Sr. Director, Patient Financial Services
Architected solutions for all three phases of revenue cycle operations pre-service, time-of-service, and post-service. The result included onboarding patient accounts, RCM organizational remodeling, analytics & reporting, and redesigning patient access. Designed optimal revenue cycle processes to exceed industry standard best practices. Created a comprehensive training program focused on the patient experience and staff certification. Addressed EMR set up issues, which impeded cash velocity resulting in significant improvements in clean claim rates and AR reduction. Reduced bad debt through implementing financial counseling functions, data capture protocols, and front-end quality assurance software solutions.
- Performed gap analysis, which identified inconsistencies in systems set-ups, procedures, workflows, AR support tools, and reporting.
- Conducted evaluation of remaining talent pool. Identified weaknesses and developed training and education programs to strengthen these individuals.
- Engaged consultants to assist with redesign of systems and workflows in Patient Access, Patient Accounts, and utilization management.
- Worked with Human Resources to address pay scale inequities resulting in the creation of a new industry standard.
- Designed initial onboarding training program, which included 120+ hours of course work in revenue cycle operations.
- Recruited and hand picked all hires with goal of creating a consistency in vision and expectations.
- Created bonus incentive program to reward high performing staff.
- Created KPI’s and performance metrics to monitor the performance of the accounts receivable.
- Created all new best in class efficient workflows.
- Created/revised all policy and procedures.
- Created Authorization manual for the Utilization, and Patient Access department. Previous to this the organization did not understand what potential services were to be authorized.
- Implemented the HRS denial management system.
- Implemented RelayClearance insurance verification software. This software was owned by the organization for several years with unsuccessful attempts to implement.
- Implemented intellisoft credentialing software. Prior to this implementation all credentialing performed was via a manual paper process with no ability to track re-credentialing due dates or expiring licenses.
- Created revenue cycle budget inclusive of salary and expense, as well as capital budget.
- Improved billing clean claim rate from 45% to 95% in four months.
- Reduced denials for insurance eligibility and authorization by 75%. This was accomplished with the implementation of a structured insurance eligibility program and more efficient authorization validation processes. Virtually eliminated all technical denials as a result of faulty legacy system setups.
- Reduced AR 31.5% from a high of $54 million in April 2017 to $37 million at year-end 2017.
- Reduced credit balances from $1.2 million to $400,000 in six months.
- Reduced unapplied cash balance from $900,000 to $150,000 in three months.