Celeste Rucker Email & Phone Number

• Supervise a team of 8 Revenue Integrity QA Analyst.
• Conduct root-cause analyses with Revenue Integrity Analysts to identify opportunities for error reduction.
• Perform audits and reviews activities to improve the revenue cycle, claims production and coding integrity. Review data and systems to target areas of improvement.
• Serves as a subject matter expert and in a consultative role to RI Specialist and vendors.
• Present information effectively in a variety of settings: RI Specialist team, one-on-one, small and large groups, with peers, direct reports, and superiors.
• Manage all aspects of Revenue Cycle support including performance improvement, development, documentation, testing, training and upgrades. Assist management in examining processes to improve workflow.

Jacksonville, Florida, United States

• Scheduled touch point calls with vendors to review rebuttals and edit questions.
• Skilled in each area of service center including; Billing, AR follow up, Denials, Cash posting to assist with process improvement.
• Reviewed RI Specialist accounts and scheduled touch points with vendors to indentified trends/patterns and
• Communicated and followed up with internal departments regarding the completion of provider files according to established criteria.
• Used established project management tools and methodology to conduct revenue cycle assessments.
• Worked toward meeting institutional goal of increasing revenue through improved charge capture processes.

Jacksonville, Florida, United States

• Communicated inventory goals and staffing assignments to team during morning meetings and newsletters.
• Facilitated new hire on-board training & provide continuous education and training to the Global Revenue Integrity Team.
• Scheduled touch point calls with the vendor to discuss inventory management as well as any account edit questions for resolution and ongoing education.
• Instrumental in creating the new standardized QA tool for the Integrity team.
• Reviewed and respond to vendor rebuttals and provide additional training as need.
• Designed daily QA random engine sampling and upload data for the QA tool.

Jacksonville, Florida, United States

• Developed and implemented the client services Revenue Integrity Core Training Programs for all new hires.
• Facilitated ongoing education and refresher training for team members.
• Executed QA for all new and existing staff where the QA average is to be maintained and within compliance.
• Ensured staff was in compliance with the required RI mandatory HealthStream.
• Worked closed with our independent client services to resolve any issues associated with billing compliance and maintained a great customer relationship with our clients.
• Performed medical necessity reviews for our client services.

Jacksonville, Florida, United States

• Ensured billing compliance of patient charges by reviewing the clinical documentation to determine appropriate charge capturing of services.
• Performed charge audits to ensure adherence of federal and state regulations.
• Analyzed and resolved billing edits for various payers (i.e. NCCI edits, OCE edits, medical necessity reviews, and specific payer billing edits).
• Ensured the accuracy of the Charge Description Master (CDM).
• Communicated any identified educational opportunities and trends to respective departmental leadership.
• Extensive reimbursement experience with MS-DRGs, APCs and MPFS.