Robert Russell
Aventura,Florida
Summary
Subject matter expert of contract administration with medical and dental billing and follow up with experience in contracts and reimbursement reviews and analysis of all insurance payment methodologies; recognized as technical expert on contract content and compliance requirements.15 years of performing contracting functions, including drafting proposals, execution, and completion backed by17 years in healthcare and financial settings. Relentless in defining the optimal strategy and most efficient approach to data collection, analysis, and reporting to steer organizational growth and transformation. Exceptionally well versed in business and technology—supported by intellectual curiosity and a razor-sharp focus on exposing, understanding, and seizing opportunities in marketing and customer care. In-depth understanding of business rules dictated by health plan contracts on enrollment, eligibility, and social care. Instrumental in tracking issues identified by revenue cycle and other stakeholders while collaborating closely with key stakeholders to resolve operational issues in specified time frames related to payer contracts. Credible history of examining reimbursement to assess the correct expected reimbursement per the provider contract terms and executing analysis on received payments. Adept at identifying business unit needs using various analysis techniques such as data flow modeling and workflow analysis.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Senior Payer Contracts Administrator
Dermcare Management
02.2024 - Current
- Coordinate all needed actions from cradle to grave with contracts to achieve favorable reimbursement to Dermcare Management
- Maintain accurate records of payor contracts, amendments, and related documents
- Provide regular reports to the Vice President of Revenue Cycle and CFO on payor contract performance and related financial metrics
- Support the Vice President of Revenue Cycle and CFO in the negotiation and administration of payor contracts to achieve favorable terms
- Review and analyze payor contracts to ensure compliance with established guidelines and financial objectives
- Collaborate with internal stakeholders, including finance and legal teams, to align payor contract efforts with organizational goals
- Assist in the development of strategies to optimize payor contracts and reimbursement rates
- Serve as a liaison between Dermcare Management and payors, addressing contract-related inquiries and escalations
Contracting and Payer Relations Specialist
Avero Diagnostics
07.2022 - 10.2023
- As a contracting, enrollment and payer relations specialist, I serve as a subject matter expert with commercial, Medicaid, Medicare and Health Exchange contracts
- I also serve as a subject matter expert with insurance requirements and obligations with companies that we have entered contracts with
- I also serve as a data/reporting specialist by reviewing and analyzing pulling data that I have extracted from various systems
- By using this information, it can be determined where gaps exist with revenue and accounts receivable and make recommendations for correction
- I also ensure that these agreements adhere to the Health Insurance Portability and Accountability Act, Medicare, Medicaid and other federal and state regulations
- I also serve as an escalation point for more complicated issues between the payers and our organization
Sr. Contracts Operations Analyst / Payor Relations
Payor Contracting Proliance Surgeons, Inc.
12.2018 - 02.2022
- Spearhead end-to-end contract negotiations from initial reviews to preparation and execution, while researching systems and vendors to identify best fits for the business needs of the organization
- Support the proposal process of contract rates, structures, and terms internally; communicate terms with payors; act as liaison between corporate and internal stakeholders for revenue and payor contracting (medical/non-medical) issues
- Serve as a contract content expert from multiple entities ranging from front-line personnel to Executive Leadership to triage contracting questions and concerns
- Track service levels and review invoices as well as monitor payment policies and procedures and distribute to internal stakeholders
- Pool resources with IT and rev cycle on special projects in addition to contracted administration and customer support for care centers
- Study payor code edits, authorizations, and referral requirements as well as translate contracts, serve as a liaison to internal stakeholders, and interpret contracts to support care center operations
- Manage and monitor accuracy of Experian, a contract management tool
- Maintain working knowledge of applicable commercial, federal, and state reimbursement laws and regulations, policies, and procedures
- Interfaced with contracted vendors and internal stakeholders including legal counsel review to guarantee that contract stipulations were being followed and escalated as necessary to ensure compliance
- Conducted audits, examined contract language, and acted as a subject matter expert, auditing current contracts and making recommendations to minimize risk and loss and increase revenue
- Liaised between corporate and care centers for billing and reimbursement issues, uncovered changes in regulations and payor policies on a timely basis, and articulated changes to care centers
- Addressed questions on network status, authorizations, referrals, payor policies and edits, and reimbursement amounts; collaborated with provider representatives to resolve high-level payment issues and disputes
- Analyzed claim payments to ensure correct contract implementations, while monitoring compliance with contractual terms
- Coordinated with IT and other internal departments on stakeholders and on special projects and process improvements
Call Center Operations Manager, Support Services
UW Medicine
06.2017 - 03.2018
- Led management of day-to-day operations of scheduling with UWMC, Eastside Specialty and Roosevelt Radiology areas
