Shalita Wilcher
Ruskin,FL
Summary
Insightful Manager with experience directing and improving operations through effective employee motivational strategies and strong policy enforcement. Proficient in best practices, market trends and regulatory requirements of industry operations. Talented leader with analytical approach to business planning and day-to-day problem-solving.
Overview
14
14
years of professional experience
Work History
Manager, Research Billing
Moffitt Cancer Center
08.2019 - 01.2025
- Resource the teams appropriately to ensure billing is compliant and timely
- Test monthly and quarterly controls to ensure efficient billing and report on any procedure updates needed
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Enhanced product quality by instituting rigorous quality control procedures, resulting in fewer customer complaints.
- Spearheaded transition to remote work during global health crisis, ensuring business continuity and employee safety.
- Led cross-functional teams to achieve project goals, fostering collaboration and innovation.
- Enhanced team productivity by implementing agile methodologies, leading to more efficient project completion.
- Improved customer satisfaction scores by overhauling customer service protocols and training staff in customer engagement techniques.
- Facilitated team brainstorming sessions that led to innovative solutions for long-standing operational challenges.
- Managed budgets effectively, ensuring optimal financial performance while investing in necessary resources for business growth.
- Reduced operational costs through comprehensive process improvement initiatives and resource management.
- Mentored junior team members for career advancement, fostering a pipeline of future leaders within the organization.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Educate team members on process changes, efficiencies, and operational changes
- Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
- Maintain a detailed knowledge about research billing, compliance, and research regulation
- Coordinated with IT department to upgrade technology infrastructure, enhancing operational efficiency and data security.
- Assist team members with interpretation of difficult or complex protocols/budgets
- Communicates regularly with Investigators, Clinical Trials Billing Office (CTBO), Clinical Trials Coordinators (CTC) and Coverage Analysis (CA) teams to ensure compliance with protocols, federals and industry accepted regulation and proper data collection and reportage
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Prepare and Review protocols, amendments, consent forms, case report forms and other trial related documents
- Utilize PM techniques and methodologies to plan, organize, monitor, conduct, report, and complete clinical studies within budget expectations
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
Revenue Cycle Complex Claims
Surgery Partners
04.2018 - 04.2019
- Responsible for negotiating and settling surgery, anesthesia, and pain relief center accounts with attorneys for services rendered
- Performed daily audits on accounts to ensure the insurance paid based off of the contractual agreement or the PIP statute
- Work accounts to reduce AR and meet the revenue goal
- Evaluate patient financial status and establish payment plans
- Keeps informed on all current applicable third-party payer regulation and requirements informs management and other staff members of changes and keeps documentation current and accessible
- Follow up with attorneys to keep updated case status and provide current balance and charges for services rendered
- Follow up with secondary and tertiary payers to ensure payment has been received
Supervisor of Operations/ Revenue Cycle
Stymco Technologies/ Bill DME
03.2016 - 03.2018
- Supervised staff of 18 for AR Posting, Collections, verifications
- Tracked metrics for daily workflow and productivity and provided support and guidance of roles and responsibility
- Direct contact for Premium clients and third-party doctors and providers to ensure proper intake and utilization management of claims for patients and that we adhere to the terms of insurance contractual agreements
- Responsible for preparing Monthly income Drafts for account reconciliation and balance payment for each client/provider based on their contractual agreement by using Quick Books and excel
- Negotiate with UM departments and Care managers for reasonable pricing on products based on state guidelines
- Responsible for verifications billing and collection of Commercial Workers Compensation Medicare and Auto Claims with correct use of HCPC codes, Modifiers, Utilization Referral Notes corresponding with the carrier for coverage verification purposes and request authorization
