REVENUE CYCLE MANAGER
CLEMENCEAU MEDICAL CENTER ( HOSPITAL)
مجموع سنوات الخبرة :18 years, 7 أشهر
Project Management & Business Development
1. Part of project team reviewing the vendor solutions for patient order entry workflows.
2. Involved in identified vendor solution workflow that would optimize patient flow
3. ERP-Vendor & Regulators involved - 3M, DHA-Eclaims, Bestcare, IQVIA, Infor- SCM.
4. Identification of key integration points b/n vendor applications (Physician order, Billing & Claims Module, 3M, Inventory Flow for billing)
5. Worked with Management team to identify "Focus speciality Centres” the hospital.
6. Charting target market with business development to identify immediate patient volumes for the hospital.
7. Identifying Health programs with Clinical & Quality, for the hospital’s model of care.
7. Supported the accounting team to identify Doctor’s contract payment module inputs.
8. Decision Support Inputs for Remittance management for A/R flow- Finance.
Revenue Cycle Operations Strategy
1. Identifying patient access for Insurance empanelment and contracting needs.
2. Charge Master & Pricing Strategy for targeted health insurance contracts.
3. Identification of workflows b/n all RCM stakeholders (Clinical & Non-Clinical).
4. Process identification b/n EMR and ERP- Vendor solutions for user management.
5. Program Plan for DRG implementation based on DHA eclaims.
6. Inpatient Discharge process focus on; Admit- Physician Clearance- Nursing, Pharmacy and Consumable order Clearance- Visiting Closing- Finalization of Coding & Claims.
7. Working with IT integration team to ensure GAPS identified as part of process non-compliance was addressed with necessary CR changes.
8. Focused on Real time data flow scenarios b/n Bestcare (EMR) & IQVIA (RCM ERP) to establish a patient visit closing target of 70% and further improve it, post Go Live.
9. Patient Access management process flows (Appointments-Eligibility Verification- Patient Counselling & Patient Visit closing processes)
Insurance Pricing and Contracts Management
1. Handling 11 units (1 Day surgery, 3 medical clinics, 2- Emirates Catering Corporate clinics, 2- Transguard gatekeeper clinics, 3 pharmacies - Deira, Immigration, Muhaisnah)
2.Identified GAPS & enhanced "Scope of Service additions" in the CDM tariff with insurance companies. (350+ addition of services resulting in 18% of additional service utilization)
3. Identified and successfully initiating Pricing enhancement with all established Insurance providers in the UAE.
4. Corporate pricing with scope specific initiatives of ATMC medical group.
5. Establishing corporate & wellness initiatives with Insurance companies adding to provider acceptance & confidence.
6. Strategic pricing strategy for the upcoming hospital in 2019 (W.I.P.).
Business Development & Revenue Cycle Operations Strategy
1. Identifying market competencies to draw optimal revenue streams.
2. Enhancing patient network matched to patient base near to the branch centres of the group.
3. Working with governmental compliance achieving an interconnected health referral network.
4. SWOT analysis end solutions & process flow improvement initiatives for patients point of contact & end to end responsibilities b/n all RCM stakeholders.
5. Ensuring operations team work within the code of SLA's established inter-departmentally.
6. Patient Access management (Appointments-Authorization-Billing & Financial counselling processes)
Payment Reconciliation Strategy (EMR, Claims Reconciliation, Medical Coding & Documentation)
1. Identified full & final closure of 2017 claims through both QTD & YTD FY closures with Finance.
2. Identifying minimum & speciality specific standards through constant training and orientation for physician coding and documentation needs.
3. Speciality wise Rejection orientation with Doctors to reduce medical necessity rejections.
4. Same day EMR completion with a focus on coders - physician interactive initiatives, activating service exclusions, blocking unlisted CPT / HCPCS code usage, insurance specific coverage reducing medical rejections.