- Created more efficient processes and workflows as well as hired new staff, executed staff performance reviews, and initiated corrective actions
- Employed modern technology including a new phone system, prompts, call recording, and screen capture for staff development and training
- Actively engaged in advancing EPIC training in Cadence
Manager, Reimbursement Analysis and Recovery Revenue Cycle Management
UW Medicine
05.2013 - 06.2017
- Led and guided staff using the Payment Integrity Compass (PIC) tool to monitor and follow up on underpayments from commercial, federal, and state payers
- Utilized multiple systems within the UW Medicine System for highly proficient reporting
- Ensured the smooth operation of contract analysis, underpayment identification and collection within the Revenue Recovery Team
- Pooled resources with all levels of staff and management encompassing executive-level leadership as well as clinical staff to ensure needed information communicated, clearly and accurately
- Examined and verified that contracts loaded timely and correctly within the contract reimbursement compliance system
- Engaged in day-to-day interaction with all levels of staff and management, including executive-level leadership as well as clinical staff to ensure needed information communicated as needed, clearly, and accurately
- Headed the deployment of a new contract system for the review and collection of underpayments to minimize lost AR
- Ensured maximum collection potential achieved during underpayment analysis by working with key departments within the University of Washington Medical Center and Harborview Medical Center Hospitals to include contracting and payer relations, patient financial services, revenue cycle management, and various clinics and management
- Streamlined operation of contract analysis, underpayment identification, and collection within the revenue recovery team
- Led implementation of a proprietary contract compliance system, requiring the deployment of file transfer procedures to ensure the contract terms setup correctly through testing and also the ongoing integrity of the contracts contained
- Guided the staff working with commercial, federal, and state payers to ensure compliance with billing processing, payments, and contract stipulations
Manager, Commercial Billing and Follow Up Unit Patient Financial Services
UW Medicine
03.2008 - 05.2013
- Harmonized underpayment analysis and payment recovery for Patient Financial Services as well as organized contracted vendors assisting with underpayment recovery
- Worked with external vendors to ensure that contracts maintained appropriately and that guidelines followed by vendors per contract guidelines
- Set up staff performance criteria and conducted annual performance reviews to steer improvements
- Improved skills in registration, EPIC, ORCA, and other MCIS systems/programs that dictates billing, follow up, recovery, and reporting
- Conducted frequent and ongoing reporting duties including, pulling reports and analyzing data, recommending needed action to executive level leadership, and summarizing and clearly communicating data
- Led and managed15 staff supervising all commercial insurance payors in billing and follow up
- Interfaced with contracted vendors on quarterly basis to ensure contracts meet business needs and review future proposals
- Acquired expertise in advanced accounting principles with contracts and accounts receivable management including budgeting while maintaining knowledge of commercial, federal, and state rules and regulations that govern compliant billing and reimbursement
Education
Data Analyst Certificate - Data Analysis
Google
Skills
- Contract Administration
- Contracting (Medical/Non-Medical)
- Medical Billing / Coding / Denials
- CPT Coding / EMR Systems
- Staff Training & Development
- Accounts Receivable / Payable
- 835,837 and HL7 files and formats
- Business Analysis
- Customer Focus & Orientation
- Vendor Management
- Reimbursement Analysis
- Revenue Cycle Management
- Process Improvements
- Quality Assurance / Control
- Business / Underpayment Analysis
- Requirements Gathering
- Claims Denials
- Data Analysis
Certification
- Epic Certification – Expired
- Certified Dental Assistant (WA State) - Expired
Additional Experience
- Manager, Patient Accounts Office, University of Washington School of Dentistry
- Billing System Coordinator, Patient Accounts Office, University of Washington School of Dentistry
- Business Analyst, Group Support Department, Washington Dental Service
- United HealthCare, Claim Analyst
- Molina Healthcare, Supervisor
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Languages
English
Native or Bilingual
Spanish
Professional Working
Timeline
Senior Payer Contracts Administrator
Dermcare Management
02.2024 - Current
Contracting and Payer Relations Specialist
Avero Diagnostics
07.2022 - 10.2023
Sr. Contracts Operations Analyst / Payor Relations
Payor Contracting Proliance Surgeons, Inc.
12.2018 - 02.2022
Call Center Operations Manager, Support Services
UW Medicine
06.2017 - 03.2018
Manager, Reimbursement Analysis and Recovery Revenue Cycle Management
UW Medicine
05.2013 - 06.2017
Manager, Commercial Billing and Follow Up Unit Patient Financial Services
UW Medicine
03.2008 - 05.2013
Data Analyst Certificate - Data Analysis
Google
Similar Profiles
Jill ChaitJill Chait
Senior Vice President of Clinical Operations at DermCareSenior Vice President of Clinical Operations at DermCare
Marlanna BrooksMarlanna Brooks
Regional Business Development Contractor at MJ Management, Hutchinson Auto Group, American Management ServiceRegional Business Development Contractor at MJ Management, Hutchinson Auto Group, American Management Service
Mia LacroixMia Lacroix
Modeling at Wolves Management, Maggie Inc., Wanted ManagementModeling at Wolves Management, Maggie Inc., Wanted Management
Erica KnudsenErica Knudsen
Learning & Development Manager at Four Seasons Hotels and ResortsLearning & Development Manager at Four Seasons Hotels and Resorts
Heilis VasquezHeilis Vasquez
Cashier Floor Supervisor at Rainbow ShopsCashier Floor Supervisor at Rainbow Shops