Hi, I’m
Shirley Collins
Saginaw,TX
Summary
Results-driven, Sr. Revenue Cycle Director experienced in financial statement review, auditing and reporting. Well-versed in producing reports, evaluating department operations and handling month- and year-end closings. Meticulous, conscientious and methodical in approach. Proactive Sr. Revenue Cycle Director with strong background in financial analysis, budgeting and forecasting. Develops and implements financial plans and delivers strategic financial advice.
Overview
30
years of professional experience
Work History
United Surgical Partners International (USPI)Dallas
Director of Revenue Assurance
05.2022 - 02.2024
Job overview
- Developed and led a new RCM Escalation Team with a specific focus on the capture of previously uncollected aged revenue.
- Developed the Loss of Discount Project with an emphasis on provider and payer contractual compliance.
- Scheduled monthly meetings with Aetna, BCBS, and Cigna to discuss new or ongoing special payment projects.
- Payment Escalation Team responsible for collecting revenue for claims of 2nd level collectors was unsuccessful. The goal of collections for the team is $1M monthly.
- Direct supervision of all revenue cycle management manager/team leaders and associated functions (scheduling, registration, data collection/entry, billing, collections, and credentialing).
- Reduced denial rates from 48% to 21% monthly within 2 years.
- Increase denial overturn rates from 38% to 78% within 2 years.
- Worked diligently to recoup previously uncollected revenue.
- Perform analytical loss of discount audits for Baylor Scott and White hospitals and other ASCs.
- Assisted RCM Departments on denial trend resolutions to include special projects while providing state and Federal regulation-supported suggestions.
- Worked directly with RAC Auditors to recover previously recouped revenue.
Created special projects with BUCA payers to address erroneous denial treads from the payer within 2 years we were able to recover more than $ 4 million between 6 facilities. - Developed improvement strategies that affected each revenue cycle department.
- Trained RCM outsourced Vendors to strengthen their knowledge of US-based State and Federal Regulations.
- Establish internal KPIs on end-to-end billing and RCM processes.
Analyzed Denial Management Reports Monthly to discuss with leadership during monthly meetings.
Advanced Medical Business Services (AMBS)Bedford
Co-Founder Chief Auditor/ Senior RCM Director
10.2012 - 03.2022
Job overview
- Participates in the development of short- and long-term strategies and tactics for enhancing and diversifying professional service revenues.
- Partner with clinical leadership and support staff to ensure their understanding and adherence to payor guidelines to eliminate no-authorization.
- Collaborate with other departments (ex: Accounting, IT, and Clinical Services) in the development of policies and procedures supporting reimbursement of services.
- Provided payer guidelines training to scheduling, billing, and collection staff.
- Perform analytical audits for all onboarding clients.
- Direct RPMs and Team Coaches on issues found and provided regulation-supported suggestions.
- Worked closely with the Client Service Team to ensure client satisfaction.
- Established company-wide RCM Structure.
- Analyzed clients’ overall AR to identify denial trends and to provide directives to ensure claim-level resolution.
- Collaborated with the coding department leads to develop and implement coding protocols for each client according to their specialties and specific needs.
- Developed and implemented reimbursement strategies and protocols client-specific.
- Analyzed clients to establish and implement action plans to correct any departmental deficiencies.
- Created, administered, and monitored “The Great AR Reduction Project” to eliminate and/or reduce the company-wide greater than 90-day buckets.
- During the 6 months that “The Great AR Reduction Project” was in place, we reduced the greater than 90-day aging from $68 Million to $43 Million with insurance collections of $17 Million, patient collections of $3.2 Million and $5 Million of adjustments.
- Specialize in working with older claims otherwise considered non-collectable.
- Special project negotiations with all carriers at the executive level for both participating medical service groups as well as non-participating medical service providers.
- SME directly with The Texas, Georgia, Illinois, New York, and Colorado Departments of Insurance to secure interest and penalties according to the Prompt Payment Act.
- Worked with EBSA and DOJ to encourage adherence to prompt payment regulations for self-funded claims and enforcement for carriers that violated those regulations.
- Trained and directed more than medical collection employees on the correct way to work with the insurance companies, how to understand exactly what the adverse decision letters were saying, and specifically what the carriers were looking for when additional information was requested and developed and administered the training for insurance verification, demographics, prior authorization, and billing departments for consulting clients.
Destiny Surgical Center/MD Consultants, LLC
RCM SR Director
10.2009 - 10.2012
Job overview
- Participate in the establishment of and monitor departmental and organizational key performance indicators and dashboards regarding revenue cycle operations.
- Oversee the development and adherence to operational policies and procedures governing revenue cycle management and billing compliance for the organization.
- Reviews and makes recommendations to professional service revenue-related agreements for alignment with organizational goals and objectives.
- Investigate and analyze issues, root causes, patterns, or trends and identify and implement process improvement actions in support of revenue cycle objectives in coordination and communication with other Journey teams.