5. Implemented 4 cycles of claims submissions & 3 cycles of denial resubmission per month, resulting in improved payment recovery.
Hospitals Pricing Strategy
Performs periodical payer contract performance assessments (utilization review)
Support and Facilitate on Insurance negotiations & pricing strategies
Ensure knowledge distribution to teams of all contract and coverage guidelines.
Worked extensively on the Insurance pricing tariff to curtail gaps seen on the current Service List. (Original List 2500-4000 services, Finalised List 7800 services, 52% improved service availability)
Claims Cycle Strategy
Claims Submission activity increased to 3 times a month, from the previous monthly submissions, to improve average collection period.
Rolled out Auto-Reconciliation of payment remittances in order to cut down lost time on resubmissions.
Accuracy rate of 81% achieve in a span of 5 months with improved payment collections (currently 68-92 days, originally 95-150 days)
Rolled out DRG utilization analysis, to improve reimbursement efficiency.
Final Sign off completion for old financial years to bring insurance collection & reconciliation needs live up to 2016 claims. (Work in-progress on 2016, 2017 Q1 sign offs with Insurance companies)
Operations & Insurance Functionaries
Part of the Business Transformation Committee to suggest and facilitate improvement initiatives in areas of operations and insurance revenue efficiencies.
Ensured billing of System Duplicated CPTs was minimized (reduced billing errors by 22%)
Identified deficit Staffing & Departmental structure strategy for insurance management.
Active Policy Management Committee Member.
Built the Physician & Nursing Insurance Working Committee to identify root cause of documentation causing charging & diagnosis inefficiencies.
Introduced Bi-Daily Charging Rounds (IP Billing) across the hospitals to reduce last minute charging of services which was contributing to 18% of technical denials.
Supporting patient affairs executives with best practices to Clinical orders optimization and utilization.
Currently working with Coding committee - with medical coding team to identify service wise accuracy for documentation and claim needs. Objective is to build rules within the HIMS system for reduced coding and billing errors.
Revenue Cycle Management
•Successful working and assisting on Insurance contract negotiations & pricing strategies
•Performs periodical payer contract performance assessments.
•Comprehensive working knowledge of all contract and coverage guidelines.
•Worked on Self pay pricing feasibilities for both local and international patients.
•Mystery shopping skills to compare market bench market and strategize pricing initiatives
•Initiating end user problem identification & decision support in facilitating operational improvement initiatives.
•Optimized the CCI claim edits utility reducing billing errors by 38% & optimized billing reimbursements.
•Providing optimal solutions for age trial balance, claims recovery & reconciliation
•Improved reimbursements rates by 18% after the initial six months of accounted reimbursements.
•Performs periodic analysis of CPT, HCPCS, DRGs, ICD-9 or ICD-10 or any other
healthcare codes.
•Workflow orientations with Patient Access, Billing, HIMS & Clinical staff to ensure compliance & best practices.
•Decision-making by providing an analysis of options regarding which insurance payers CCAD will contract with that will allow for maximum revenue realization.
•HIS implementation in line with HAAD claims adjudications and compliance.
•Alignment of chargeable versus non-chargeable services.
Hospital Operations
•Key Project Start up team member- Revenue Cycle, Finance.( from June 2013 till Go live- Q1 2015)
•Orientation of newly recruited staff to CCAD's culture & values.
•Clear understanding of environment current & best practices in the Abu Dhabi & rest of UAE
•Working extensively with supply operations to ensure chargeability of high cost surgical supplies critical to delivery of service matched at 87% accuracy.
•Supporting patient relations with best practices to Clinical orders optimization and utilization through EPIC.
•Successfully worked with Business intelligence analysts to facilitate and determine the impact of cost-revenue allocation across the clinical departments.
•Identified key training initiatives for clinical & non-clinical operations that helped clinical & order documentation match with the services provided - this translated to 30% improvement of documentation within 6 months actioning the exercise.
