Makeyta L. Email & Phone Number

Murfreesboro, TN, US

• Serves as customer operational expert for all aspects of assigned customers.
• Operate as Revenue Cycle Consultant and Process Improvement SME.
• Create and execute customer specific revenue retention and growth strategies for clients leveraging return on investment analysis, operational efficiency/utilization reviews, sales opportunity qualification, and.
• Work closely with clients at different levels from Clinical staff, Revenue Cycle teams, and up to C-Suite level leaders to identify opportunities for improvement through reporting and analytic analysis.
• Monitor client KPI metrics and benchmark comparisons to ensure SLAs and performance expectations are aligned and met.
• Engage and support providers and payers as a core member of the Client Success Team.

• Operate as Revenue Cycle Consultant and Process Improvement SME.
• Engage and support providers and payers as a core member of the Client Success Team.
• Conduct denial acuity assessments on new and current clients to determine denial performance and identify opportunities for improvement.
• Develop goals and action plans to reduce denials, reduce final write-offs, increase reimbursement, improve denial recovery, and improve denial performance.
• Create and analyze denial reports to identify trends on denial reasons, root causes, payer, and provider issues.
• Provide clients recommendations on denial prevention strategy, denial workflow optimization, denial mitigation, and end-to-end revenue risk management.

• Manage daily operations for prior authorization teams that support surgical and transplant hospital admissions and clinic visits across Mayo Enterprise.
• Manage daily operations for notice of admission team.
• Manage daily operations for team of clinical nurse reviewers to provide coding, policy, and clinical expertise and support to internal and external stakeholders (revenue cycle, clinic, hospital leadership, etc).
• Manage, coach and mentor direct reports and staff: supervisors, nurses, and reps.
• Collaborate with Epic Systems for work queue optimization and build.
• Serve as SME and point of contact to internal and external stakeholders.

• Develop efficient workflows for denials management, audits and appeals tracking.
• Create and promote standardization of processes across the revenue cycle continuum for continuity of operations.
• Analyze and measure workflows and processes for clinical/technical denial types, appeal tracking, insurance follow up, audits, account transaction reconciliation and denial write-offs.
• Direct operations and assignments of remote and onsite staff from multi-faceted denial teams.
• Review and research denial and payer trends for best practices.
• Review and approve chargemaster changes and pricing of services and supplies.

• Manage Direct reports: team of RNs, LPNs, RAD Techs, non-clinical staff, team lead, supervisor, and remote representatives.
• Manage hospital claims billing, coding, insurance follow up, denial resolution, payer audits and appeals.
• Recognize and analyze denial trends and potential revenue risks. Work with facilities to implement action plans to improve clean claim rate through strong prebill initiatives and effective claim editing.
• Enforce strategic claim f/u, denial management and timely appeals to help reduce A/R days and increase reimbursement recovery.
• Workflow with high focus on preventing delayed payments, claim denials and operational loss of revenue risks.
• Provide support and expertise in project management, financial reporting, scripting and maximizing artificial intelligence to improve workflow efficiencies.

• Work closely with Facility Leadership and Business Partners in the development, measurement and achievement of targets for revenue cycle functions.
• Direct operations of daily cash posting, billing for professional and institutional claims, insurance follow up, audit workflow and account transaction reconciliation.
• Coordinate log reconciliation for government payers used for Medicare/Medicaid cost reporting.
• Evaluate and analyze existing systems and processes to implement improvements that support revenue cycle goals.
• Responsible for providing direction and leadership to all revenue cycle functions and setting monthly cash goals.
• Establish and implement standard metrics and reports to monitor revenue cycle performance.

• Manage Direct reports: team of RNs, LPNs, RAD Techs, non-clinical staff, team lead, supervisor, and remote representatives.
• Monitor the tracking, filing and management of clinical denials. Identify trends in denials to communicate those issues with the facilities to implement changes to prevent future denials.
• Workflow assignment of appeals to ensure timeliness in submission of appeals according to payer guidelines. Determine appropriateness of downgrading claims due to inappropriate level of care provided.
• Conduct training on persuasive and aggressive appeal arguments to payers. Identify DRG, Per Diem, Fee for Service, PAR and Non-PAR contract reimbursement methodologies.
• Provide training to staff and facilities on best practices for patient registration, insurance collections/appeals, documentation requirements and insurance billing guidelines.
• Train staff on Denials and Appeals workflow, processes and compliance standards.

• Obtain retro authorizations for services performed without valid authorization.
• Submit appeals for denied claims post service.
• Facilitate monthly meetings with Hospital Leadership (CFO, Case Management, Pt. Access, etc.) to discuss denial trends.
• Participate in payor audits (onsite/virtual) to validate and defend billed charges, pricing and level of care.

• Obtain prior authorizations for scheduled outpt/inpt procedures.
• Validate medical necessity of procedures based on LCD/NCD and payor medical policies/guidelines.
• Operate as liaison between the physician offices and payors for pending/denied cases.
• Assist with completion of pre-registration packets prior to admissions.

• Responsible for assisting the surgeon with in-house procedures and hospital surgeries.
• Serve as Physician Extender visiting with Inpatient hospitalized patients.
• Perform vital signs, lab work, fetal monitoring and daily nurse calls.
• Assist with in office pregnancy ultrasounds.
• Obtain pre-cert for surgeries, radiology test and medicines.
• On call for emergency surgeries.

• Operate multi-line phone system.
• Receive verbal orders from physicians.
• Electronically order labs/x-rays/procedures.
• Perform EKG's, heart monitors setups, transport Air Evac patients.
• Operate EMS dispatch radio system.
• Provide any needed support during emergent events (ex: CPR in progress and trauma incidents).

Master Of Business Administration - Mba, Business Administration And Management, General

Bachelor Of Science (B.S.), Business Administration And Management, General