- Oversees and supports the development and administration of the organization’s fee schedule for services.
- Maintains an in-depth knowledge of all funding source requirements related to reporting of program services and allocations and assists staff in the implementation of that reporting.
- Assist in EHR upgrades, maintenance, and reporting functions.
- Trained the following departments: scheduling, billing, payment posting, refunds, quality control, and collections.
- Served as SME working directly with The Texas, Georgia, Illinois, New York, and Colorado Departments of Insurance to secure interest and penalties according to the Prompt Payment Act
- Direct supervision of all revenue cycle management manager/team leaders and associated functions (scheduling, registration, data collection/entry, billing, collections, and credentialing).
- Worked with Insurance carriers to ensure that no claim was left behind and all claims were paid fairly and according to a negotiated contract.
- Ensured that all out-of-network (OON) claims were paid according to the patient's plan benefits.
- Worked diligently to ensure that OON claims were paid according to the UCR or Fair Health (www.fairhealth.org) standards.
- Negotiated with the carriers to ensure that all claims were adjudicated according to the patient's plan benefits.
The C. Bryant Law PLLCHouston
Staff Accountant
12.1993 - 09.2009
Job overview
- State and Federal healthcare regulatory officer for clients.
- Served as State and Federal Healthcare SME for clients.
- Responsible for payroll for 4 states and 75 employees.
- Conducted New Hire Orientation and bi-weekly payroll.
- Prepared and recorded asset, liability, revenue, and expense entries by compiling and analyzing account information.
- Summarized financial status by collecting information, and preparing balance sheet, profit and loss, and other statements.
- Oversee General accounting operations by controlling and verifying financial transactions. Reconciled account balances and bank statements maintained general ledger, and prepared month-end closing procedures. Combined excellent analytical skills with a thorough knowledge of accounting principles to analyze financial reports and forecasts.
- Participated in internal and external audit processes to establish accurate financial records and comply with Generally Accepted Accounting Principles and regulatory requirements.
- Helped with preparation of year-end and statutory accounts to compare past reports and evaluate financial health of company.
- Increased accuracy of financial statements through diligent attention to detail and thorough review processes.
Education
Canterbury Christ Church University, Canterbury England
Master of Arts from Accountancy
05.1991
Canterbury Christ Church University, Canterbury England
Bachelor of Arts from Business Administration And Management/Accountancy
05.1989
Skills
- Revenue Cycle Management SME Consultant to 35 hospitals
- Resolved Special Investigation Unit (SIU) cases with the Major Commercial Insurance Carriers as well MAC audits for Governmental Carriers
- SME for commercial and governmental contract negotiations and compliance
- Trained 2nd Level Collectors on escalated collections, payor relations, and effective appeals processes
- Collection of more than 68% of previously written-off claims
- Developed departmental-level special projects to increase revenue by reducing costs and negotiating contracts with carriers and vendors
- Multiple location management improving long and short-term strategies
- Collaborated with RCM supervisors to redesign billing and collections processes and workflow
- Developed a working relationship between TDI, OIG, DOJ, and Major Insurance Company executives in an effort to resolve reimbursement issues
- Lead and direct revenue cycle functions including commercial insurance and government payer A/R, facility billing and collections, insurance underpayment, and recovery activities
- Work closely with RCM Department to ensure that KPI metrics of Revenue Cycle Operations are achieved while quality standards are being met
- Develop, lead, and manage claims special projects with payers
- Identify and implement strategies to build a high-performance team including building a successful leadership, supervisory, and team pipeline
- Forging strong internal and external relationships, driving strategic financial decisions
- Work with facilities to document core workflows, develop standard operating procedures, and coordinate implementation plans for the roll-out of new procedures
- Perform proactive oversight of the billing functions, reducing referral denial rates, and bad debt
- Served as internal RCO SME for all facilities and ASCs
- Developed effective appeal strategies relating to timely filing, no-authorization denials, medical necessity, and underpayment denials
- Perform new client data analysis to identify weaknesses and areas for improvement
- Software integration for clients working with both mainstream and site-specific software
- Negotiated provider contracts and enforced loss of discount clause to increase revenue
- SME with State and Federal Regulations and guidelines
- POC for Texas, Oklahoma, Arkansas, Tennessee, and California Department of Insurance
Timeline
Director of Revenue Assurance
United Surgical Partners International (USPI)
05.2022 - 02.2024
Co-Founder Chief Auditor/ Senior RCM Director
Advanced Medical Business Services (AMBS)
10.2012 - 03.2022
RCM SR Director
Destiny Surgical Center/MD Consultants, LLC
10.2009 - 10.2012
Staff Accountant
The C. Bryant Law PLLC
12.1993 - 09.2009
Canterbury Christ Church University
Master of Arts from Accountancy
Canterbury Christ Church University
Bachelor of Arts from Business Administration And Management/Accountancy
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