UNIQUE RAY
Healthcare Revenue Cycle Management
Arlington
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
17
17
years of professional experience
6
6
Certifications
Work History
Senior Denial Prevention Process Improvement Advisor
Ensemble Health Partners
09.2023 - Current
- Lead enterprise-level denial prevention and payer optimization initiatives across multiple acute-care hospitals, managing full project lifecycle from assessment through implementation and performance monitoring.
- Serve as primary client-facing advisor to executive leadership (Revenue Cycle, Finance, Managed Care, Clinical Operations), translating complex healthcare data findings into strategic action plans.
- Manage cross-functional implementation efforts involving HIM, Coding, Patient Access, CDI, Managed Care, and IT to address systemic data integrity and workflow breakdowns.
- Oversee payer platform optimization projects, including RFI workflow redesign and data submission validation, ensuring appropriate utilization of electronic connectivity tools.
- Conduct structured root cause analysis across high-volume 835/837 claims datasets, identifying data anomalies, eligibility discrepancies, authorization gaps, and system configuration issues.
- Implement corrective workflow solutions that reduced first-pass denials, improved clean-claim rates, and strengthened front-end data accuracy.
- Develop standardized reporting dashboards and executive-level analytics summarizing denial trends, financial exposure, and measurable performance improvement outcomes.
- Facilitate stakeholder governance meetings, manage issue logs, track deliverables, and monitor KPI performance to ensure project accountability and sustained results.
- Lead interim operational workaround implementations (e.g., Cath Lab authorization reconciliation workflow) coordinating multi-department communication and measurable denial reduction tracking.
- Identify system-level data inconsistencies (e.g., code mapping anomalies, eligibility classification errors) and partner with technical teams to resolve configuration gaps.
- Supervised team members to ensure project objectives were met.
- Worked remotely to facilitate project communication and collaboration.
- Healthcare Data Implementation & Project Leadership
Senior Charge Description Master Specialist
Providence Health
10.2021 - 09.2023
- Led multi-site healthcare system standardization initiatives during Epic transition and charging workflow optimization.
- Served as liaison between hospital ministries and enterprise revenue integrity leadership to align technical charge capture workflows with regulatory and payer requirements.
- Managed system-wide CDM governance, data integrity validation, and compliance alignment across Meditech and Epic platforms.
- Delivered enterprise-level training on Epic charging workflows, reconciliation work queues, and charge review processes.
- Supported large-scale implementation efforts during Epic go-live events, ensuring data accuracy, workflow readiness, and system adoption.
- Partnered with local revenue integrity leaders to analyze data trends, identify charge capture breakdowns, and implement corrective action plans.
- Remote
RI Coordinator Ethics & Compliance
HCA MEDICAL CITY LEWISVILLE
02.2019 - 09.2021
- Led implementation of structured reconciliation processes for high-risk charging areas including supplies and crash carts, improving charge capture accuracy and reducing revenue leakage.
- Partnered directly with department directors and clinical leadership to redesign charging workflows and ensure operational compliance with CMS, NCCI edits, and payer billing guidelines.
- Provided targeted education to department leads and frontline staff to strengthen documentation accuracy, charge integrity, and regulatory adherence.
- Conducted ongoing denial trend analysis and implemented corrective action plans to prevent repeat compliance and billing errors.
- Ensured hospital-wide compliance with NCCI edits, CMS regulations, and internal audit standards, reducing risk exposure and strengthening financial integrity.
- Collaborated with executive leadership during regulatory audits and compliance reviews, presenting findings and recommending sustainable process improvements.
Revenue Integrity Analyst
CHILDREN’S HEALTH CORPORATE OFFICE
09.2017 - 02.2019
- Direct ongoing CDM reviews ensuring the accuracy and completeness of the departmental charge masters, which encompasses the coordination, monitoring and approval of all changes made to department CDMs.
- Performs retrospective chart reviews comparing clinical documentation to charges posted to patient accounts to assess accuracy and completeness of department charge capture.
- Reduces compliance risks through studying, reporting, and making recommendations related to on-going and emerging compliance issues.
- Capture trending claim edits.
- Performs ongoing monitoring of estimated gross revenue impact, related to already strengthened internal controls, driven by Revenue Integrity audits/reviews.
- Audits Epic preference lists and documentation flow sheet rows quarterly to ensure revenues originating from these charging mechanisms are accurate, complete, and compliant.
- Develops and presents educational material for department management regarding CDM updates and maintenance procedures for billing codes and pricing; procedures for CDM "new item" requests; department-specific changes to charging/billing regulations affecting the CDM.
- Follow-up on billing issues created by charge capture errors.
- Maintains current knowledge of Epic functionality as it relates to charging mechanisms and EAP build.
- Aids staff in clinical areas in relation to the department charges. Resolves errors identified through the Epic work queues.
