revenue cycle management resume

ANYA M. LILLEY-FOX ADMINISTRATIVE MANAGERT Proficiency ~ Competence ~ Results

Accomplished leader with over ten years of extensive medical billing, third-party payer contracting, Payer/Provider relationships, and operation management experience in a variety of settings. Polished professional and Naval Veteran of Desert Storm, skilled in improving operational efficiency and delivering effective workflow management. Excellent strategic planning and interpersonal communication skills. Capable and adept at negotiations, contracting, and compliance requirements. Areas of Expertise include:

Operations Management Third-Party Contracting Pricing/ReimbursementClaims ProcessingAccounts Receivable CollectionsReferral source networkingAudit/ComplianceMicrosoft OfficeTrending Analysis

Denial ManagementMedicare/Medicaid

regulationsResource ManagementStrategic PlanningSupplier Standards

Revenue Cycle ManagementHIPAA / Hi-Tech ComplianceTraining and DevelopmentManaged Care contractsHealthcare network affiliationsAccreditation Standards

PROFESSIONAL EXPERIENCE

Bundy Management, Inc. Polson, MT 2012 – PresentHME BILLING MANAGER Responsible for Revenue Cycle management, Third-party payer contracting, Healthcare trending/reporting/analysis, Audit and Compliance reviews & submittals, Pricing & fee reimbursement negotiations with payer networks. Referral and payer resource relationships and customer care. Supervisor and mentor to 10+ staff.KEY ACCOMPLISHMENTS:Increased cash flow by 35%, passing all federal audits through development and implementation of workflow

system improvements.Decreased company denial rate from 82% to 22% over an 18-month period.Reduced claim payment from over 65 days to an average of 11 days.Improved company DSO from in excess of 150 days to 61 days over a 24-month period.Developed and delivered comprehensive documents and reports to facilitate month-end and year-end reporting

and evaluation.Trending analysis, budget review, and contracting requirements for division.Reviewed & negotiated Worker’s Comp and State Health program contracts.Reviewed, Revised, and implemented appropriate pricing per industry standardsImplemented effective audit worthy EHR management system for companyImproved DSO, denials, and workflow issues through comprehensive strategy development.Developed and delivered policies and procedures related to Medicare B and third-party payer requirements.Software Administrator and key troubleshooter on technology employed for operationsEstablished and nurtured relationships with Insurance Groups to manage contractual agreements.Developed and delivered training on all medically necessary guidelines to customers, staff, and physicians.Served as the company lead for Revenue Cycle Management.Promoted employee growth and development through development and delivery of company-wide HIPAA

compliance training and continuous education programs.Created and Promoted interpersonal relationships with Vendors, third-party payers, and home health agenciesCollaborated on hiring, performance evaluations, and disciplinary actions for all staff.Research and integration of national business models and methodology to maintain industry standards.

508 2nd Street West Polson, MT 59860 (406)314-2832 [email protected]

Intermountain – Restoring Hope for Children Kalispell, MT 2011 – 2012KALISPELL DIVISION COORDINATOR

Served as the Central Coordinator for HR, IT, Business, and Clinical Audit functions. Operational manager for Non-Profit Outpatient Therapy Clinic.KEY ACCOMPLISHMENTS:Established division proficiency through networking of departments into central coordination.Improved operational Key Performance Indicators for division, meeting and troubleshooting all identified areas

and issues.Processed and documented all donation and clinical payments, and executed billing and audit readiness activities

for the outpatient therapy clinic.Executed divisional IT coordination and troubleshooting for all vendor, purchasing, and dispensing activities

across all departments.Served as the HR liaison for employee issues, requests, and new hire requirements.Promoted and Collected donations for organization interdepartmental appreciationDeveloped & cultivated third party payers for effective & prompt patient payments.Performed all compliance and audit reviews for clinical outpatient therapists.

Bundy Management, Inc. Polson, MT 2007 - 2011BILLING TECHNICIAN

Responsible for management and execution of Accounts Receivable management, Claim Processing, Denial Management, Customer Inquiries, Insurance Guidelines, and Allowances.KEY ACCOMPLISHMENTS:Recovered $30K in revenue from aged accounts.Developed and implemented a rental tracking procedure to retrieve non-returned equipment.Collaborated with the State Insurance Commissioner to work through Payer issues.Reconciled and updated all billing codes for Durable Medical Equipment billable under contract.Managed, verified, and monitored usual and customary pricing in compliance with Medicare guidelines.Promoted staff growth and development through delivery of education on OIG guidelines, Medicare Billing,

Montana Medicaid Billing, and HIPAA/Hi-Tech Regulations.Built Company software Inventory database.Collaborated & lead companywide software conversion, including training & Top Level Administrative duties.

Bundy Management, Inc. Polson, MT 2006 - 2007CSR – DIRECT CARE ASSOCIATE

Responsible for providing technical and retail information to patients. Performing patient intake, and responsible for all retail transactions, inventory, and purchasing. Researched and initiated new technologies for work group efficiency.KEY ACCOMPLISHMENTS:Increased retail sales by 18% over a one-year period through development and implementation of a program to

effectively schedule clinical patients with clients.Executed prescription processing, clinical documentation requests, and paperwork intake.Ensured accuracy through updating of patient profiles and loading of patients into the appropriate systems.Performed inventory and rental tracking, and executed inventory purchasing and receiving activities.Executed cash handling, as well as software updates and research for company purposes.Established and nurtured vendor affiliations and relationships.

Salish Kootenai College Pablo, MT 2003 - 2006AUXILIARY SERVICES CLERK

Responsible for providing assistance to the Administrative Officer in tracking campus security breaches, summarizing and submitting all cafeteria charges, and logging all complaints and follow up activities.KEY ACCOMPLISHMENTS:Developed and delivered student housing intake packages and billing.Executed submission of campus bookstore funds and tracked profits to business office.Performed administrative duties as required and attended meetings on behalf of the Administrative Officer


EDUCATION

Associates of ArtsBusiness Management

SALISH KOOTENAI COLLEGE | Pablo, MT | 2006

Associates of ScienceInformation Technology


UNITED STATE NAVY

1992-1996HONORABLE DISCHARGE

STATIONED LAMADDELENA, SARDINIA

USS. SIMON LAKE

CERTIFICATIONS

Medical Office ClerkCertificate of Completion


Office ProfessionsCertificate of Completion



Documents

revenue cycle management resume