Shobhna Kumar
Reno,NV
Summary
Brings over 20 years of progressive experience in Revenue Cycle Management, including roles as Analyst, Specialist, and Supervisor across diverse healthcare settings. Proven track record in claims processing, A/R follow-up, denial management, and payer reconciliation using leading platforms such as Epic, Meditech, Kareo, IDX, Star/HBO, and SMS Billing. Demonstrated expertise in resolving billing edits, payer rejections, and insurance denials with a strong focus on maximizing collections and minimizing AR days. Adept at appealing claims, identifying payment variances, and initiating timely escalations, ensuring compliance with payer guidelines and timely filing requirements. Experienced in leading teams, monitoring performance metrics (KPIs), conducting performance reviews, and optimizing workflow processes to meet and exceed departmental goals. Strong knowledge of HCPCS, CPT, and ICD-9/10 coding standards, Medicare/Medicaid billing regulations, and TPL adjudication procedures. Technically skilled in utilizing Medicare DDE systems, CareMedic, E-Premise, NDC Health, HDX Billing, and other claims submission tools. Recognized for critical thinking, problem-solving, and multitasking skills in fast-paced, remote environments. Currently completing a Master’s in Business and Healthcare Administration, with a strong commitment to continuous learning and improvement. Committed to maintaining documentation accuracy, achieving quality assurance benchmarks, and supporting collaborative team-based results in line with revenue cycle KPIs.
Overview
15
15
years of professional experience
Work History
A/R Follow Up Specialist
Elevate PFS Holdings, INC
07.2023 - 05.2024
- Maintain a queue of Third-Party Liability accounts as assigned by management.
- Maintain an average of 30-35 unique accounts worked per day.
- Support hospital patients by answering any questions about the Third-Party Liability process.
- Submit hospital bills to insurance companies for payment, and request hospital liens to be filed, as applicable.
- Maintain contact with insurance adjusters and/or personal injury attorneys during the claims adjudication process to ensure that the hospital bill/lien is paid timely and in full.
- Provide updates to Elevate PFS’s account management system as account work is completed.
- GAP - 05/2024 - Present
- Reason - (Took time off to care for my mother following her heart attack)
Revenue Cycle Specialist
Eliassen Group
03.2021 - 09.2021
- Currently working remotely for Change Healthcare in Texas
- Duties as assigned: Monitored online claim editing, submission, and reconciliation procedures, editing claims as needed, research claims for better understanding of revenue cycle.
- Payment Positing, Payment Adjustment and Write off’s
- Ensures compliance with CPT, HCPCS and ICD-10 coding regulations and guidelines.
- Pediatrics claim processing and follow up
- Handle heavy workloads and short deadlines in a positive manner.
- Adapted quickly to changing conditions, assimilating new processes into job functions, and taking ownership.
- Identify, prioritize, resolve and/or escalate complex problems claims promptly.
- Other duties as assigned by management.
- GAP - 09/2021 - 07/2023
- Reason - (Took time off for my wedding)
At Home Caregiver
IHSS
09.2018 - Current
- Provide personal care, such as feeding and bathing
- Perform household tasks such as laundry, shopping, meal preparation, and light housecleaning
- Provide transportation
- Offer protective supervision
- Administer certain paramedical services as ordered by a physician
- GAP - 03/2020 - 03/2021
- Reason - (Pandemic Hit)
Uber/Lyft Driver
10.2017 - 03.2020
- Providing rides to riders from point A to point B.
Revenue Cycle Analyst Supervisor
Optum360
11.2015 - 09.2017
- Supervised the workload of assigned PFS team members by empowering, coaching, answering questions, giving guidance, and leading by example.
- Managed 15-20 employees.
- Ensured compliance of PFS Management expectations and requirements.
- Processed Medicare/Medicaid claims.
- Ensured compliance with state and federal law regulations for Managed Care, Government (Medicare/Medi-Cal) Billing and Collections, and other Third-Party Collection procedures.
- Maintained ongoing knowledge of UB-04 and other mandatory state billing forms and filing requirements, as well as industry-specific electronic file formats such as 837 billing file, 835 payment file, 276/277 claim status, and response file.
- Monitored online claim editing, submission, and reconciliation procedures, editing claims as needed, research claims for better understanding of revenue cycle.
- Payment Positing, Payment Adjustment and Write off’s
- Ensures compliance with CPT, HCPCS and ICD-9 coding regulations and guidelines.
- Ensured compliance with state and federal laws and regulations for payers including the Fair Debt Collections Practices Act.
- Facilitated the identification of issues and solutions by team members.
- Provides feedback to the PFS Manager regarding personnel and issues within the PFS department.
- Provided team members with appropriate coaching and developmental opportunities for learning, creativity, and personal growth.
- Generated enthusiasm and commitment among employees, fosters and reinforces team-based results.
- Evaluated individual and team performance, identifies areas for improvement and makes recommendations to team members.
- In coordination with the PFS Manager, conducts monthly and yearly performance reviews and provides feedback to team members.
- Works with team members to improve, track and develop areas of overall performance to meet or exceed expectations.
- Monitored the performance of assigned PFS units and ensures key performance metrics are met.
- Developed and monitored workflow processes to meet organizational goals and objectives.
- Created agendas and communication materials for team meetings.
- Collaborated with others to discuss new opportunities.
- Attended departmental meetings, providing feedback to enhance future performance.
- Improved customer satisfaction by finding creative solutions to problems.
