Summary
Overview
Work History
Education
Skills
Timeline
Generic

Valencia Lee

Jacksonville,FL

Summary

Medical billing professional with experience in revenue cycle management. Ensuring efficient financial processes and revenue optimization. Comprehensive experience with medical billing and coding, ensuring accurate and timely submission of claims. Utilizes strong analytical skills to resolve billing discrepancies and manage patient accounts. Knowledge of insurance regulations and compliance requirements, contributing to smooth billing operations and ensuring reliable and consistent results.


Overview

17
17
years of professional experience

Work History

IR A/R Accounts Manager

Valley Radiology, PA
01.2022 - Current
  • Contributing to the daily operations on all issues related to billing, collections, follow-up functions and providing A/R analysis. Responsible for resolving all outstanding A/R for all providers, office, hospital, and outpatient facilities. Billing & submitting claims, corrections, and appeals for previously denied charges by adhering to payer-specific guidelines and utilizing online portals and direct correspondence, resulting in an increase in the successful appeal rate. Verified insurance plan eligibility and benefits by utilizing payer portals and real-time verification systems. reducing claim denials due to missing authorizations by obtaining referrals & authorizations when needed. Corresponding with insurance plans for record request and clinical review. Updating physicians, management, and staff regarding new or updated plan policies and medical requirements. Monthly meeting with billing company accounts manager regarding claims, payment issues and areas of concern.
  • Implemented efficient billing procedures to reduce outstanding receivables and improve cash flow.
  • Streamlined account management processes for better organization and time management.
  • Monitored industry trends to inform account strategy adjustments for maximum effectiveness.
  • Optimized internal communication between departments to address client inquiries efficiently and accurately.
  • Proactively communicated updates and changes in company policies to clients, ensuring their understanding and compliance.
  • Collaborated with managers to provide customer feedback and recommend operational changes to meet emerging trends.

Practice/Billing Administrator

Ponte Vedra Vein Institute
05.2019 - 02.2022
  • Managing and overseeing all daily aspects of the practice/facility operations and functions. Developing and maintaining practice processes & protocols. Continually monitoring for compliance and promptly addressing any compliance issues. Managing business finances, marketing, purchasing office & surgical supplies, collaborating with vendors and sales reps. Maintaining and developing budgets, human resources, processing payroll, financial reporting, measuring cash flow and profitability, handling invoices and checks. Recruitment of new hires, onboarding, training, conducting performance evaluations & reviews. Maintaining provider and employee work schedules, managing staff/patient records, scheduling staff, marketing, and vendor meetings. Maintaining scheduling of all patient visits, diagnostics, and surgical procedures. Obtaining referrals and prior authorizations, providing detailed verification of medical insurance eligibility & benefits, providing visit/ procedure cost estimates to all patients of their financial responsibilities. Establishing payment plans and/or payment assistant for patients. Managing all payments, EOB’s, and correspondence scanned to billing company. Ensuring all information is received, processed, and applied accordingly. Coordinating with the billing company regarding charges, claims, denials, or any other billing related issues. Maintaining all insurance plans/medical policy guidelines are current and relaying any new data, plan changes or any pertinent information to providers and clinical staff. Auditing claims and clinical documentation review. Facilitate patient flow, mitigate patient concerns, with emphasis on patient experience, and communicate with patients regarding inquiries and complaints.

Director of Billing

Precision Imaging Centers
11.2018 - 05.2019
  • Managing all aspects of medical billing, EDI & denials, credentialing, referrals, and authorizations for four practice locations. Responsible for the day-to-day operations of the pre-registration, insurance verification and patient customer service department. Managing 26 staff members and providing all the necessary tools and resources for success. Negotiated and updated insurance payer contracts. Providing A/R analysis, written processes & procedures, and identifying and implementing required education & training for staff & office locations to include payer changes, fee schedules and provider contract information. Continuing education and training of staff regarding proper verification of insurance benefits and eligibility, policy coverage, limitations and/or plan exclusions, referrals, and authorizations. Monthly management of the reconciliation process to ensure all charges/procedures billed. Monthly QA chart audits, tracking trends, modality performance and employee productivity. Implemented SOP’s, processes, and protocols to maximize performance. Analyze month end reports to identify areas of concern and improvement regarding billing, charge entry, payment posting, adjustments and denials. Developed In-House collections for patient balances and delinquent accounts. Created processes and training for Pre-Registration and Customer Service Reps to provide quality patient customer service. Responsible for ensuring the credentialing process for all providers and updating provider payer portals. Mitigate patient concerns, complaints, and billing issues. Monthly staff meetings to provide performance feedback, discuss goals & objectives, claims/billing issues or areas of concern. Monthly executive & management meetings with CEO, administrators and location managers regarding month-end performance, productivity, & P & L’s, goals, and objectives.
  • Trained and mentored staff on procedures, compliance requirements, and collections techniques.
  • Reviewed billing problems, researched issues, and resolved concerns.
  • Collaborated with cross-functional teams to resolve billing-related issues swiftly, minimizing negative impacts on overall operations.
  • Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
  • Implemented policies that improved accounts receivable collections, resulting in reduced outstanding balances and increased cash flow.
  • Boosted team productivity through effective delegation of tasks, setting performance targets, and providing constructive feedback.