•Working with clinical and non-clinical areas in the Maintenance of Policies & Standards as per JCI & HAAD regulations.
Revenue Cycle Management
•Successfully working on Insurance contract negotiations & pricing strategies
•Performs periodical payer contract performance assessments.
•Comprehensive working knowledge of all contract and coverage guidelines.
•Worked on Self pay pricing feasibilities for insurance and cash patients.
•Mystery shopping skills to compare market bench market and strategize pricing initiatives
Initiating end user problem identification & decision support in facilitating operational improvement initiatives.
•Optimized the CCI claim edits utility reducing billing errors by 38% & optimized billing reimbursements.
•Providing optimal solutions for age trial balance, claims recovery & reconciliation
•Improved reimbursements rates by 18% after the initial six months of accounted reimbursements.
•Performs periodic analysis of CPT, HCPCS, DRGs, ICD-9 or ICD-10 or any other healthcare codes.
•Workflow orientations with Patient Access, Billing, HIMS & Clinical staff to ensure compliance & best practices.
•Decision-making by providing an analysis of options regarding which insurance payers CCAD will contract with that will allow for maximum revenue realization.
•HIS implementation in line with HAAD claims adjudications and compliance.
•Alignment of chargeable versus non-chargeable services.
Hospital Operations
•Key Project Start up team member- Revenue Cycle, Finance.( from June 2013 till Go live- Q1 2015)
•Orientation of newly recruited staff to CCAD's culture & values.
•Clear understanding of environment current & best practices in the Abu Dhabi & rest of UAE
•Working extensively with supply operations to ensure chargeability of high cost surgical supplies critical to delivery of service matched at 87% accuracy.
•Supporting patient relations with best practices to Clinical orders optimization and utilization through EPIC.
•Successfully worked with Business intelligence analysts to facilitate and determine the impact of cost-revenue allocation across the clinical departments.
•Identified key training initiatives for clinical & non-clinical operations that helped clinical & order documentation match with the services provided - this translated to 30% improvement of documentation within 6 months actioning the exercise.
•Working with clinical and non-clinical areas in the Maintenance of Policies & Standards as per JCI & HAAD regulations.
•Over 6 years experience at Mediclinic Welcare Hospital and Mediclinic Ibn Battuta serving as an Officer in Insurance Relations & Claims Management
•Part of the Startup commission team for Medi clinic Ibn Battuta (6 months)
•Key focus on revenue cycle workflow process (Supply chain consumption process; Patient relations process; HIS implementation; Clinic claims billing; Claims submission process; Claims payment, Revenue realization and reconciliation workflow process)
•Liaising directly with Network coordinators of insurance companies for entering into contractual agreements, upgrade validation & renewal of insurance network with the group along with tariff updations.
•Actively involved along with all insurance coordinators of the group level in liaison with the Group Revenue cycle manager in annual Tariff suggestions- additions, revisions and deletions of diagnostic services.
•Clinic Licence, Medical licence updates - inclusions & renewals with insurance companies
•Dispatch of claims and re-submission of returned claims within specified time frame with a team of administrators.
•Reconciliation & ageing analysis comparison of insurance companies and follow ups of due receivables.
•Reconciliation of daily cash/credit realization; eventually significant to Revenue Reporting, Budgeting and Tariff/price revisions.
•Problem solving oriented to patient queries and issues in relation to insurance & payments.
•Deputy to the Clinic Administration Manager and carrying out his responsibilities during his absence in all forms of administration and clinical activities which include clinic purchase control, inventory control, front office & clinical requirements.
CPC certification covering areas of medical billing and coding, from AAPC
COMPLETED BASICS IN MEDICAL BILLING & CODING ; with 88% duration of course:6 months. subject included, understanding & using clinical classifications such as ICD-10CM/ICD-9CM, CPT, HCPCS for insurance billing claims & reconciliation purposes.
MBA in Financial Management
B.com - Advanced Accounting
