Sharma Guillory
Summary
Diligent Revenue Cycle Manager eager to utilize over 25 years of Revenue Management Front and Back end, Financial Analysis, Billing/Collections and Reserve monitoring to bring immediate increased in revenue. Highly skilled in Managing Billing cycle performance and executing financial reporting to inform stakeholders of areas of improvement to generate a smoother revenue stream. Eager to offer a passion for process improvement and an unfailing work ethic. Able to interpret contract languages from Third party insurance payors.
Strong analytical skills, Billing Methodologies, Collection Process, Refunds, Appeals and Denial Management. Meticulous Revenue Cycle Manager pursuing an opportunity to apply strong knowledge of A/R, Lockbox payments, Claim rejections, Refunds, Denials, Clearinghouse Reporting and Payment posting. A proven history of implementing improvements to increase financial performance and achieve company objectives. Specialized in DME, Opioids, LTR/IRF/SNF and Hospital Billing
Overview
16
16
years of professional experience
Work History
Lead Billing Specialist (remote)
Vibra Healthcare
Pennsylvania, PA
03.2022 - Current
- Participated in Revenue Cycle processes LTR/IRF/SNF, overview to maximize profitability and increase revenue.
- Lead Biller assisting staff of 12 all remote. 32 Inpatient/Outpatient Hospitals in several states.
- Performed quantitative analysis and other data research using company software to identify trends and opportunities.
- Assist with Billing and Collection with Denials, Appeals, ICU Site Neutral payments and partial payments.
- Presented regular status updates and workflow recommendations to Senior Management.
- Identified and correct payment problems involving patients or third-party payers - Medicare, Medicare Advantage, Medicaid, Affordable Health Care, VA and all Commercial payers.
- Completed weekly account reconciliations to identify discrepancies.
- Analyzed budgets and implemented action plans to rectify issues.
- Oversee complete lifecycle of revenue operations.
- Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
- Review completed aging spreadsheets
- Review and assess quality trends of staff performance
Senior Manager Revenue Cycle Management
BayMark Health Services
Lewisville, TX
09.2018 - 12.2021
- Promoted to Senior Manager
- Managed the Life Cycle RCM department in revenue cycle processes, coordinating daily task assignment for a of 22 team a long with 3 Managers and 4 Supervisor, 2 Leads. Focusing on maximizing profitability and increasing revenue.
- Insurance Verification, Authorization, Billing Collections, Refunds, Payment Posting, Cash Collections, Denials, Appeals and Reimbursement for Opioid Treatment Programs (OTP) (OBOT) (MMT) with Medication Assisted Treatment (MAT)
- Participated in all hiring for Managers, Supervisor and nonexempt workers. Oversaw training on relevant systems, department standards expectations and producers
- Responsible for ensuring claims were billed timely and accurately
- Served as a subject matter expert (SME) through analytical support and guidance in relation to the data integrity and operations of system.
- Ensured staff met departmental goals in their assigned areas.
- Focused on continuous improvement by contributing to the development and implementation of strategies initiatives and processes which would maximize efficacy and efficiency of the functions
- Identified, researched and resolved outstanding Billing and Collection issues with government payors - Medicaid, Medicare, Medicare Advantage Plans, Market Place Plans and Commercial Plans. Residential and SNF Billing, Appeals
- Development and implementation of policies and procedures within the assigned function
- Support internal and external audits as necessary
- Work with the clinics Fiscal Clerk, TCD and Business Office Service Coordinators (BOSC) for insurance setup and training over the back end of RCM.
- Work with Credentialing to become PAR providers. PECO Credentialing
- Client success Team Management Experience (company lowest for department retention)
- Maintain Compliance with clients policies and procedures.
- Improved billing accuracy through collaborative relationship with IT and ensuring UB04/837/HCFA changes are completed accurately for billing
- Analyze the top denials reasons to reduce claims rejections.
- Mentor employees, conduct performance evaluations, team development, provide disciplinary actions to assigned personnel. Coordinate staffing schedule to business needs
- Conduct weekly, monthly, quarterly meetings for out of state and in state clinics regarding Billing, Denials and Authorization issues.
