Summary
Overview
Work History
Education
Skills
Timeline
Generic

SHAWNAE ALSTON

Richmond,Texas

Summary

Efficient Healthcare Revenue Cycle Manager highly skilled in procedure optimization and revenue metrics analysis to increase financial performance. Aiming to utilize 15 years of healthcare administration to drive profit and contribute immediate value.

Overview

16
16
years of professional experience

Work History

Account Manager

Legacy Healthcare LLC
04.2023 - Current
  • Implemented quality control measures that reduced customer complaints by 20% and enhanced customer satisfaction ratings by 15% by addressing unexpected consequences in claims processing
  • Ensured consistent customer satisfaction by successfully delivering projects, cultivating strong business relationships, and executing additional revenue generation for clients
  • Proactively anticipated client needs using analytics, identifying potential performance issues, and suggesting opportunities for improvement
  • Established weekly training programs for clients and staff, focusing on system education, industry updates, and changes in collection processes and protocols.
  • Coordinated with internal teams to facilitate prompt delivery of client projects.

Revenue Cycle Director

ALTUS HEALTHCARE
06.2022 - 03.2023
  • Monitored and guided revenue cycle operations
  • Ensured proper staffing for billing, coding, and patient financial services staff in accordance with budgetary guidelines
  • Effectively recruited, hired, coached, trained, and developed billing team
  • Collaborated with cross-functional teams to establish new guidelines for vendors, resulting in improved quality control and 10% decrease in denials
  • Managed offshore team to ensure continuity in revenue cycle processes
  • Provided KPI reporting to Executive Leadership on performance benchmarks for collections, coding, and patient collections for $10 million in AR.
  • Supported clinical team members with revenue cycle procedures and addressed coding issues.

Reimbursement Manager

CLOUDMED
08.2021 - 06.2022
  • Tracked and validated financial benefits of DRGV and Charge Capture initiatives for 15+ clients, resulting in monthly cost savings
  • Served as subject matter expert in monthly client reimbursement and invoice processes resulting from additional revenue obtained
  • Executed client implementation for seven new accounts based on individual SOW for DRGV and charge capture review
  • Assisted Coding Educators, system's Compliance Department, and any external auditing partners in support of new provider onboarding and orientation for physicians and non-physician practitioners
  • Provided documentation, coding education, and input on new client onboarding templates
  • Worked in collaboration with coding and reimbursement staff to research payer policies that may affect practice's clinical and billing operations
  • Ensured DRGV and charge capture coding and documentation are optimized for reimbursement and compliance for Medicare, Medicaid, and commercial payers.

Senior Revenue Cycle Manager

ALTEON
01.2018 - 02.2021
  • Partnered with vendors to outsource aged accounts for optimal cash collections and maintenance of current account receivables
  • Managed operations of Billing department while auditing procedures to improve efficiency of billing and collections operations positively affecting daily 1.4 million cash goal
  • Increased account receivable goals by 5% and strengthened individualized performance by preparing and submitting monthly and annual reviews while providing positive feedback for team members' success
  • Supported financial director with special projects and additional job duties.
  • Collaborated with C-level executives and stakeholders to develop long-term financial plans

Team Lead Regulatory & Compliance

MEDSTAR HEALTH
01.2017 - 01.2018
  • Contributed to achievement of established department goals and objectives and adhered to department policies, procedures, quality standards and safety standards while complying with governmental and accreditation regulations
  • Supported Billing and Customer Service Team with patient-related inquiries regarding payments and denials
  • Addressed and monitored daily coding issue (CPT/HCPCS) reports for volume and trends within company's ten facilities
  • Analyzed Charge Description Master requests for accurate implementation into charge dictionary within 24 hours of receipt
  • Organized and initiated Medicare RAC and MAC appeals for all inpatient facility denials.
  • Reviewed claims data to assess compliance with medicare and medicaid regulations.

Utilization Review Representative

GILCHRIST SERVICES
01.2008 - 01.2017
  • Negotiated and maintained managed care contracts monthly for optimal professional and facility reimbursement
  • Served as liaison between insurance company, hospice staff and patients
  • Facilitated workgroup meetings with medical personnel and case management to find effective solutions to issues
  • Decreased turnaround time of requests and approvals by 45%, resulting in 20% increase in patient admissions and continued stay
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches
  • Evaluated medical guidelines and benefit coverage monthly to determine appropriateness of services for average of 80 patients.

Education

B.A. - Healthcare Management

University of Maryland Global Campus
Adelphi, MD
2018

Skills

  • Project Management
  • Compliance
  • Process Improvement
  • Payroll and Timekeeping
  • Root Cause Analysis
  • Microsoft Office Suite
  • Practice Management
  • Data Analysis
  • Electronic Health Records Systems
  • Key Performance Indicators (KPI)
  • Change Management
  • Hospital /Practice Billing and Coding
  • Revenue Performance
  • Monthly Closings
  • Best Practices and Standards

Timeline

Account Manager

Legacy Healthcare LLC
04.2023 - Current

Revenue Cycle Director

ALTUS HEALTHCARE
06.2022 - 03.2023

Reimbursement Manager

CLOUDMED
08.2021 - 06.2022

Senior Revenue Cycle Manager

ALTEON
01.2018 - 02.2021

Team Lead Regulatory & Compliance

MEDSTAR HEALTH
01.2017 - 01.2018

Utilization Review Representative

GILCHRIST SERVICES
01.2008 - 01.2017

B.A. - Healthcare Management

University of Maryland Global Campus

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SHAWNAE ALSTON