Summary
Overview
Work History
Education
Skills
Languages
Timeline
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KIMBERLY McNAMEE

Maryville

Summary

Qualified [Desired Position] with proven track record in leading teams and driving operational efficiency. Demonstrated ability to implement strategic initiatives that enhance productivity and foster growth. Known for utilizing strong leadership and communication skills to facilitate team collaboration and achieve organizational goals.

Overview

11
11
years of professional experience

Work History

Revenue Cycle Manager, Call Center

GI Alliance
11.2024 - Current
  • Company Overview: GI Alliance is the nation’s leading network of gastroenterology providers, offering comprehensive services for adult and pediatric gastrointestinal health. They also expanded into Urology and Rheumatology in 2024. GI Alliance has 862 independent gastroenterologists in 345 practice locations across 20 states.
  • I manage a total of 48 onshore staff including: 2 Supervisors, 2 Analysts, 1 Quality Analyst, 9 Pre-Pay Collectors, 5 Klara staff (text messaging application), 27 Patient Support Coordinators and 2 Collections Coordinators. I also work with 3 offshore vendors to manage pre-pay letters, scanning and logging of returned mail and the processing of corrected addresses for returned statements, refunds and mail. I also work with a collection agency to turn over bad debt accounts.
  • Other Responsibilities:
  • Support Supervisors and Analysts with various needs
  • Monitor self-pay collections to ensure we meet our KPI goals for >90-day AR to be
  • Monitor phone queues to ensure staff are assigned appropriately and to keep our abandoned call rate down to ensure patient satisfaction
  • Monitor the Klara (texting platform) team to ensure patients are responded to within 24-48 hours
  • Created, along with my supervisors, a pre-collection agency department to attempt to collect accounts prior to turning them over to the collection agency
  • Created the quality assurance audit form and monitor monthly
  • Created and complete a monthly departmental newsletter
  • Write standard operating procedures as needed
  • Conduct annual employee performance reviews and deliveries to employees
  • Provide employee feedback, coaching and counseling
  • Review and approve bi-weekly payroll for salary and hourly staff
  • Create Requisition requests, interview and hire open positions
  • Successfully worked with a new vendor to implement a new phone system, to ensure the Klara texting numbers and voicemail numbers were entered correctly to ensure text messages and voicemails were routed correctly across RCM
  • This was completed in 3 phases to include 5 different regions

Manager of Accounts Receivable

QualDerm Partners
09.2024 - 10.2024
  • Company Overview: QualDerm Partners supports 158 practices in 17 states, spanning across the full spectrum of dermatology, skin cancer care, cosmetics, plastic surgery, and pathology with continued plans to expand further across the nation. On average, we see over 120,000 patients every month and support more than 350 providers.
  • Manage a total of 20 onshore staff including: 2 Managers, 3 Supervisors, 4 Team Lead’s, 10 Accounts Receivable Representatives. Work with 2 offshore vendors to manage current AR.
  • Other Responsibilities:
  • Support AR Managers with various needs
  • Monitor AR Reports for the timely collections of Accounts Receivable
  • Analyze AR Aging’s and review reports for AR areas for focus
  • Work with the teams to analyze and identify denial trends or payor issues and how to fix them
  • Work with other verticals to assist in the prevention of denials
  • Lead a Denial Prevention monthly meeting and report denial findings and what was completed to resolve the denial with all Senior Managers, Directors, VPs, and SVP
  • Monitor terminating sites 3 months prior to termination date to ensure all information required from the facility is obtained prior to termination date
  • Monitor terminated sites to ensure AR is trending downward and no issues arise
  • Provide support and guidance to onshore and offshore staff on escalations and when problems arise
  • Meet with offshore management staff weekly
  • Oversee weekly training with offshore vendors
  • Work with Practice Administrators on payor issues or patient accounts as needed
  • Compose department policies and procedures (SOP’s)
  • Compose Master Data Management (MDM’s) to update company software
  • Review and maintain the AR Manual