- Acquisition and Mergers completing Due Diligent reports after site visit
- 35% travel
Manager Revenue Cycle Management
BayMark Health Services
Lewisville, TX
03.2016 - 09.2018
- Promoted from Supervisor
- Oversee Billing, Processing Claims for (OTP, OBOT, MMT, IOP), Denial, Appeals and Reconsideration
- Audit delinquent accounts to include payment from patient, refunds and write off for bad debt
- Prepare financial and collection data
- Answer a variety of correspondence from patients and their representatives regarding billing, insurance and payment
- Assist in the preparation of reports for months end close
- Interact with all levels of the organization
- Oversee Insurance benefits and Eligibility and track authorization for certain payors
- Resolve issues with payment and billing, authorization process.
- Maintain accurate accounts
- Contact patients for payment of accounts and/or make payment arrangement according to current policy. Financial agreement (FA107)
- Track Self-Pay balances
- Grant portal access to all staff
- Work closely with Call Center Staff and training of understanding insurance (copay, coinsurance, deductible, OOP)
Supervisor Billing/Collections
BayMark Health Services
Lewisville, TX
07.2013 - 02.2016
- Reviewed accounts to determine payment plan compliance for OTP, OBOT and MMT outpatient facility
- Contact payors Medicaid/Medicare and commercial healthcare insurance companies to follow-up on outstanding accounts receivable
- Work closely with the Lead to facilitate daily work assignment
- Identified billing errors for resubmission and payment from Secondary Payers
- Oversee the Clearinghouse and Practice Management system.
- Posting Payments
- Reconciling Patients accounts to true balance
- Offer support to clinics and in-house staff for billing concerns
- Work with patient regarding disputes of benefits (copay, coinsurance, deductible, OOP)
- Setup training for end users of applications
- Team of 10
Lead Account Manager
Better Source DME
Arlington, TX
03.2008 - 04.2013
- Negotiated contracts, closed agreements and supported sales team in new product launches.
- Measured DME (Durable Medical Equipment) for patient and delivered
- Billed all claims, Workman's Comp, Personal Injury, Commercial, VA and Medicaid/Medicare claims. Enforced payments for LOP's on file from attorneys.
- Researched, prepare and submit appeals and reconsiderations and notate all actions taken on accounts with clear concise notes
- Coding for claim submission
- Handle complex patient account functions contractual adjustments and payment
- Generate specialized reports to resolve overpayments and refunds for payor and patients
- Ordered and shipped all supplies
- Inventory Control
- Managed team of 8
- 50% travel
Education
Business Administration And Management
Northwood University
Cedar Hill, TXCertificate Human Resource - Business Administration And Management
UTA
Arlington, TXBusiness
Tarrant County College District
Fort Worth, TXSkills
- Revenue metrics analysis
- Procedure optimization
- Clinical personnel support (Front and Back end)
- Billing cycle performance
- Knowledge and experience with all payor mixes Medicaid/Medicare, Medicare Advantage Plans, Medigap, Commercial, Market Place, VA Triwest, Spend down plans and COBRA
- Grant invoicing and billing - STR/SOR
- Skilled Nursing Facility, Long Term Acute Care billing
- Substance Abuse billing (IOP, PHP, MMT, MAT, OTP, OBOT)
- Behavioral Health/Psych billing
- Physician billing
- DME billing
- CPC certification - expired 2021
- Pain Management - Work Hardening billing
- Hospital and Facility billing
- EMR/PM systems - NexGen, Aprima, SAMMS, Medisoft, eClincalWorks, ZirMed, Epic, Meditech, Salesforce, Availity, Emdeon, Gateway, Practice Insight, Ability, WayStar, DDE Claim Management
- Call Center staff scheduling
- Experienced Billing for several states - Texas, Maryland, Pennsylvania, North Carolina, Ohio, Nebraska, Georgia, Alabama, Louisiana, Utah, Indiana, Colorado, W Virginia, Arizona, Kentucky, Idaho, Detroit, Dakotas, South Carolina, California, Denver, Portland,
- Denial Management, Appeals, Reconsiderations, Peer to Peer reviews
- Surgery Scheduling
- Credentialing and Interpret contract language
- Training, SOP creations, Employee Evaluations
- Hiring and staff development including Off shore
Timeline
Lead Billing Specialist (remote)
Vibra Healthcare
03.2022 - Current
Senior Manager Revenue Cycle Management
BayMark Health Services
09.2018 - 12.2021
Manager Revenue Cycle Management
BayMark Health Services
03.2016 - 09.2018
Supervisor Billing/Collections
BayMark Health Services
07.2013 - 02.2016
Lead Account Manager
Better Source DME
03.2008 - 04.2013
Business Administration And Management
Northwood University
Certificate Human Resource - Business Administration And Management
UTA
Business
Tarrant County College District
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