Senior Charge Capture Analyst
TEXAS GENERAL HOSPITAL CORPORATE OFFICE
10.2016 - 10.2017
- QA coder I & II
- Correct claim errors in Rycan System are preventing claims from being valid.
- Assigns codes in 3M.
- Perform audits to ensure that only correct requested information is submitted to insurance companies and that HIPAA laws are not being violated.
- Analyzes and interprets medical record documentation to determine complete and accurate information for charges on a claim.
- Determines acuity class, procedural levels, injection/infusion charges, & other charges as appropriate
- Completes the paper or electronic charge sheet.
- Scan or import and index the electronic charge sheets into the imaging system.
- Reconcile charges daily using the Revenue Cycle Charge Capture System.
- Serves as a liaison for assigned clinical areas by answering questions related to charge capture issues.
- Maintains reconciliation paper and/or electronic worksheets per retention schedule.
- Works collaboratively with revenue integrity, coding, and other departments to ensure billing edits get processed.
- Educates and trains appropriate staff on charging and coding standards, ensuring accuracy of charging.
Underpayment Analyst- Clinical Appeals
HCA
03.2016 - 10.2016
- Performed follow up with payer for payment as appropriate.
- Verified information from appropriate parties to ensure proper claim disposition.
- Reviewed account information via Legacy and Concuiy.
- Communicated regularly with analysts regarding accounts needing assistance in providing resolutions via Erequests.
- Maintained and updated proper account documents in multiple systems.
- Made written appeals to payers on denied claims.
- Submitted appeals via insurance co portals.
- Communicated daily with other departments via Erequest systems to rectify issues with billing/coding.
- Adhered to the “Code of Conduct” philosophy and “Mission and Value Statement.”
- Met established individual and team goals for volume and value of underpayments identified.
- Applied analytical techniques during report review to remove inaccurate information.
- HCA PARALLON BUSINESS SOLUTIONS
Compliance Analyst
HCA PARALLON BUSINESS SOLUTIONS
01.2015 - 03.2016
- Pulled reports using Batch Net to view which accounts had missing Physician information.
- Worked on bill edits by correcting issues that were preventing the account from final billing.
- Communicated regularly with six HCA facilities regarding Physician edits.
- Ensured physician information was updated in our system for each facility notating accounts in Erequest to communicate with others on how to resolve patient holds.
- Verified accuracy of charges before releasing in Host.
- Monitored and reported potential clinical compliance issues, maintaining records, and ensuring patients’ privacy by following HIPAA guidelines.
- Monitored charge capture activities and collaborated with staff to resolve issues.
- Prepared reports to communicate audit progress and findings.
- Monitors that were given timely filing practices were utilized by reviewing ageing reports to ensure all claims were billed.
Compliance Coordinator
HCA MEDICAL CENTER OF ARLINGTON
08.2009 - 01.2015
- Reviewed all assigned ED charts daily and assigned appropriate E&M level, procedure category, and medication administration charges.
- Entered observation hours in Meditech based on daily nurse auditor report.
- Assisted in the OR by charging for miscellaneous items, Communicating, and documenting recurring documentation issues to department manager/director.
- Worked on special projects assigned by managers, department directors or CFO.
- Took action to ensure that issues of an urgent nature were addressed in a timely and efficient manner.
- Identified the diagnosis text, disposition at discharge, treatment times, level of care and acuity, and charges for procedures and supplies for processing through hospital computer systems.
Education
Master of Science - Healthcare Leadership
East Texas A&M University
05-2027
Bachelor of Applied Arts and Sciences - Health Services Administration
East Texas A&M University
07-2026
Skills
- Healthcare Data Implementation
- Project Lifecycle Management
- Client-Facing Consulting
- Data Quality & Validation
- Claims & Eligibility Data Analysis
- Root Cause Analysis
- Cross-Functional Leadership
- Analytical thinking
- Critical thinking
- Problem-solving
- Training and mentoring
Certification
Healthcare Financial Management Association (HFMA)
Timeline
Senior Denial Prevention Process Improvement Advisor
Ensemble Health Partners
09.2023 - Current
Senior Charge Description Master Specialist
Providence Health
10.2021 - 09.2023
RI Coordinator Ethics & Compliance
HCA MEDICAL CITY LEWISVILLE
02.2019 - 09.2021
Revenue Integrity Analyst
CHILDREN’S HEALTH CORPORATE OFFICE
09.2017 - 02.2019
Senior Charge Capture Analyst
TEXAS GENERAL HOSPITAL CORPORATE OFFICE
10.2016 - 10.2017
Underpayment Analyst- Clinical Appeals
HCA
03.2016 - 10.2016
Compliance Analyst
HCA PARALLON BUSINESS SOLUTIONS
01.2015 - 03.2016
Compliance Coordinator
HCA MEDICAL CENTER OF ARLINGTON
08.2009 - 01.2015
Master of Science - Healthcare Leadership
East Texas A&M University
Bachelor of Applied Arts and Sciences - Health Services Administration
East Texas A&M University