Michael SemiaoBoston, MA - Billing Revenue Cycle Manager
SummarySummary & ObjectivesJob TargetRespected professional with extensive experience in the healthcare receivables / facility, physician, laboratory and medical device industry providing comprehensive understanding of efficiency optimization resulting in decreased receivables and increased cash flow. Key contributor to numerous system and technological enhancements. Excellent communicator, confidently interacting with executive team in tactical planning and strategy sessions. Talent for building and managing high-performance teams, consistently achieving project goals and production objectives. Trusted consultant with reputation for cost-savings and revenue building initiatives. Six Sigma Black Belt Technologically proficient. Core competencies include:
• Strategic Financial Planning
• Workflow / Efficiency Stratagem / SOP
• Budgeting & Cash Flow Optimization
• Technology Enhancement & Integration • Debt Recovery Processes
• Team Building & Leadership
• Account Receivable Management
• Facility, Physician, Laboratory and DME Billing
Position: Contract Experience: 10 years Career Level: Director Travel: Moderate travel (25% to 50%) Relocation: Not open to relocation
Dorchester, Massachusetts02/2014 - Present
Director of Revenue Integrity (DIR) (Interim)
• Codman Square Health Center is a community-based, outpatient health care and multi-service center which includes staff of 280 multi-lingual and multi-cultural expert clinicians, medical staff and employees. Patient encounters 110,000 per year. Codman Square Health Center is a Federally Qualified Health Center (FQHC) and receives federal support through its designation as a Section 330 community health center. Codman Square Health Center, Inc. is covered by the Federal Claims Tort Act
• The DIR has fourteen full time and six part time employees within the registration department and three managers as direct reports. The DIR has direct oversight to outsource third party billing component at (CSHC).
• Responsibilities include: Position reports directly to the CFO Manage registration and preregistration department for the health center Evaluate core competency for the registration staff Develop benchmark for performance level of the registration staff Manage relationship between the outsourced third party billing company and CSHC Establish key performance indicators for the third party billing company Perform quality assurance procedures to ensure regulatory compliance Review and audit
Biddeford, Maine10/2012 - 01/2014
Billing and Collections Manager
• SMMC is 150-bed, not-for-profit, full-service medical center with diagnostic & therapy centers in Saco and Kennebunk. Home health care is provided by SMMC Visiting Nurses. SMMC is accredited by the Joint Commission, and is a member of the MaineHealth network. SMMC has been providing quality medical care to this community since 1906. SMMC offers a full range of medical, surgical, obstetric, mental health and educational services to York County.
• Managing seven full time employees within the billing department, thirteen full time employees within the SMMC physicians coding department, four full time employees within the customer service department and supervising 20 patient service representatives (PSR) who are located at the physicians practice locations. Fifteen practice sites which include the specialty offices Women's Health, Pain Clinic and Orthopedic Therapy.
• Selected accomplishments:
• Applied performance metrics to the PSR's daily, weekly and monthly output to reduce error rates Identified and developed daily work flows for the patient registration, billing department and customer service staff
• Developed daily performance standards centered on customer service at each physician practice and also within the customer service department Instituted monthly staff meetings with the PCR's which would include any hospital policy changes, industry updates, closing months performance and outlined goals for the upcoming month Reduced the over 150+ receivable by 75% within the first 120 days through settlement negotiations with the major insurance carriers associated with that debt.
• Instituted productivity standards within the billing department through re-designed work flows, development of aging reports and through focused strategic follow up efforts.
• Created performance metrics within the coding department
• Instituted central scheduling for patients through the SMMC call center
• Designed and created system edits and reports for the patient registrations completed at the practice sites Reduced unlocked visits by two weeks which increased cash by 35% for aged accounts 0-30.
North Andover, Massachusetts02/2012 - 04/2012
Project Manager / Supervisor
• Non Profit- Privately Held
• Founded in 1980, The MENTOR Network is a national network of local health and human services providers offering an array of quality, community-based services to adults and children with intellectual and developmental disabilities, brain and spinal cord injuries and other catastrophic injuries and illnesses, and to youth with emotional, behavioral and medically complex challenges as well as their families.
• Selected accomplishments:
• Executed, transitioned and consolidated multiple states and the central billing office (CBO) functionality to the shared service center (SSC)
• Hired and trained billing staff on all aspects of the revenue cycle components from each of the states that were transitioned to the SSC
• Developed and validated policies and procedures for each transitioned state to the SSC
Providence, RI09/2011 - 11/2011
• Selected accomplishments:
• Credit Balance Reconciliation Credit and Collection Policy Development
Concord, MA05/2011 - 08/2011
• Non-Profit; Dermatology
• Adult & Pediatric Dermatology founded in 1992, this practice offers complete medical, surgical, and cosmetic skincare for patients of all ages, from newborns to the elderly.
