Vanessa Ploessel, MHA

Manage a team of 54 professionals with 8 direct reports.

Accountable for complete revenue cycle including clinical documentation improvement, coding, and billing for multiple hospitals and physicians nationally for outpatient wound care clinics.

Created new revenue streams through implementation of denials prevention of creation of regulatory compliance team. Reduced AR days from 72 to 54 resulting in millions of dollars in additional cash flow.

Successfully settled multi-claim denials for contractual interpretation issues with Anthem, Health Net, and Cigna resulting in multi-million dollar recovery.

Denial recovery of up to 85% and reduction of accounts aged greater than 365 from 27% to 6%.

Implemented self pay collections, standardized charge master, removed routine supply charges remaining revenue neutral.

Centralized authorizations processes and staff for southern CA hospitals saving over $3 million in revenue errors and $250k in reduced salary cost.

Responsible for overseeing client-centric approach to the revenue cycle components, enabling clients to achieve its overall strategic and financial goals. Facilitate communication with leadership and applicable revenue cycle departments at the client site, to ensure that trending issues are analyzed for root causes and corrected upstream in the patient account process.

Develops training programs for billing, coding staff, and creates job aids for medical practice offices to reduce rejects and denials.

Prepares financial analysis for use in the commercial party and managed care negotiation payer process.

Implements and monitors collection procedures, minimizing contractual and bad debt write offs, and maximizing cash collections.

Responsible for creating, formulating, and interpreting Patient Access (PA) Policies and Procedures as well as providing guidance across the entire health system.

Evaluated all hospital locations across the entire health system by conducting regular audits, ensuring adherence to established quality standards and requirements by the admission/registration/front office staff.

Provided detailed reports on quality metrics to senior management, enabling informed decision-making regarding process improvements.

Provide detailed review, coordination, management and strategic planning of technical denials requiring background and understanding from a provider operational and payer logistical perspective.

Manage overturn rate data and evaluates trends for improvement opportunities. Communicate trends and other data findings to senior leadership for consistent and effective feedback to the hospitals and the contracting team to assist in developing and implementing processes to maximize collections on denied accounts.

Work to develop and improve the business and revenue aspects of various departments within the hospital by incorporating efficient and effective business processes, create short and long term obtainable goals, and analyze and research data to help provide thorough insight on root causes.

Assess denials for hospitals across the health system for possible overturn prospects. Work directly with payers both on the phone and through electronic means to resolve denials and receive payment on accounts.

Track and manage denied accounts, including triaging clinical denials to expeditiously evaluate turn over.

Present fact-based information to hospital liaisons on a regular basis on technical denial performance with recommendations on process improvements to avoid denials in the future.

Recognize and escalate consistent issues and trends with payers to support leadership in meetings with payers to resolve issues. Work personally with leadership to comprehend contract specifics and provide contracting with data to support negotiations with payers.

Utilized multiple information systems and resources to research and identify denials and trends from government and commercial payers. Performed follow-up, completes appeals, adjustments and makes referrals to outside agencies for difficult or denied accounts as assigned.

Researched issues related to patient access, care management, billing, and follow-up resulting in denials and delays in payment and reports findings to the Patient Accounting Management Team as appropriate.

Major AR Recovery Accomplishments:

2008 – 2009

• Lowered net A/R days from 60.4 to 55
• Increased back-end cash collections from $30 million to $32 million a month
• Developed and implemented insurance workshops to cross-train billing and collections personnel

2009 – 2010

• Lowered net A/R days from 55 to 49.1
• Increased back-end cash collections from $32 million to $35 million a month
• 85% recovery rate success in denied claims