Sylvia G. Guajardo
North Richland Hills,TX
Summary
Introduction Summary: As my ongoing title of Corporate Revenue Reimbursement Analysts that is detailed oriented with 10+ years of experience in RCM in the Health Care Industry. Proven strengths in account planning and payer contracting management, Tracking variances between anticipated and actual revenues and recommending course corrections. Eager to contribute in senior-level role.
Overview
13
13
years of professional experience
Work History
Revenue Cycle Reimbursement Analysts
Cornerstone Health Group
06.2017 - Current
- Conducted data review and followed standard practices to find solutions for less financial impacts .
- Controlled and manged all payers contract and their rates in CBO software system including but not limited to Commercial, State Medicaid, Workers Comp and Medicare 3m Groper government CCR for 16 Hospital in and out patient statuses
- Determined root cause of payment deviations and implemented appropriate corrective and preventive actions throughout product development process.
- Analyzed financial and statistical data related to revenue cycle, creating in-depth reports to show CFO's.
- Collaborated with other businesses management Administrators to help streamline tasks and duties in effort to improve overall profit efficiency.
- Utilized payer revenue cycle information in easily understood terms to educate Patient Access and collection team representatives on how to avoid authorization denials
- Tracked and reported variances between OON revenue payer's and actuals which increased payers payments by 30%.
- Led small team of 5 in managing accounts valued up $75,000 to but not limited to $1million inpatient revenue payment. With increased payer follow up of every 14 to 30 days based on Periodic billing.
- Conducted in depth researched on revenue cycle data to deliver to upper management and executives for Quarterly and year end cost reporting.
- Used DDE and Excel to identify Medicare A/P financial trends.
- Balanced and reconciled accounts Daily, weekly and Monthly.
- Participated in RCM meetings to discuss financial analysis and strategies to lower DSO.
- Monitored Multi payer markets Reimbursement methods to identify emerging trends that would effect over all Revenue Cycle outcomes to Director .
- Coordinated with financial advisors to develop long-term strategies avoiding Revenue impact by providing payer reimbursement's trends.
- Maintained precise and accurate charts and reports tracking Medicare and managed Medicare reimbursements for DRG down grade and LTCH criteria's met for Site Neutrality standards IPPS payments.
PFS Level IV Specialist
Christus Health
05.2016 - 06.2017
- Managed and responded to correspondence and inquiries from payers.
- Effectively communicated with clients about payment needs and ongoing updates, for detailed accurate ledgers.
- Managed complex problem-solving for upper management in order to complete projects on-time and within budget.
- Reconciled account information and reported figures in CBO software system.
- Reconciled accounts, managed audits and updated financial records with remarkable accuracy.
- Presented audit findings to accounting manager after reviewing results and paperwork.
- Input financial data and produced reports using PCON
- Gathered, evaluated and summarized account data in detailed financial reports.
- Reduced financial discrepancies effectively by push through 14 - 30 day regulatory calls to payers following up on payments when denials have been appealed.
Revenue Cycle Analyst
Vibra Healthcare
08.2013 - 05.2016
- Communicated revenue cycle information to Collection team members in easily-understood terms.
- Tracked and reported variances between revenue plans and actuals.
- Applied quarterly evaluations of revenue cycle processes for recommendations to senior management.
- Used account receivables reports to offerer revenue improvement for newly purchased Hospitals.
- Reached out to insurance companies to verify coverage.
- Identified and resolved payment issues between patients and providers.
- Audit general ledger payment journals needed to be reconciled for financial statement.
- Processed multiple payer type A/P and A/R repots as needed for month end RCM close.
Medical Records Coordinator
SCC Corp
07.2012 - 08.2013
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Uploaded records to patient's individual vault.
- Kept accurate log of requests for medical information and records.
- Recorded patients' medical history, status, services provided and other information necessary for compliance with reporting requirements.
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
- Established and managed policies for completing, coding, signing and indexing records.
- Maintained patient records systems by archiving, scaning and indexing important documents and files.
- Reviewed charts and flagged incomplete or inaccurate information.
- Analyzed complex medical records to identify discrepancies in accuracy and completeness.
- Assisted in preparation of medical records to release to other medical facilities requesting for patient history and information.
- Created and uploaded PHI ADR files to Medicare web portal for 1st and 2nd SNF denials.
- Following HIPPA Compliance's Prepared patient clinicals with payer denials including appeals for Attorneys regulatory ADJ hearings.
Lead Patient Access Representative
Convergent
04.2010 - 07.2013
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Providing excellent customer service by promptly answering patient inquiries.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Trained new staff on hospital processes and procedures.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Resolved patient billing issues in line with established guidelines.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Addressed bad debts in line with set protocols.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Processed payments using cash and credit cards, maintaining accurate records of transactions.
- Verified patient insurance eligibility and entered patient information into system.
- Followed document protocols to safeguard confidentiality of patient records.
- Applied administrative knowledge and courtesy to explain procedures and services to front end staff
- Delivered support to medical staff in completion of patient payments and minimize complaints .
- Implemented software coding program to support clean claims process by 40%.
Education
No Degree - Finance
North Lake College, American
Irving, TX02.2018
Certificate - Procedural Medical Coding Curriculum
AAPC
Denton, TX06.2011
Certificate - Medical Billing And Coding
Anthem Allied Health Technical Institute
Irving, TX03.2007
Skills
- Skills/Competencies:
- Medical Terminology, Coding & Microsoft applications
- Knowledge of provider contracting, financial arrangements fee schedules including CMS methodologies & Guidelines
- Experience evaluating potential new products ,including but not limited to services & programs with MCR, MCD WC, and Commercial payers
- Excellent oral, written and interpersonal communication skills
- Extensive knowledge of cost reports database and data analytical technology of cost to charge MCR ratios In the revenue Cycle MgmtFollow CMS Billing Regulations through payer web portal
- Modeled Contracts administrator
- Software Experience;
- OAS Gold
- Excel
- DDE
- McKesson
- Waystar
- Wellsky
- ClaimRemedi
- HMS\MedHost
- Availity
- Meditech
- My MCR Data MVP
- EPIC
- E solutions
- PECON
- HFS
- Account Reconciliation's
- Financial Journal Audits
- Account Planning and Management
- Revenue Operations
- Insurance Collaboration
- Revenue Forecasting
- Invoice and Payment Tracking
- Best Practices and Standards
- Senior Management Updates
- Medical Billing
- Past Due Balance Management
- Accounts Payable and Accounts Receivable
- Revenue Cycle Process Improvements
- Charge Capturing
- Verbal and Written Communication
- System Updates
- Procedural Codes
- Diagnostic Codes
- Records Coordination
- Consolidation Reporting
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Never forget that we are just people working with people!
Sylvia G. Guajardo
Timeline
Revenue Cycle Reimbursement Analysts
Cornerstone Health Group
06.2017 - Current
PFS Level IV Specialist
Christus Health
05.2016 - 06.2017
Revenue Cycle Analyst
Vibra Healthcare
08.2013 - 05.2016
Medical Records Coordinator
SCC Corp
07.2012 - 08.2013
Lead Patient Access Representative
Convergent
04.2010 - 07.2013
No Degree - Finance
North Lake College, American
Certificate - Procedural Medical Coding Curriculum
AAPC
Certificate - Medical Billing And Coding
Anthem Allied Health Technical Institute
Additional Information
- Links; http://www.linkedin.com/in/sylvia-g-1b954970
References upon Request
References Upon Request
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