Shelly Ann Castillano
Summary
Process Improvement Consultant with extensive experience in healthcare revenue cycle management and compliance. Successfully led initiatives that standardized processes and enhanced operational performance across medical facilities, ensuring regulatory adherence and improved patient experiences.
Overview
20
20
years of professional experience
Work History
PROCESS IMPROVEMENT CONSULTANT III
KAISER PERMANENTE
01.2023 - Current
- Lead new hire training, retraining initiatives, and operational education programs that support regulatory compliance and performance goals.
- Developed and standardized operating procedures, training materials, and educational resources for admitting and registration teams, enhancing operational consistency.
- Conducted quality assurance audits and operational reviews, identifying improvement opportunities and ensuring compliance with regulatory standards.
- Evaluate new system capabilities and recommend workflow improvements that increase efficiency, consistency, and patient experience.
- Perform onsite operational assessments across Hawaii medical facilities to evaluate workflows, identify variances, and provide real-time coaching and support.
- Serve as Revenue Cycle subject matter expert and primary contact for self-service capabilities and front-end operations.
- Monitored third-party eligibility vendor performance, providing feedback that enhanced accuracy and timeliness of operational outcomes.
- Partner with operational leaders, technical teams, and national stakeholders to support implementation of strategic Revenue Cycle initiatives.
COORDINATOR |CASHIER AUDIT, OPERATIONAL COMPLIANCE
KAISER PERMANENTE
HONOLULU, HI
01.2017 - 01.2023
- Collaborated with department managers to develop and communicate corrective action plans for policies and procedures, enhancing compliance standards.
- Liaised with departments to recommend improvements, promoting compliance in billing, coding, and documentation processes.
- Collaborates with coding operations and other operational units to resolve documentation, billing, and compliance issues.
- Conferred with physicians, providers, and health care team members to clarify billing requirements and streamline related processes.
- Engaged in self-development activities to enhance professional knowledge. and keeps abreast of federal and state laws and regulations, accreditation standards, advances in technology and operational processes.
- Works closely with Hawaii Regional Compliance department on various National and Hawaii region audits.
CODING ANALYST
KAISER PERMANENTE
Honolulu, Hawaii
01.2010 - 01.2017
- Resolving claim edits with modifiers
- Working closely with Hospital coders to ensure correct coding for facility
- Resolve edits for Ambulatory Payment Classification (APC) workgroup
as the Patient Financial Services representative to review, resolve,
research information to ensure smooth rollout of implementation in addition to creating workflows on resolving CCI edits for bundling, unbundling and appropriate modifiers. - Provides assistance and guidance with RAC, MAC, and DNBE accounts to ensure accurate record keeping.
- Gather and prepare SOX reports to ensure compliance
PATIENT ACCOUNTING REPRESENTATIVE HOSPITAL BILLER
KAISER PERMANENTE
Honolulu, Hawaii
01.2007 - 01.2010
- Resolved Medicare, Medicaid, Tricare and Commercial denials and correspondence
- Researched and settled Medicare Correct Coding Initiative (CCI) edits for Laboratory and Radiology charges
- Tracked and trended denials and no pay issues by payor and department to provide feedback to manager for providers
- Tracked and trended denials and no pay issues by payor and department to provide feedback to manager for providers
- Review and ensure accurate coding, procedure, and supply charging
on UB-04 claims - Review and resolve any additional claim errors in ePremis for claims processing both paper and electronic submission
- Contributed to Ambulatory Payment Classification (APC) workgroup as Patient Financial Services representative, developing workflows to address CCI edits and streamline implementation
Education
Licensed Massage Therapist -
Kapiolani Community College
Honolulu, HI01-2005
High School Diploma -
Waipahu High School
Waipahu, HI06-1996
Skills
- Federal regulations
- State regulations
- Medicare
- Medicaid
- Billing guidelines
- RAC/MAC accounts
- DNBE accounts
- Regulatory compliance
- Revenue cycle audits
- Operational training
- Process optimization
- Data analysis
- Microsoft Word
- Excel
- PowerPoint
- Outlook
- Problem solving
- Attention to detail
- Organization
- Prioritization
- Verbal communication
- Written communication
- Oral communication
- Influence
- Interpersonal relations
- Verbal communication
- Stakeholder presentations
- Cross-functional collaboration
- Teamwork
- Results orientation
- Mathematical ability
- Proofing
- Systems thinking
- PCI compliance
Technical Skills And Compliance
- Demonstrated knowledge of and skill in Microsoft Word, Outlook, PowerPoint, and Excel.
- Excellent verbal and written communication with internal and external stakeholders.
- Mathematical ability, diligence (organization, prioritization, proofing).
- Experience in training/giving and receiving instructions.
- Working knowledge of relevant federal and state regulations, Medicare, Medicaid, and third-party billing guidelines.
- Provide assistance and guidance with RAC/MAC and DNBE accounts.
- Demonstrated knowledge of and skill in customer service, detail oriented, group presentations, group process facilitation, influence, interpersonal relations, oral communication, problem solving, quality management, results orientation, statistical analysis, systems thinking and teamwork.
- Assisted with PCI assessments for the Hawaii Market, collaborating with PCI National Partners and Market leaders to conduct credit card device audits and ensure compliance with PCI standards.
Leadership Experience
- Collaborates with department managers in developing, updating, and communicating corrective action plans to related policies and procedures.
- Serves as liaison with other departments and recommends improvement to promote billing, coding, and documentation compliance.
- Collaborates with coding operations and other operational units to resolve documentation, billing, and compliance issues.
- Confers with Physicians, providers, and health care team members to promote understanding of billing related requirements and processes.
- Assumes responsibility for ongoing self-development and keeps abreast of federal and state laws and regulations, accreditation standards, advances in technology and operational processes.
- Works closely with Hawaii Regional Compliance department on various National and Hawaii region audits.
Analytical Skills
- Conducts audits of department processes & deliverables in accordance with operational policies and procedures (i.e., SOX).
- Compiles, analyzes, and evaluates results of audits to identify appropriate corrective action plans.
- Conducts investigations and reviews claims to facilitate compliance with federal & state laws and regulations and accreditation standards.
- Investigates claims and billing compliance issues or trends identified by Independent Review Organization (IRO).
- Provides interpretation of federal and state laws and regulations, accreditation standards, and operational policies and procedures.
- Reviews claims for quality, timeliness, & adherence to laws & regulations, accreditation standards, & operational policies & procedures.
Certificates And Licenses
- Certified Professional Coder, AAPC, 01/01/10
- Certificate of ICD-10 Proficiency, AAPC, 01/01/14
- HFMA – Certified Revenue Cycle Representative (CRCR), 01/01/26
Timeline
PROCESS IMPROVEMENT CONSULTANT III
KAISER PERMANENTE
01.2023 - Current
COORDINATOR |CASHIER AUDIT, OPERATIONAL COMPLIANCE
KAISER PERMANENTE
01.2017 - 01.2023
CODING ANALYST
KAISER PERMANENTE
01.2010 - 01.2017
PATIENT ACCOUNTING REPRESENTATIVE HOSPITAL BILLER
KAISER PERMANENTE
01.2007 - 01.2010
Licensed Massage Therapist -
Kapiolani Community College
High School Diploma -
Waipahu High School