Director
Taiba Hospital
Total years of experience :15 years, 7 Months
Experience with Epic Research Billing
· Familiarity with system interfaces, HL7 messaging, and overall system integration.
Directed the day-to-day performance of 32 direct and 38 indirect staff overseeing the revenue lifecycle. Developed and executed key strategies and continuous improvement initiatives focused on financial health and efficient management. Updated the Charge master (CDM) and IDX Dictionary. Liaised cross-departmentally to drive cohesive practices. Held accountable for overseeing the remittance process and miscellaneous cash posting. Analyzed processes to identify areas of improvement in billing, collection, and posting to build resolution strategies. Managed an accounts receivable client portfolio of 20 insurance clients. Collaborated with the Executive Director and CFO identify and remediate issues within revenue integrity.
•Slashed A/R average days by 19 over a three-month period leading to a 15% enhanced collection.
•Decreased administration costs by 20% through strategic price negotiations with vendors.
•Patient Access Department Head, responsible for managing 75 employees in insurance verification, registration, and financial counselors.
•Stimulated a 39% decrease in clearinghouse denials as well as a 15% reduction in bomb rates over six months.
•Effectively negotiated reimbursements from LOA's, Pre-registration, Insurance Verification, Billing, Account Follow Up, Registration, Coding, Point of Service Cash Collections, Cash Posting, Bad Debt, Credentialing, Medical Records, Financial Counseling, and Customer Service Collections.
•Instrumental in the practice-wide installation of a new software system utilized in preparation for ICD-10.
•Managed and Supervised the Billing, Collections and Claims processing team consisting of 45.
•Provided overall supervision and management of the all collected revenue and miscellaneous revenue.
•Project Manager for RFP search and implementation of Meditech and hospital management system
•CDM management and oversight
•CDM Review and pricing structure
•CDM Analyzing of billable charges; claim payments price creations
•Maintenance, development and implementation of the CDM
Oversaw the healthcare revenue cycle for primary care services encompassing collections, charge entry, cash management, and account progression ensuring accuracy to financial performance, charging methodologies, capture, and revenue enhancements. Selected, hired, trained, and mentored a staff of 20. Evaluated performance and issued corrective action. Researched the market to identify and communicate revenue and reimbursement trends. Generated reports outlining key performance indicators (KPI) and productivity. Administered healthcare functions including the interpretation of Managed Care contracts, verification and negotiation of reimbursements, pre-registration, insurance verification, billing, coding, POS cash collection, posting, bad debt, credentials, medical records, financial advisory, and customer service collections. Performed quality assurance audits to maximize reimbursements.
•Promoted the achievement of organizational goals through the implementation of technology and process training.
•Key contributor to the successful integration of a new electronic system by facilitating training, testing system adequacy, and development of policies and procedures.
•Championed the development and execution of the Revenue Cycle Dashboards presenting KPI measurements against best practices.
•Ensured appropriate financial reporting and accounting revenue.
•Ensured consistent application of divisional wide operational practices, policies and procedures.
•CDM management and oversight
•CDM Review and pricing structure
•CDM Analyzing of billable charges; claim payments price creations
•Maintenance, development and implementation of the CDM
•Revenue code and description review and oversight
•Charge code review and oversight
Sheikh Khalifa Medical City, Abu Dhabi, UAE
Collections and Claims Processing Project Manager, Finance
, Finance (Insurance Claims Processing, Verification & Collections)
Manage day-to-day activities of the Revenue Recovery Operation which audits daily submission
resubmission of claims Invoicing, denials and other billing criteria. Worked closely with Front-End Processes
related to Patient Financial Services including Patient Access, Registration, Outpatient Clinics and Admissions.
Worked closely with the CFO, COO, CMO and CNO including clinical staff and administration staff.
Reviewed and analyzed accounts receivable accounts and variance reports.
Periodically reviewed and reported the status of accounts to the Director of Patient Financial Services and the CFO.
Developed and implemented policies and procedures for financial recovery and monitor of financial clearance, transactions resulting in standardized reports.
Ensured data accuracy and accountability for divisional financial performance, charging methodologies and capture of revenue enhancement.
Managed and monitored front-end billing production workflow along with denial management and recovery sections, insurance verification and authorization.
Developed policies and procedures along with workflow and IT changes and implementation.
Focused on process improvements in accordance with policy standards.
CDM oversight and management.
Resource planning; financial workflow for data collection; financial analysis and reporting.
Collections, Payment Posting, Insurance Processing and Billing
Responsible for collections, aging, establishing write-off standards and claim denials. Process management of claims to
Collect payments, answering billing inquiries from patients, verifying insurance coverage for patient Verifications and
Authorizations.
•Coordinated the resolution of complaints with appropriate division and facilities.
•Responded to complex issues relating to members, patients, insurance companies, attorneys, employees, and if appropriate, follow-up with written responses.
•Wrote policies and procedures for billing, collections and posting, including charge capture.
•Trained physicians and administration staff to ensure compliance on correct coding and documentation.
•Provided instruction, leadership and supervision for a team of 20 employees.
•Monitored revenue against benchmark for front-end metrics and accounts receivables targets.
•Resolved budget variances.
•Oversight of CDM and CDM compliance
•ERP
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Professional Development & Qualifications Medical Terminology-CPT, HCPCS, ICD-10, Coding Rules and guidelines | Medical Billing, Collections Management, Denial Management | Claims Submission and Re-submission Management | Claims Data and Data Scheme | Government Health Policies and Mandates | Government Health Claim Process and Adjudication | Government Billing Regulations/MOH Healthcare Regulations | Clinical Documentation and Assessment | Clinical Documentation Investigation | JCI Standards on Patient Safety and Quality Healthcare
Professional Development & Qualifications Medical Terminology-CPT, HCPCS, ICD-10, Coding Rules and guidelines | Medical Billing, Collections Management, Denial Management | Claims Submission and Re-submission Management | Claims Data and Data Scheme | Government Health Policies and Mandates | Government Health Claim Process and Adjudication | Government Billing Regulations/MOH Healthcare Regulations | Clinical Documentation and Assessment | Clinical Documentation Investigation | JCI Standards on Patient Safety and Quality Healthcare