Responsible for leading a team of project managers in the overall delivery and execution of Large & Complex Provider RCM implementation projects.

• Responsible for managing the scope, schedule, and quality of Large & Complex implementation projects. • Lead implementations to help drive project activities, implementation schedule and team resources to produce measurable outcomes.• Deliver an exceptional customer experience beginning with the sales hand-off throughout the entire implementation process through support hand-off.• Improve and maintain up-to-date organizational process assets, including templates, to ensure that… Show more • Responsible for managing the scope, schedule, and quality of Large & Complex implementation projects. • Lead implementations to help drive project activities, implementation schedule and team resources to produce measurable outcomes.• Deliver an exceptional customer experience beginning with the sales hand-off throughout the entire implementation process through support hand-off.• Improve and maintain up-to-date organizational process assets, including templates, to ensure that processes are thoroughly documented and followed.• Develop project teams by holding teams accountable for their commitments, removing roadblocks.• Manage interdependencies, leverage organizational resources to improve capacity for program work; coordinate with resource managers to insure appropriate levels of resource utilization across projects. Show less

• Work with all levels of Availity management, Program Management, Account Management and Sales to organize the resources needed to accomplish project tasks. This includes leading client-based projects and managing cross-functional teams for delivery on client deliverables, scope and risks.• Responsible for managing the overall implementation process for our largest, most dynamic clients, primarily Epic Professional and Hospital Billing clients. • Primary point of contact and subject… Show more • Work with all levels of Availity management, Program Management, Account Management and Sales to organize the resources needed to accomplish project tasks. This includes leading client-based projects and managing cross-functional teams for delivery on client deliverables, scope and risks.• Responsible for managing the overall implementation process for our largest, most dynamic clients, primarily Epic Professional and Hospital Billing clients. • Primary point of contact and subject matter expert for clients for accountability, escalation and resolution of issues originating from assigned clients.• Focus on project management and client facing activities during product implementation by documenting implementation decisions and coordinating work for the assigned Implementation Coordinator and Analyst to ensure deployment success is achieved. • Responsible for developing project plans, creating long- and short-term plans, which includes setting targets for milestones, adhering to deadlines and allocating resources.• Manage multiple projects in varying phases of implementation simultaneously.• Responsible for communicating with Internal and External stakeholders on overall project status, risks/escalations, and action items.• Coordinate all internal and external meetings to ensure overall project scope and timelines are met.• Customize agendas, reporting, training plans and project plans to ensure implementation project success. Show less

• Responsible for managing the overall implementation process for new client sales, with a focus on project management and client facing activities during production implementation.• Primary point of contact and subject matter expert for clients for accountability, escalation and resolution of issues originating from assigned clients.• Coordinate cross-functional teams through meetings and progress measurement activity which bring distinct, specific projects to completion both on time… Show more • Responsible for managing the overall implementation process for new client sales, with a focus on project management and client facing activities during production implementation.• Primary point of contact and subject matter expert for clients for accountability, escalation and resolution of issues originating from assigned clients.• Coordinate cross-functional teams through meetings and progress measurement activity which bring distinct, specific projects to completion both on time and within budget. • Manage all tasks for Premier client implementation from Sales Hand-off to Go Live.• Customize agendas, reporting, training plans and project plans to ensure implementation project success. Show less

• Account Management for Large Tier 1 Strategic clients (100+ provider count)• Primary point of contact for accountability, escalation and resolution of issues originating from assigned clients.• Provide Revenue Cycle Management support to specific clients to include daily monitoring and management of issues of high revenue clients.• Work with Administrative Leaders within to discuss, define and help accomplish organizational revenue goals.• Maintain knowledge of… Show more • Account Management for Large Tier 1 Strategic clients (100+ provider count)• Primary point of contact for accountability, escalation and resolution of issues originating from assigned clients.• Provide Revenue Cycle Management support to specific clients to include daily monitoring and management of issues of high revenue clients.• Work with Administrative Leaders within to discuss, define and help accomplish organizational revenue goals.• Maintain knowledge of client operation systems and goals to provide recommendation on Availity RCM solutions that would assist in meeting operational goals and/or KPI metrics.• Build and maintain strong relationships with clients to include Administration, Management, EDI, Technical Support, Analysts and SME's.• Knowledge of several billing systems, including Epic, IDX, NextGen.• Collaborate with internal stakeholders to provide exceptional client support and timely issue resolution.• Monitor and provide Key Performance Indicators (KPIs) to include claim and error volume analysis, and other specialized metrics monthly.• Conduct Annual Business Review meetings with clients to review performance indicators and initiatives to access progress and barriers to strategy execution. Review client dashboards, success plans, product roadmaps and goals/strategic objectives.• Conduct recurring meetings with clients to review performance of operating departments and business functions, initiatives and goals, monthly metrics and open items.• Proactively communicate with clients on Industry, Availity RCM and Payer specific updates.• Provide training to management and end-users.• Manage At-Risk clients by completing and maintaining Action Plans and engagement with Senior Leadership. Successfully transitioned At-Risk clients to Wins. Show less