Anesthesia Senior Manager of Accounts Receivable

Envision Healthcare Services
02.2022 - 07.2024
  • Company Overview: Envision Healthcare Services is a physician-led healthcare company that develops creative, customized healthcare solutions that leverage the provider network to address patient needs no matter where or when those needs arise. Envision has more than 48,000 team members and affiliates. There are 25,000 Physicians and advanced practitioners that focus on delivering high-quality, patient focused care.
  • Manage a total of 20 onshore staff including: 2 Managers, 3 Supervisors, 4 Team Lead’s, 10 Accounts Receivable Representatives. Work with 2 offshore vendors to manage current AR.
  • Other Responsibilities:
  • Support AR Managers with various needs
  • Monitor AR Reports for the timely collections of Accounts Receivable
  • Analyze AR Aging’s and review reports for AR areas for focus
  • Work with the teams to analyze and identify denial trends or payor issues and how to fix them
  • Work with other verticals to assist in the prevention of denials
  • Lead a Denial Prevention monthly meeting and report denial findings and what was completed to resolve the denial with all Senior Managers, Directors, VPs, and SVP
  • Monitor terminating sites 3 months prior to termination date to ensure all information required from the facility is obtained prior to termination date
  • Monitor terminated sites to ensure AR is trending downward and no issues arise
  • Provide support and guidance to onshore and offshore staff on escalations and when problems arise
  • Meet with offshore management staff weekly
  • Oversee weekly training with offshore vendors
  • Work with Practice Administrators on payor issues or patient accounts as needed
  • Compose department policies and procedures (SOP’s)
  • Compose Master Data Management (MDM’s) to update company software
  • Review and maintain the AR Manual

Anesthesia Manager of Accounts Receivable

Envision Healthcare Services
11.2021 - 02.2022
  • Manage a total of 7 staff including: 2 Supervisors, 3 Team Lead’s, 2 Collectors
  • Other Responsibilities:
  • Adjustments / Efforts Exhausted / MDM’s
  • Oversee the adjustments’ role
  • Review all adjustments to ensure they are precise, and no further effort needs to be done in working the account before final adjustments / loss revenue
  • Implementation of the outsourcing adjustments to an offshore vendor
  • Created the SOP, policy and procedure, audit form and training guidelines for knowledge transfer
  • Work with various departments to ensure accuracy with the MDM process
  • Denials / Business Integration
  • Run and analyze Visiquate reporting to trend the top denials and review through the PIT reports to drill down the issues
  • Monitor and audit the billing processes to identify trends that cause unnecessary initial denials which ultimate delay payor reimbursement
  • Identify large payor trends and work with payors to resolve any issues that could impact reimbursement
  • Ensure all claims that are affected by an MDM have been refiled to the payors and monitor to ensure the issue was corrected
  • Work with offshore teams to identify initial denials impacting initial denial rates
  • Work with Business Integration team with onboarding new acquisitions and monitor AR for the first 6 months
  • Review facility / practice terminations to ensure denials are trending downward and to notify PE of any enrollment issues still outstanding
  • Attend vendor calls to educate on trends and awareness of touches that were not quality to have the claim adjudicated
  • Provide deep denial and adjustment reviews as requested by practice administration or any other communications requested
  • Complete payroll bi-weekly
  • Adhere to all Envision HR policies and procedures

Billing Analyst

Mednax Services, Inc
06.2021 - 11.2021
  • Company Overview: Mednax is a provider for Women and Children’s Solutions with over 1,200 partner facilities, 2,300 physicians and 1,200 advanced practice providers in over 41 states.
  • Responsibilities:
  • Review and respond to all communications from the practice, clinicians, vendors and Mednax leadership
  • Track, audit and upload all daily Census logs and hearing screen files from facilities to the vendor site
  • Monitor the vendors RFI physician and client portal coding requests daily to identify any issues or trends
  • Address any issues found with vendor and / or Mednax
  • Converse with the providers to complete necessary task or documentation within the portal that could potentially delay reimbursement or result in lost revenue
  • Work closely with billing to vendors to identify any missing demographics that did not properly come across within the interface. Retrieve necessary documentation from the hospital portal and submit to vendor for claims processing
  • Communicate closely with the Director of APRN on any midlevel documentation issues as well as practice medical directors for any deficient documentation
  • Run and evaluate weekly vendor performance reports. Compare to performance metrics in service-level agreement
  • Pending provider report. Ensure vendors are not incorrectly pending provider claims for enrollment if effective date has been issued
  • Ensure hearing screens are released
  • Review and evaluate initial denial report.
  • Identify any possible trends that could delay reimbursement or result in lost revenue
  • Work to identify any billing edits that could be created to avoid denials
  • Submit any performance issues to the Client Relationship Manager. Requests action plan to
  • Attend all acquisition calls with director to ensure smooth RCM implementation