- Handles LOP negotiations and settlements and reconciliation of WC and Auto claims with Attorney's, Providers and Adjusters
- Reconciles claims and collections issues, process customer refunds, process and Review account adjustments resolve client discrepancies and short payments
- Responsible for monitoring and maintaining assigned accounts- customer calls., account adjustments, small balance write off, customer reconciliations and processing credit memos
- Enlist the efforts of sales and senior management when necessary to accelerate the collection specialist
- Prepare insurance claim forms or related documents and review them for completeness and filed via mail, Email, or fax for appeal, subpoena and deposition purposes
Collections Specialist
Rx Development / Doctors Medical
08.2015 - 03.2016
- Collection calls and/or correspondence in a fast-paced goal orientated collections department
- Maintained relationship with Physicians to provide guidance with front end issues
- Handled all LOP and WC accounts related to collection and settling
- Responsible for all subpoenas and depositions for assigned accounts
- Provided customer service regarding claims and collections issues, process customer refunds, process
- Review account adjustments resolve client discrepancies and short payment of Workers Compensation Claims
- Responsible for monitoring and maintaining assigned accounts- customer calls., account adjustments, small balance write off, customer reconciliations and processing credit memos
- Followed guidelines specific to state of service for billing and collection purposes
- Review of Utilization Reports to determine if treatment was necessary
- Enlist the efforts of sales and senior management when necessary to accelerate the collection specialist
- Prepare insurance claim forms or related documents and review them for completeness and filed via email, or fax
Behavioral Health Technician
Agency for Community Treatment Services, Inc
04.2013 - 10.2015
- Responsible for leading individual and group therapy sessions as a part of case plan
- Interview new/existing patients, completed admissions form to assess their mental health status, or to obtain their mental health and treatment history
- Collaborate with or assist doctors, psychologists, or rehabilitation therapists in treatment plan as needed
- Performed routine bed checks for up to 75 bed facility
- Conducted staff training for new hires
- Assist with de-escalation and or restraint as needed for treatment
ADMINISTRATIVE APPEALS SUBJECT MATTER EXPERT
Express Scripts
01.2014 - 06.2015
- Transmit and processed adjudication for coverage of procedures both foreign and domestic
- Followed guidelines specific to Medicaid, Medicare, Gers, coverage gaps, CAP, OOP
- Provided services to team members at the training and escalation level
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review
- Analyze information gathered by integrator, and report findings and recommendations
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims
- Prepared insurance claim forms or related documents and review them for completeness and filed via email, or fax
- Worked from medic in a fast-paced setting
SUPERVISOR MED TECH
Hudson Manor ALF
11.2010 - 01.2014
- Supervised staff of 4 caregivers assuring they provide the necessary care needed
- Administer medications and treatments
- Document or otherwise report observations of patient behavior, complaints, or physical symptoms to nurses
- Communicate with patients to ascertain feelings or need for assistance or social and emotional support
- Gather information from caregivers, nurses or physicians about patient condition
- Assisted with activities of daily living for a 75-bed patient facility
- Assist nurses or physician in the services provided as needed
Education
Bachelor of Science - Science
SpringField College
Tampa, FL12-2017
Skills
- Team leadership
- Time management
- Decision-making
- Task delegation
- Strategic planning
- Operations management
- Project management
- Cross-functional teamwork
- Project planning
- Staff development
- Performance evaluations
- Budget control
- Key performance indicators
Timeline
Manager, Research Billing
Moffitt Cancer Center
08.2019 - 01.2025
Revenue Cycle Complex Claims
Surgery Partners
04.2018 - 04.2019
Supervisor of Operations/ Revenue Cycle
Stymco Technologies/ Bill DME
03.2016 - 03.2018
Collections Specialist
Rx Development / Doctors Medical
08.2015 - 03.2016
ADMINISTRATIVE APPEALS SUBJECT MATTER EXPERT
Express Scripts
01.2014 - 06.2015
Behavioral Health Technician
Agency for Community Treatment Services, Inc
04.2013 - 10.2015
SUPERVISOR MED TECH
Hudson Manor ALF
11.2010 - 01.2014
Bachelor of Science - Science
SpringField College
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