Summary
Overview
Work History
Education
Skills
Websites
Certification
Timeline
Generic
Sylvia J. SanMiguel

Sylvia J. SanMiguel

Mesa

Summary

Results-driven leader adept at guiding high-performing teams and implementing strategic initiatives to drive business success. Known for fostering collaborative environment and achieving measurable milestones. Exhibits strong leadership and adaptability to changing business needs.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Senior Director of Revenue Cycle Management

Alium Health
04.2024 - Current


  • Report to CFO for all RCM oversight.
  • Restructure of Billing Dept and management of daily production work.
  • Cleared backlog of previous held A/R prior to my arrival.
  • Reduced LAG from over 2 years to less than 3 days.
  • Designed new workflows and created functionality within their billing system.
  • Set KPIs for RCM roles.
  • Reduced A/R Aging from over 4 years to less than 35 days.
  • Collaborated with Clinic Operations for SOPs and best practice solutions to drive RCM success.
  • Reduced denials and found improvements to keep near zero.
  • Oversight of project team leading in conversion from Athena One to NextGen EPM.
  • Project implementation of conversion from Athena to NextGEN for end to end billing functions.
  • System configuration work in NextGen to facilitate efficiencies in EHR/EPM functions.

Director of Revenue Cycle Management

Valley Perinatal Services
05.2021 - 04.2024
  • Reduced/restructured/cross-trained RCM teams; Authorizations, Charge capture, Billing, Coding, Collections and Credentialing for improved performance and increased competencies.
  • Created new/improved workflows for clinic and hospital service lines charge capture.
  • Implemented new application for tracking fee schedules, underpayments and for estimates of services to patients for prepayment collection.
  • Identified denials for improved coding and recovery of any loss of revenue.
  • Trained Coders for greater proficiency and how to find areas of opportunity in provider documentation to maximize reimbursement.
  • Identified areas of missed revenue in charge capture and created processes for charge reconciliation.
  • Reduced lag from 30 days to less than 7 days.
  • Senior Coder/Biller for Surgical and procedures by Maternal Fetal Medicine Clinic/Hospitalists and Hospital services.
  • Cross-collaboration with Operations for Compliance areas and for improvement of documentation for maximum revenue.
  • 30-38 Day A/R

Associate Director, Coder Physician Practices

Banner Health
05.2009 - 03.2021
  • Ambulatory operational support of remote workforce; 3 Coding Managers and 30 Coder direct reports that cover Hospitals, Academic Departments and Clinics in AZ, CO, WY and NE.
  • Oversight of daily production ambulatory coding; E&M visits, procedures and surgeries with charge capture to meet performance goals and metrics.
  • Educator to physicians through analysis of clinical documentation for charge integrity and RVU improvement.
  • Cross-collaboration with practice leadership, financial analysts and coding depts to find revenue opportunities.
  • Analysis of coding denials for purposes of revenue recovery and creation of process improvements.
  • Management of staffing levels of areas through hiring and onboarding/training practices.
  • Knowledge of end-to-end revenue cycle; claim submission, claim edits, billing practices, payer specific coding requirements, payment methodologies, payment posting and reimbursement.
  • 96% Leadership Effectiveness score as of 2021
  • Top 10% of Leaders (out of 50,000 employees) for 2018, 2019 and 2020.

Senior Practice Manager

05.2009 - 01.2012
  • Management of hospital and clinic-based physician practices in Critical Care, Neurology and Urology specialties.
  • Set-up of new outpatient clinics for Neurology and Urology practices at BGSMC and BDMC.
  • Oversight of 18 physicians, front and back office clinical and support staff at various sites.
  • Physician coding educator to providers for E&M, procedures and DX guidelines.
  • Implementation of productivity measures and/or internal protocols for billers and coders.
  • Representative for physicians in committees, meetings and other event attendance as needed.
  • Developed and maintained strong relationships with physicians and other staff in hospitals and clinics.

Healthcare Consulting and Practice Management services

Self-Employed
12.2007 - 12.2010
  • Contract certified coding, physician coding education, medical billing, EOB and patient payment posting, denials research/auditing for loss of revenue and recovery of monies, credentialing, marketing, practice administration/management and software conversion services.
  • Clients included an OB/GYN provider and behavioral health therapists at CHILDHELP USA and a Scottsdale psychotherapy clinic.

Billing Manager/Certified Coder

Southwest Sports Medicine
12.2007 - 03.2008
  • Established billing department and management of staff for charge entry, claim submission, payment posting, collections and grievance filing.
  • Denials management and auditing (successfully recovering $170,000 for loss of revenue in clinic visits and procedures for prior year (in first 6 months).
  • Sole coder for orthopedic private practice; coding of surgeries, outpatient procedures, clinic, physical therapy and radiology services.
  • Physician coding educator for physical therapy, clinic and hospital visits/procedures and research of new technologies in procedures.

Education

CPC Certification -

AAPC
11.2012

CCS-P Certification -

AHIMA
01.2010

ICD-10 Trainer - undefined

AHIMA
01.2015

undefined

Mesa and Phoenix Community College

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Mountain View High School

Skills

  • Team management
  • Staff development
  • Operations management
  • Organizational development
  • Practice operations management
  • Administrative oversight
  • Innovation management
  • Verbal and written communication
  • Process improvement
  • Stakeholder engagement
  • Performance management
  • Risk management
  • Regulatory compliance
  • Collaborative leadership

Websites

Certification

  • 2024-2025: Coding support at Alium for all services.
  • 2021-2024: Coding support at Valley Perinatal Services.
  • 2009-2021: Denials Coder at Banner Health (second job)
  • 2018: Coding support at Banner Health in Radiology.
  • 2007-2008: Coding support at SW Sports Medicine.
  • 2005-2007: Sole hospital coder at AZ Orthopedic Hospital.
  • 2006: Contract coder at VA Hospital.
  • 2004-2005: Outpatient coder at Dignity Health.
  • 2002-2004: Sole hospital coder at AZ Spine and Joint Hospital.
  • 2001-2002: Outpatient coder at Banner Health.
  • 1999-2001: Inpatient/Outpatient Certified Coder for High Risk OBGYN/MFM at Obstetrix/PPA.

Timeline

Senior Director of Revenue Cycle Management

Alium Health
04.2024 - Current

Director of Revenue Cycle Management

Valley Perinatal Services
05.2021 - 04.2024

Associate Director, Coder Physician Practices

Banner Health
05.2009 - 03.2021

Senior Practice Manager

05.2009 - 01.2012

Healthcare Consulting and Practice Management services

Self-Employed
12.2007 - 12.2010

Billing Manager/Certified Coder

Southwest Sports Medicine
12.2007 - 03.2008

ICD-10 Trainer - undefined

AHIMA

undefined

Mesa and Phoenix Community College

undefined

Mountain View High School

CPC Certification -

AAPC

CCS-P Certification -

AHIMA

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