Billing Manager

St. Johns Vein Interventional & Vascular Institute
09.2011 - 10.2018
  • Revenue Cycle Management: Responsible for daily operations and management of the practice and business revenue for each office location. Monitoring cash flow, payment trends, and insurance reimbursement according to negotiated insurance payer contract agreements. Analyze month end reports and identify opportunities for process improvements with respect to the claims process and patient billing issues. Implementation of office policy and procedures. Developed process flows to improve submission of claims & payment posting. Resolving claim denials and appeals. Ensuring compliance with HIPAA, CMS and AHCA and all government and state regulatory compliances. Auditing claims and clinical documentation review. Responsibilities included: All Charge Entry, Billing & coding of all services to include office visits, surgical procedures, and diagnostic testing. Ensuring all patient encounter forms were received daily, reviewing all medical records & operative reports for proper procedural, diagnostic, E & M coding, and diagnosis. Follow-Up & Collections, EDI and denials management, appeals, payment posting, verification of insurance eligibility & benefits. Patient Financial Counseling, verifying insurance benefits, providing cost estimates, and setting up patient payment agreements. Third-Party Collections. Managing business banking account statements, credit card reconciliation, accounting ledgers and QuickBooks. Credentialing, managing & maintaining physician files & updates, CAQH, and National Data Bank information. Management of Accounts Receivables & Accounts Payables. Human Resources-processing all new hire documentation and paperwork. Managing company 401K plan enrollments. Processing company payroll. Maintaining & updating medical insurance payer contracts. Monitoring all insurance plan Medical Policy Guidelines, negotiating insurance/provider contracts, and updating provider fee schedules. Educating and training front office staff to assist with verification of insurance plans eligibility, benefits, and authorizations. Monthly meetings with the CEO regarding month-end performance, productivity, and any pertinent billing issues and areas of concern.

Billing Manager

21st Century Oncology of Jax
06.2010 - 08.2011
  • Managing the daily functions and operations of the Billing Department. Ensuring daily charge entry, billing & coding, claims submissions, payment posting, follow up and collections and accounts receivables were captured and entered daily. Responsible for monthly reporting and monitoring payment trends, adjustments, and collections. Implemented policies, protocols, and SOP’s. Maintaining insurance plan contracts and fee schedules. Monitoring all claims payments, daily accounts receivables and cash flow. Monthly reporting to the administrators and corporate office on all business revenue, performance, and productivity. Responsible for hiring and training staff. Managed employee timecards and submitted payroll for all billing employees. Conducted performance evaluations. Monthly meetings with administrators and location managers regarding month end performance.
  • Reviewed contracts for accuracy before finalization, ensuring that all agreed-upon terms were documented correctly per customer negotiations.
  • Maintained up-to-date knowledge of industry regulations and compliance requirements, ensuring the department remained compliant at all times.
  • Collaborated with cross-functional teams to resolve billing-related issues swiftly, minimizing negative impacts on overall operations.
  • Created a transparent work environment that fostered open communication between team members, promoting collaboration and problem-solving skills development.

Billing Manager

Digestive Disease Consultants
04.2008 - 06.2010
  • Responsible for the daily management of the Billing Department and employees. Responsibilities included ensuring all daily functions, processes and billing transactions were completed promptly. Tracking patient census, hospital and office encounter forms to ensure all patient information and charge data documented. Verification and processing of all inpatient & outpatient hospital charges. Monitoring productivity & claims reimbursement. Reviewing reports for billing issues, denials, and areas of concern. Processing patient refunds. Month end reconciliation and reporting. Monthly and quarterly reporting. Perform QA audits, tracking trends and each office & physician productivity. Responded to patient inquiries, setting up payment plan agreements, sending delinquent patient accounts to outside collections agency.
  • Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
  • Trained and mentored staff on procedures, compliance requirements, and collections techniques.
  • Reviewed billing problems, researched issues, and resolved concerns.
  • Collaborated with cross-functional teams to resolve billing-related issues swiftly, minimizing negative impacts on overall operations.
  • Reduced errors and discrepancies in invoicing by closely monitoring billing data and conducting regular audits.
  • Implemented policies that improved accounts receivable collections, resulting in reduced outstanding balances and increased cash flow.
  • Boosted team productivity through effective delegation of tasks, setting performance targets, and providing constructive feedback.
  • Conducted performance reviews and implemented improvement plans.
  • Worked with customers to develop payment plans and bring accounts current.

Education

Associate of Science - Business Administration

Florida Community College
Jacksonville, Florida
06.1990

Skills

Core Competencies:

  • Account management
  • Cash flow management
  • Payment tracking
  • AP and AR management
  • Month-end reporting
  • Invoicing
  • Payroll processing
  • Payroll management
  • Account reconciliation
  • Microsoft Office
  • Excel
  • Word Documents
  • QuickBooks
  • Accounting

Technical Skills:

  • Epic
  • Allscripts
  • Meditech
  • Medic
  • Window Path
  • Mysis/Mysis Tiger
  • Athena
  • StreamlineMD
  • StreamlineMD PM Plus Management
  • MedInformatices
  • EBC
  • CZAR

Timeline

IR A/R Accounts Manager

Valley Radiology, PA
01.2022 - Current

Practice/Billing Administrator

Ponte Vedra Vein Institute
05.2019 - 02.2022

Director of Billing

Precision Imaging Centers
11.2018 - 05.2019

Billing Manager

St. Johns Vein Interventional & Vascular Institute
09.2011 - 10.2018

Billing Manager

21st Century Oncology of Jax
06.2010 - 08.2011

Billing Manager

Digestive Disease Consultants
04.2008 - 06.2010

Associate of Science - Business Administration

Florida Community College

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Valencia Lee