SONIA RESTREPO
Bronxville
Summary
Accomplished healthcare revenue cycle leader with extensive experience in overseeing professional billing, coding, credentialing, payer relations, and financial operations for a 450-provider physician enterprise. Renowned for driving system-wide transformations, including the optimization of Oracle Health (Cerner Millennium) and the implementation of AI-enabled coding that increased physician charges by 23%. Demonstrated success in accelerating cash flow, reducing accounts receivable, and enhancing operational performance through strategic data analysis and workflow redesign. Skilled communicator with a proven ability to cultivate high-performing teams, and spearhead cross-functional initiatives that yield significant financial outcomes.
Overview
17
17
years of professional experience
Work History
Director of Physician Financial Services
St Joseph's Health System
03.2019 - Current
- Oversee professional billing and collection trends across the organization.
- Successfully transitioned system-wide EMR as Operational Team Lead for network practices. Responsible for design, testing, workflow validation, rollout, and metric capture for dashboard reporting.
- Directed closure of legacy professional billing system (Athena) for the Physician Enterprise, decreasing the outstanding AR to from $25M within one year to $4M.
- The yield improved by 12.2 percentage points on services since 2023 has realized $28.3M of additional cash collections as compared to the baseline.
- Improved cash collections with the creation of 15 automations that helped with insurance denials and decreased the overall AR.
- Decreased days in A/R from 72 to 41 within eighteen months; now at 40 days within organization.
- Designed and implemented provider coding education on various specialties and coding audit policies for 450 providers.
- Redesigned the physician coding team into one streamlined department, reducing coding denials by 27%, implementing AI (Computer Assisted Coding) coding across the organization.
- Increase revenue for the physician medical group in 2024 by 14% from 2023 with AI coding.
- Redesigned payer credentialing team to maximize reimbursement for the onboarding of 450 new physicians & opening of 52 new clinics in 2022 through 2026. Leading to an increase in charges of $3 Million monthly.
- Streamlined denial workflows by automating processes and reducing FTE hours and accelerating cash by an average $300k monthly.
- Collaborated with business office vendor to ensure health plans are paying in accordance with contracted rates with over $3.1M collected as a result of identified underpayments.
- Responsible for the development of insurance credentialing processes for all employed physicians. Increasing the overall participation rate from the medical group from 57% to 93% in 9 months.
- Manages department budgets and ensures operating expenses are within budget.
- Implemented standardized revenue cycle monthly financial performance meetings with the department chairs of each service line.
- Responsible for measuring, monitoring, and meeting key performance indicators and departmental goals in accordance with established policies and procedures by the organization.
- Ensures compliance with applicable laws and regulations as set by the organization.
- Leader of Physician Revenue and Reimbursement Committee for review of best revenue cycle practices for the physician side of the organization.
- Develops and builds relationships across various departments working with leadership and service line stakeholders to develop goals for service lines and programs.
- Spearheaded new business development initiatives that drove revenue growth.
Revenue Cycle Manager
St Joseph's Health system
03.2014 - 03.2019
- Responsible for the accounts receivable of physician billing physician practices with $6 million in monthly revenue.
- Led initiative to revise the department workflows, which resulted in an increase of 23% in physician charges.
- Participated in an organizational-wide initiative to optimize physician credentialing, which resulted in an increase of payments of 16%.
- Oversaw the design and implementation of the Cerner millennium for over 200 ambulatory practices.
- Delivered monthly KPI's to the departmental chairman and executive team on all matters pertaining to physician revenue and denial trends.
- Provide account receivable analytical support and developed operational recommendations to improve reimbursement.
- Created workflows to capture inpatient physician billing.
- Support clinical team members with revenue cycle procedures and address any issues as needed.
- Routinely collaborate with department directors/managers to correct problems and improve patient services.
- Conducted regular audits of financial records to identify errors or inconsistencies in data entry or documentation.
- Provided training on coding updates, changes in billing guidelines, and new software applications.
- Built relationships with internal departments such as clinical staff and finance department, to ensure smooth workflow.
- Utilized data analytics to identify areas of improvement within the revenue cycle process.
- Oversaw daily operations of the revenue cycle department including scheduling resources.
- Coordinated with IT personnel to troubleshoot technical issues related to billing software system.
Senior Executive Account Manager
MD Everywhere, Inc.
06.2009 - 04.2013
- Responsible for the accounts receivable of physician billing for large hospitals and multi-physician practices with $60Million in revenue, including credentialing, denial management, and the third party follow up.
- Coordinated the implementation of new clients using EMR, third party applications, and MD Everywhere applications.
- Provided front and back-end assessments and collaborated with clients to recommend financial strategies that increase revenue for clients.
- Supported and trained clients in the use of all applications to optimize front-end processes, billing flow, and reimbursement to clients.
- Acted as a liaison between MD Everywhere and the client in the coordination of daily activities and special projects.
- Formulated monthly and yearly financial reviews for executive teams.
- Assessed current revenue cycle procedures and implemented improvements to foster efficiency.
- Monitored and guided revenue cycle operations.
- Coordinated with other internal departments and customers to keep operations running smoothly and solve both routine and complex problems.
- Analyzed market trends and competitor activity to identify opportunities for improvement.
- Demonstrated strong problem-solving skills to resolve customer complaints efficiently and effectively.
- Identified areas of improvement within existing accounts, resulting in increased customer satisfaction ratings.
- Utilized excellent communication and interpersonal skills to build relationships with clients and stakeholders, by working closely with all levels of administrative and clinical personnel.
Education
Masters in Business Administration - HealthCare Management
Capella University
Minneapolis, MN04-2024
Bachelors/ Master of Science - HEALTHCARE ADMINISTRATION
University of Phoenix
Phoenix, AZ06-2021
Skills
- Process optimization expertise
- Data interpretation
- Leadership Development
- Relationship building
- Key performance indicator management
- AI/ Computer-assisted coding expertise
- Organizational strategy development
- Financial budget management
- Data-driven decision making
- Financial analysis
- Operations management
- Oracle Health/ Cerner Millennium
- Contract and vendor management
- Athena Software
- Modio Software
- Soarian Financials
- Proficient in Microsoft Office Suite
- Proficient in Spanish
Timeline
Director of Physician Financial Services
St Joseph's Health System
03.2019 - Current
Revenue Cycle Manager
St Joseph's Health system
03.2014 - 03.2019
Senior Executive Account Manager
MD Everywhere, Inc.
06.2009 - 04.2013
Bachelors/ Master of Science - HEALTHCARE ADMINISTRATION
University of Phoenix
Masters in Business Administration - HealthCare Management
Capella University