Elizabeth Hilton Email & Phone Number

Cincinnati, Oh, Us

New York, Ny, Us

Leading No Surprise Act (NSA) Pre and Post Negotiation and Out of Network Client Service teams. The NSA Operations team is responsible for managing appeal intake from payer clients and providers, preparing information to be sent to negotiators including setting the negotiation parameters and returning results to the clients. The Out of Network service team manages all requests from the clients including patient balance billing, provider network contract review, and review of negotiations handled by Multiplan. * Led data standardization and process improvement efforts that decreased average manual intake time per claim from 8 days to 48 hours even as open NSA claim inventory managed increased from 6k in June 2022 to over 50k in January 2024.* Working with data analysts and senior leadership we improved NSA Negotiations success rate from 3% to 16% during the same period as a result of strategic review of negotiation ceilings using multiple pricing methodologies segmented by geographic area and provider specialty.* Developed data processing scripts with the IT team that allowed us to fully automate 62% of all inbound intake transactions.

Cincinnati, Ohio, Us

Led the expansion of a centralized outpatient call center. * Key Metrics Improvements December 2020 to December 2021 * New patients scheduled by the call center: 21% increase * Average Speed to Answer: 60% decrease * Abandoned Call Rate: 76% decrease* Led operations projects to improve IVR routing and call distribution capabilities.* Developed a standardized training curriculum for all new hires.* Led projects to implement automated phone calls to remind patients of their appointments and referrals.

Dayton, Oh, Us

Led an operations department that processed 4,500 member enrollment files consisting of over 33 million records per year. Agile Product Owner for IT Application development team, managed vendor contracts with annual spend of more than $10M. Proposed and oversaw IT data management initiatives with annual budgets of $4M. • Improved eligibility data accuracy led to: - Recoupment of $8.2M in 2019 by re-adjudicating claims after correction of third-party liability information to enable accurate coordination of benefits, COB. - Pharmacy spend cost avoidance of $5M achieved in 2018-19 through mapping improvements in the data interface with the Pharmacy Benefits Manager, CVS.• Led Operations team in PBM transition from CVS to Express Scripts (ESI) with go live in January of 2020. This resulted in a further decrease of 50% in Pharmacy Termed Member spend.• Decreased department clerical staff by 25% ending contracts for temporary staff and re-allocated work to existing teams.• Led development of PowerBI dashboards to track membership demographic trends and operational KPIs.

Cincinnati, Oh, Us

Led development of centralized outpatient scheduling call center. By mid 2016 the call center had grown to include practices that made up 70% of the health system’s outpatient appointment volume, answered over 80,000 calls per month and included 53 full time employees.Key Metric Improvement: New Patient Appointment Lag Days: 27.88 in May 2011 to 22.58 in Dec. 2015Bump Rate: 6.0% in May 2011 to 2.9% in Dec. 2015Patient Satisfaction: 77% in May 2011 to 89% in Dec. 2015• Worked with providers to develop diagnosis driven scheduling algorithms. This allowed the transition to centralized referral processing ensuring consistency, accuracy and complete documentation in the EHR.• Developed internal reports using EPIC operations data and Avaya phone system monitoring to track scheduling efficiency, provider utilization and new patient distribution.• Led projects to implement video, e-visits, online patient scheduling, automated phone calls and texts via vendor Televox to remind patients of their appointments and referrals.• In conjunction with the Marketing department grew 475-8000, a phone number that was originally used for the West Chester location only, into a true system wide general information line which enabled the organization for the first time to publish a single phone number. This was used in the 2016 campaign “We See UC Health”.

Cincinnati , Ohio, Us

Managed physician licensure, credentialing, appointment scheduling, patient concierge service, insurance pre-certification, coding, charge entry, payment posting, insurance and patient account follow-up. Staff included 5 managers and 35 clerical employees both local and remote. Restructured department, initiated quarterly bonus program, moved to paperless charge entry, coding and payment posting.• Designed and led project to implement a Patient Concierge Program, resulting in a 25% increase in patient collections.• 7% Net increase in billing collections = $ 3 M additional revenue realized • Paperless system for backend processing = $130 K annual cost savings• Reduced claim submission time = 48 hours

Cincinnati , Ohio, Us

Managed data processing, customer service and medical transcription. Staff included 5 managers, 37 clerical employees, both local and remote, and oversight of 20 transcription sub-contractors.• Increased report processing capacity by 50% = $ 3.3 M additional revenue generated• Product Delivery Turn Around Time decreased by 53%• Product Delivered on Time increased by 35% • Automated 50% of existing workflow for licensure and credentialing through implementation of a new data management system.

Cincinnati , Ohio, Us

Managed implementation of the software suite that automated front office functions for users in 26 imaging centers and back end operations for the billing department. Configured and deployed HL7 scheduling interface that communicated patient demographic information to existing RIS databases in teleradiology department.

Cincinnati , Ohio, Us

Managed all phases of corporate web and database project development. Designed back end SQL Server database and built web application to manage teaching files for visiting fellowship programs. Designed and built marketing and education SQL database to track course attendees and CME product sales. Designed data structure and managed the creation and implementation of a corporate intranet.

Mba, Business Administration And Management, General

Bfa, Fine/Studio Arts, General

English / Fine Art