• Responsible for managing revenue for all Non-Governmental Payer mixes which include NC Blue Cross, Out of State Blue Cross, Managed Care and Commercial Payers for Duke University Hospital and Duke Regional Hospital• Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes and work with appropriate personnel to implement improvements.• Oversee internal auditing department to ensure… Show more • Responsible for managing revenue for all Non-Governmental Payer mixes which include NC Blue Cross, Out of State Blue Cross, Managed Care and Commercial Payers for Duke University Hospital and Duke Regional Hospital• Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes and work with appropriate personnel to implement improvements.• Oversee internal auditing department to ensure proper auditing procedures are performed.• Oversee internal training efforts to ensure employee development within Hospital Billing and Collections department. Show less

• Coordinate, prepare and analyze complex accounts receivable and/or financial records• Conduct detailed research to identify root causes of insurance denials, advising PRMO leadership regarding conclusions and recommendations• Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes.• Organize and lead committee meetings to communicate denial analysis outcomes and operation… Show more • Coordinate, prepare and analyze complex accounts receivable and/or financial records• Conduct detailed research to identify root causes of insurance denials, advising PRMO leadership regarding conclusions and recommendations• Identify process improvements, including staff education/training, operational workflow modifications, system enhancements and external payer policy changes.• Organize and lead committee meetings to communicate denial analysis outcomes and operation improvement recommendations• Assist in testing system functionalities related to enhancements and/or claim logic updates Show less

• Supervise up to 25 employees• Specialize in Cardiology, Radiology, Pathology, Nephrology, Dermatology, Oncology & Hematology insurance accounts receivables, denials and follow-up• Perform Quality Audits of employee work against quality standard requirements• Monitor productivity levels and provide feedback for evaluation purposes• Provide new and existing employee training• Review and evaluate payer denials• Monitor workflow to ensure process efficiency •… Show more • Supervise up to 25 employees• Specialize in Cardiology, Radiology, Pathology, Nephrology, Dermatology, Oncology & Hematology insurance accounts receivables, denials and follow-up• Perform Quality Audits of employee work against quality standard requirements• Monitor productivity levels and provide feedback for evaluation purposes• Provide new and existing employee training• Review and evaluate payer denials• Monitor workflow to ensure process efficiency • Coordinate with provider enrollment group to resolve edits and denials• Review and initiate corrections for electronic and paper claim submission problems Show less

• Assist in overall revamping of all HCFA-1500 and UB92 claim form edits to reduce denial rates and improve reimbursement• Retrieve, review, research and analyze claim form change requests provided by various DUHS departments in efforts to improve overall billing processes• Update IDX claim form logic in the TEST system while acquiring extensive knowledge of all fields on claim forms• Load and process daily Interface files• Download files for testing HIPAA changes to ensure… Show more • Assist in overall revamping of all HCFA-1500 and UB92 claim form edits to reduce denial rates and improve reimbursement• Retrieve, review, research and analyze claim form change requests provided by various DUHS departments in efforts to improve overall billing processes• Update IDX claim form logic in the TEST system while acquiring extensive knowledge of all fields on claim forms• Load and process daily Interface files• Download files for testing HIPAA changes to ensure proper billing techniques for 837/835 formats• Assist with balancing claim transmissions/downloads and reports received thereafter• Interact with RCM Clearinghouse to acquire proper claim submission Show less

• Research complex Workers Compensation accounts to determine reasons for non-reimbursement and follow-up for maximum reimbursement for aged A/R• Analyst complex accounts to determine appropriate actions in resolving TES edits, Claim Edits, Denials, Correspondence and Refund Requests• Complete charge corrections for proper billing of Professional and Hospital claims • Analyze patient accounts to determine proper resolution of credits• Initiate refunds to insurance companies and… Show more • Research complex Workers Compensation accounts to determine reasons for non-reimbursement and follow-up for maximum reimbursement for aged A/R• Analyst complex accounts to determine appropriate actions in resolving TES edits, Claim Edits, Denials, Correspondence and Refund Requests• Complete charge corrections for proper billing of Professional and Hospital claims • Analyze patient accounts to determine proper resolution of credits• Initiate refunds to insurance companies and patients for overpayments on credited accounts• Recommend enhancements for correct claim filing logic, specializing in Medicaid and BCBS• Analyze complex aged accounts to determine appropriate action for reimbursement• Train and assist coworkers Show less