
Medical Billing Specialist
American Home Patient / Vital Med Anesthesia
01.2002 - 01.2007
Associate in Applied Science (A.A.S.) - Healthcare Administration
Southern Junior College