Summary
Overview
Work History
Education
Skills
Timeline
Generic

Wanda Helmage

Corona,CA

Summary

Results-focused Director of Revenue Cycle Management offering extensive progressive leadership experience in professional and facility revenue cycle management. Transforms high potential staff into outstanding leaders who demonstrate creativity and savvy that is critical to financial and operation success.

Overview

26
26
years of professional experience

Work History

Director of Revenue Cycle Management

LA Laser Center
Gardena, CA
04.2018 - Current
    • Oversee the day to day RCM operations for 40+ medical clinics and 10 ambulatory surgery centers.
    • Partnered successfully with providers and clinical staff to produce and increase revenue.
    • Work collaboratively with operations team as well as senior leadership to identify, install, and manage, revenue performance improvement initiative.
    • Implement SOP's for revenue standards to appeal low reimbursement and invalid denials, ensuring that A/R is worked to bring maximum physician reimbursement.
    • Extensive knowledge of the healthcare professional revenue cycle environment, application of strategic AR workflow, and strong understanding of RCM principles.
    • Provide monthly reporting to senior leadership.
    • Responsible for monitoring overall staffing levels.
    • Meet regularly with management, team leads, and billing and collection staff to communicate progress, set goals and address problems.
    • Maintain current knowledge of full cycle RCM operations.
    • Performed month end close routine.
    • Established and updated work schedules to account for changing staff levels and unexpected workloads.
    • Established and developed highly-efficient and dependable administrative team by delivering ongoing coaching and motivation while providing opportunities for career acceleration through achievements
    • Identified issues, analyzed information and provided solutions to problems
    • Exceeded goals through effective task prioritization and great work ethic
    • Resolved conflicts and negotiated mutually beneficial agreements between parties
    • Used critical thinking to break down problems, evaluate solutions and make decisions
    • Maintained excellent attendance record, consistently arriving to work on time
    • Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork

Billing Director

Physician's Choice Management Group
Buena Park, CA
09.2005 - 04.2018
  • Oversee the day to day billing operations of multi-specialty physician regarding implementing ways to increase revenue.
  • Educate, supervise and mentor over 15 team members of billing revenue management.
  • Communicate with physicians, mid- levels, front and back off on proper use of modifiers, diagnosis codes, CPT codes, TAR, HMO authorizations, timely filing issues, requesting retro authorizations to eliminate delays in processing claims which will aid in maximizing their production.
  • Oversee and established department protocols such as attaching all critical documentation to required claims to reduce denials and pending claims as well as EOB review to verify maximum reimbursement.
  • Follow and implement revenue standards to appeal low reimbursement and invalid denials, ensuring that A/R is worked to bring maximum physician reimbursement.
  • Submitting of patient statements for co-insurance, deductibles, and patient responsibility.
  • Completion of CIF's, RTD's, submitting appeal letters for additional reimbursement. Provide monthly reporting to all Clients.
  • Responsible for monitoring overall staffing levels to meet the needs and goals of PCMG's Clients.
  • Meet regularly with management, team leads, and collections and billing staff to communicate progress, set goals and address problems.
  • Maintain current knowledge of billing, coding, Compliance, and reimbursement laws, regulations, and industry standard of practice

Billing Director

University Physicians Healthcare
Santa Fe Springs, CA
12.2002 - 08.2004
    • Plan, organize, direct and control Physician billing and collection function for 35 Clinics, specializing in following insurance: Medi-Cal, Medicare, Family Pact, BCEDP, CHDP, HMO and PPO.
    • Implemented policies and procedures for billing and collections. 'Streamlined operations and prioritized tasks, allowing senior staff to increase revenue by 25%
    • Assist and train staff in maximizing their production.
    • Utilize numerous reports for staff to assist in collection efforts. Develop office procedures, reference materials and training programs for staff members: review, troubleshoot, and resolve complex account problems with staff; conduct random correspondence reviews; interview and correspond with patients, outside agencies and insurance carriers in order to secure.
    • Collection on overdue accounts; propose or recommend solutions to operational areas, or processing problems; implement procedures which allow staff to be shifted to areas with heavy inventory demands. Prepare monthly summary reports for assigned clinics. Maintain current knowledge of billing, coding, compliance, and reimbursement laws regulations, and industry standard of practice.
    • Work with CEO to address human resource issues of concern, such as hiring, terminating, or disciplinary action.

Medical Billing and Collections Manager

Practice Management Group
Culver City, CA
04.1995 - 08.2002
    • Oversee day to day operations of multi-specialty Physician Billing Company, assigned to UCLA Physician billing account.
    • Responsible for all billing and collection functions.
    • Maintain current knowledge of billing, coding, and reimbursement laws, regulations and industry standard of practice.
    • Responsible for managing multi-specialty A/R's in excess of $20 million dollars.
    • Responsible for overseeing 30 employees during billing and collection process to include; ongoing and special training, account problem resolution and troubleshooting, assigning staff to accounts to provide coverage, and annual employee evaluation.
    • Specialized in following insurance: Medi-Cal, Medicare, IPA, Grants, PPO's/HMO's, CPSP, CHDP, and PVT.
    • Works with Vice President to address any human resource issues or concerns, such as hiring, terminating or disciplinary actions.
    • Assign staff to special projects and monitor progress.
    • Responsible for monitoring overall staffing levels to meet needs and goals of PMG's Clients.
    • Meet regularly with management, team leads, and collections and billing staff to communicate progress, set goals and address problems.

Education

Nursing

Vocational Nursing School
Los Angeles, CA

Skills

  • Professional billing experience includes
    Internal Medicine, Dermatology, Cardiology, Orthopedics, Urology, Maxillary Facial, Pediatrics, OB/GYN, Neurology, Cardio thoracic, Plastics and Psychiatry, Pulmonary, Opthalmology
  • Experienced with multiple payers in multiple states
  • Technical software experience includes E Clinical EHR, Office Ally EHR, Platinum MD EHR, Medisoft, SMS (UCLA), Medical Manager, Nextgen, EMA, Modernizing Medicine, Practice Partner, EPIC, Brickell
  • Credentialing
  • Contract Negotiation
  • Consulting
  • Oversee daily clinical operations
  • Microsoft Office Suite
  • Time management proficiency
  • Front and Back Office Management
  • Goal Management
  • Strategic planning
  • Business Development
  • Staff Management
  • Planning and Coordination

Timeline

Director of Revenue Cycle Management

LA Laser Center
04.2018 - Current

Billing Director

Physician's Choice Management Group
09.2005 - 04.2018

Billing Director

University Physicians Healthcare
12.2002 - 08.2004

Medical Billing and Collections Manager

Practice Management Group
04.1995 - 08.2002

Nursing

Vocational Nursing School

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Wanda Helmage