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.• Compile and analyze data from various sources to develop recommendations leading to potential revenue cycle opportunities, including analyses related to CDM set-up, charge capture, billing and/or patient financial services.• Conduct and lead special projects to facilitate revenue management as required for new facilities/acquisitions, new departments, new service lines, changes in regulations, etc.• Implement charge capture corrective measures and monitoring tools to ensure sustainability of changes; performs, reviews, and monitors statistics and key performance indicators to identify improvement opportunities.

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.• Developing metrics to be used for ongoing monitoring.• Assisted with the development of policies and procedures that drives the day to day operations of the Program Revenue Cycle.

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. • Approved and submit time for payroll.

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.• Comprehensive knowledge of billing and coding of ICD-9-CM, HCPCS, CPT-4 and 3M Encoder software.• Member of the Facility Ethics and Compliance Committee (FECC).• Performed root cause analysis to determine any trends or patterns in charge capturing and process improvement