Collections Manager

North American Partners in Anesthesia
06.2016 - 03.2021
  • Company Overview: NAPA is a growing physician group practice of anesthesia providers serving nearly 3 million patients in 500 practices. NAPA and its affiliated professional group practices employ 1,400 physicians and 2,025 anesthetists in both hospital and office-based settings. The primary focus of their national group practice is to effectively serve the needs of the hospital partners and patients, and deliver high quality, safe, timely, efficient, effective, and equitable family/patient centered care.
  • Managed a total of 8 staff including: 1 Team Lead, 4 government collectors, 2 refund specialists and 1 patient support.
  • Other Responsibilities:
  • Refund Specialists
  • Team hit their KPI goals for government refunds >60 days goal is at $0.00
  • Managed an offshore team for managed care refunds
  • Developed and put in place a remote process to complete all refunds electronically
  • Provided final review and approval for prior day refunds to be processed to ensure compliance with SOP
  • Developed the audit process for refunds
  • Refunds Audits – Goal is >95% (QA)
  • Collection Team
  • Ensured appropriate follow up on claims for reimbursement to maintain the DSO goal of 45
  • Aging of claims
  • Total charges of AR >90 days – Goal is
  • Total charges of AR >330 days – Goal is
  • Reviewed backend denials to create billing edits in MedSuite and Availity with payors and payor specific billing guidelines
  • Reviewed denials and rejections in Availity Comparative Analytics to identify trends or billing errors that needed to be corrected or addressed with payors
  • Reviewed billing denials related to registration and worked with the frontend leadership regarding any retraining on specific payor requirements such as NPI or taxonomy issues on claim formatting as well as any trending errors by the registration staff
  • Monitored and audited the billing processes to identify trends that needed avoided to future unnecessary denials or delays in reimbursement
  • Monitored the coding review log to ensure that the department is reviewing denials related to coding and diagnosis in a timely manner. Worked with coding leadership for any deficiencies.
  • Contacted payors regarding large trend denials to resolve any issues that could impact reimbursement. Set up various meetings with payor contacts to ensure any trends were addressed prior to becoming a larger issue.
  • Anthem Indian denied $1M+ in claims for Taxonomy issue that I appealed which resulted in full reimbursement
  • Prepared a monthly AR Report to merge with another report to ensure all claims had timely follow up within payor guidelines as well as work the high dollar accounts to increase our reimbursement.
  • Reviewed and approved staff claim adjustments in TAPS
  • Reported on high dollar carriers requested to the regional director at the end of the month
  • Completed department production reports weekly
  • Performed collector audits – Goal is >95% (QA and Production) These audits were performed monthly and were used as part of annual evaluations
  • Completed payroll bi-weekly
  • Completed annual performance evaluations
  • Adhered to NAPA HR policies and procedures

Credentialing / Physician Billing Supervisor / Business Office Manager

Sweetwater Hospital Association
02.2015 - 05.2016
  • Company Overview: Sweetwater hospital is a 59 bed, acute care, not for Profit Corporation with approximately 36 providers. This hospital is in a rural area in East TN located in Monroe County with a population of 38,000. They provide a variety of physician specialties and patient care services.
  • I began my career in credentialing / provider enrollment but was soon moved to physician billing where I managed a total of 5 collectors. Later, I was promoted to the business office manager where I managed all registration staff, the authorization department, as well as hospital and physician billing. I maintained relationships with all providers at the facility for credentialing or provider enrollment assistance, as well as any billing issues that arose along with hand delivering their pay checks.
  • Other Responsibilities:
  • Completed Hospital Credentialing for all providers working at the hospital to submit to the board for approval
  • Completed all verifications and reference checks
  • Maintained all Licensure, DEA certifications, Malpractice and Board Certifications
  • Prepared all files and ensured we were always Joint Commission ready
  • Completed all Provider Enrollment paperwork for all providers working at the hospital and submitted to various insurance companies to obtain the provider number
  • Maintained all licensure and certifications at the insurance companies to ensure provider numbers remained active
  • Compiled various AR reports to complete audits to ensure appropriate and timely follow up on claims
  • Verified payroll reports (payroll was completed on a green bar report) and ensured the management team signed off on their staff
  • Reviewed and provided approval for adjustments, charge corrections, payment transfers and submitted to the CFO for final approval
  • Attended various meetings with the hospital, i.e... Medical executive committee, the ER committee meeting, etc.

Education

High School Diploma -

Maryville High School
Maryville
05-1990

Skills

  • Revenue performance
  • Denial resolution
  • Billing cycle expertise
  • Account monitoring
  • Medical billing
  • Account resolutions
  • Teamwork and collaboration
  • Willing to learn
  • Customer service
  • Problem-solving abilities
  • Multitasking
  • Reliability

Languages

English

Timeline

Revenue Cycle Manager, Call Center

GI Alliance
11.2024 - Current

Manager of Accounts Receivable

QualDerm Partners
09.2024 - 10.2024

Anesthesia Senior Manager of Accounts Receivable

Envision Healthcare Services
02.2022 - 07.2024

Anesthesia Manager of Accounts Receivable

Envision Healthcare Services
11.2021 - 02.2022

Billing Analyst

Mednax Services, Inc
06.2021 - 11.2021

Collections Manager

North American Partners in Anesthesia
06.2016 - 03.2021

Credentialing / Physician Billing Supervisor / Business Office Manager

Sweetwater Hospital Association
02.2015 - 05.2016

High School Diploma -

Maryville High School

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KIMBERLY McNAMEE