- Collaborated in development of billing procedures.
- Improved profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
- Utilized various software’s to compile data gathered from various sources.
- Supported other department by compiling paperwork and taking detailed meeting minutes.
- Achieved cost-savings by developing functional solutions to problems.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Recognized by management for providing exceptional customer service.
- Earned reputation for good attendance and hard work.
- Completed multiple projects resulting in bringing revenue.
- Improved operations by working with team members and customers to find workable solutions.
- Performed site evaluations, customer surveys and team audits.
- Worked closely with team members to deliver project requirements, develop solutions, and meet deadlines.
- Handled all delegated tasks.
Medicare, Worker's Comp Biller Specialist, Lead/Supervisor
HRG, Sutter Health, Mammoth Lakes La Grande Hospital
09.2010 - 10.2015
- Performed both sides of Epic clinical billing & Hospital Billing.
- Executed strategy and communicate knowledge of business processes and enabling technologies, specifically in a Payer-specific (Medicare, Medi-Cal, Medicaid, and/or Private) Claims function.
- Served as a reference and coach others on key Payer-specific (Medicare, Medi-Cal, Medicaid, and/or Private) Claims processes, policies, and procedures.
- Aptitude to conceptualize, plan, and implement stated goals and objectives.
- Independently set and organize own work priorities for self and for the assigned team, and successfully adapt to new priorities as part of a changing environment.
- Ensure the patient's medical information is accurate and up to date.
- Prepare bills and invoices, and document amounts due for medical procedures and services.
- Worked concurrently on a variety of tasks/projects while leading a high volume, high accuracy work team composed of individuals having diverse personalities and work styles.
- Communicated and work with patients, physicians, associates, Sutter Health leadership, multiple direct patient care providers and others to expedite the patient accounting process.
- Handle heavy workloads and short deadlines in a positive manner.
- Adapted quickly to changing conditions, assimilating new processes into job functions, and taking ownership.
- Identify, prioritize, resolve and/or escalate complex problems claims promptly.
- Established, developed, and managed customer relationships.
- Demonstrated leadership skills and the ability to provide supervision, direction, and constructive feedback to team members to support continuous improvement.
- Communicated ideas both verbally and in writing to influence others using on-on-one contact and group discussions.
- Worked on denials from workers' comp insurance carriers.
- Updated all the new information that was required from the department of labor to get paid correctly.
- Trained others on how to work on worker's comp claims.
- Negotiated payments for denials and other claims as assigned.
- Worked closely with Eligibility staff to ensure the scheduling of appointments with patients for the Sliding Fee Scale Application.
- Build and maintain collaborative relationships with both internal and external clients for more effective communication and a higher level of productivity and accuracy.
- Prioritize requests for insurance verification and benefits determination form various sources.
- Provide timely and accurate follow-up to telephone inquiries.
- Maintain a predetermined accuracy rating by regularly scheduled audits of patient accounts.
Education
Bachelor of Science - Healthcare Administration
University of Phoenix
Sacramento, CA11.2020
Associate of Science - Psychology
Sacramento City College
Sacramento, CA08.2016
Skills
- HDX Billing Application
- SMS on-line Billing
- Meditech
- Internet Explorer, Chrome, Firefox
- Synergy
- Mysis (All scripts)
- Invision
- NDC Health
- E-Premise, Care medic
- Medicare DDE systems (Ivans), Noridian, IDX
- Cirrus
- Epic/Apex
- E-clinical
- QMS
- Star/HBO
- Practice Fusion and Kareo Billing software
- Accounting, Meditech
- Accounts receivable
- Excel, Pivot Charts
- Billing- Medicare, Medicaid & Commercial
- Business processes, PowerPoint
- Coaching, Organizational
- Continuous improvement, Bathing
- CPT, Direct patient
- Creativity, Performance reviews
- Client, Personnel
- Clients, Policies
- Direction, Processes
- Editing, Coding
- Filing, Progress
- Finance, Quality
- Financial, Research
- Forms, Scheduling
- Government, Scripts
- SMS
- Hospice, Spreadsheets
- ICD-9 & ICD-10
- Insurance, Supervision
- Internet Explorer, Telephone
- Laundry, Phone
- Leadership, Answer phones
- Leadership skills, Transportation
- Accounts Receivable
- Problem Resolution
- Insurance Billing
- Eligibility Verification
- Team Building
- Account Reconciliation
- Project Organization
- Entry management
- Billing Adjustments
- Business Operations
- Planning and Coordination
- Team Management
- Invoice Generation
- MS Office
- Administrative support
- Process Improvement
- Supervision
- Customer Service
- Operational Improvement
Scheduling/ Calendar
Languages
Hindi
Native or Bilingual
Timeline
A/R Follow Up Specialist
Elevate PFS Holdings, INC
07.2023 - 05.2024
Revenue Cycle Specialist
Eliassen Group
03.2021 - 09.2021
At Home Caregiver
IHSS
09.2018 - Current
Uber/Lyft Driver
10.2017 - 03.2020
Revenue Cycle Analyst Supervisor
Optum360
11.2015 - 09.2017
Medicare, Worker's Comp Biller Specialist, Lead/Supervisor
HRG, Sutter Health, Mammoth Lakes La Grande Hospital
09.2010 - 10.2015
Bachelor of Science - Healthcare Administration
University of Phoenix
Associate of Science - Psychology
Sacramento City College
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