• Selected accomplishments:
• Fee schedule analysis and reconciliation Established financial controls within the reconciliation of the accounting program (QuickBooks) and the on-site billing system (Athena)
• Designed and implemented month end closing policies and procedures for each of those components (QuickBooks and Athena)
Boston, MA05/2010 - 08/2010
• Non-Profit; Mental Health Care Industry Bay Cove Human Services is a private, not-for-profit corporation that provides a wide variety of services to individuals and their families who face the life-long challenges of developmental disabilities, aging, mental illness and drug and alcohol addiction.
• Selected accomplishments:
• Identified and developed best practices at the operational, billing and collection levels Redesigned the patient encounter form to meet all of the HIPPA requirements
• Developed strategies to roll out clinical centralized scheduling application
• Processed test and production files for 837 and 835 claim and payment files for each of the four major payers
Boston, MA01/2010 - 04/2010
• Secured pricing with national laboratory for DNA clinical study. Worked closely venture capital group Mediphase to establish strategies for pricing model.
India09/2009 - 11/2009
Senior Billing Analyst
• Developed reimbursement strategies and standardized billing approach to maximize collections for A1C testing.
North Andover, MA06/2009 - 08/2009
Project and Billing Manager
• Managed the creation of a physician group practice. Identified the critical aspects and delivered on each for the group to continue to see there patients without interruption to there care.
Bedford, MA09/2007 - 04/2009
• Public Company; 51-200 employees; PODD; Durable Medical Equipment (DME)
• Insulet Corporation, a medical device company, engages in the development, manufacture, and marketing of an insulin infusion system for people with insulin-dependent diabetes in the United States.
• Provided pivotal financial support impacting multiple departments at publically-traded company generating $70M in annual revenue through medical device sales. Lead 12 full-time employees. Promoted positive relations with internal / external customers, including department managers, coworkers, customers / patients and vendors. Reconciled monthly sales / revenue orders. Managed workflow and oversee delivery of reports to support sales operations. Directed monthly and quarterly meetings within
Woburn, MA08/2005 - 09/2007
DIRECTOR OF INSURANCE & PATIENT BILLING
• Privately Held; Biotechnology Industry ReproMedix is the largest national reference laboratory focused on fertility testing, and a leading source of fertility research and information.
• Held full responsibility for resolving accounts receivable issues and maximizing cash flow; constantly assessed systems, staffing, and operational protocols to ensure top performance. Exercised internal / external communication skills, interacting with national sales team and physician offices to integrate billing processes. Collaborated with executive team in strategy sessions focused on viability of business development initiatives which included and reviewed opportunities to maximize out of
Cambridge, MA07/2002 - 09/2005
Manager Billing Data Entry / Manager
• Public Company; 10,001 or more employees; DGX; Health, Wellness Industry Quest Diagnostics Incorporated provides diagnostic testing, information, and services in the United States and internationally. It provides patients and physicians the access to diagnostic laboratory services through its network of laboratories.
• Managed up to 45 billing staff in laboratory billing activities, reviewing / reconciling approximately 15K patient records per day. Constantly apprised processes and systems to ensure optimal efficiency and accuracy, making necessary adjustments to achieve production objectives. Reported directly to the Director of the Billing Department.
Manchester, New Hampshire08/2000 - 07/2002
BILLING MANAGER / LABORATORY SERVICES
• Directed revenue processing for hospital reference laboratory. Hired, trained, and managed 10 staff members. Organized monthly billing schedule for the hospitals client bills. Performed daily audit of approximately 500 laboratory patient accounts with reconciliation critical to number of claims eligible for payment. Established relationships throughout hospital and physicians network.
Roslindale, MA08/1992 - 09/2000
SUPERVISOR / THIRD PARTY RECEIVABLES
• Non-Profit; 725 Bed Chronic Care Facility
• Supervised 15 billing staff in performance of daily activities. Managed $80M in annual receivables, including Medicaid, Medicare, and third-party commercial insurance. Implemented receivable software and oversaw accurate utilization and reporting processes.
Additional infoMore Additional Info• Software: Microsoft Access, Microsoft Office
• Billing Revenue Cycle Manager Billing & Collections / Systems Integration / Staff Leadership Respected professional with extensive experience in the healthcare receivables / facility, physician, laboratory and medical device industry providing comprehensive understanding of efficiency optimization resulting in decreased receivables and increased cash flow. Key contributor to numerous system and technological enhancements. Excellent communicator, confidently interacting with executive team in
• Strategic Financial Planning Workflow / Efficiency Stratagem / SOP Budgeting & Cash Flow Optimization Technology Enhancement & Integration
• Debt Recovery Processes Team Building & Leadership Account Receivable Management Facility, Physician, Laboratory and DME Billing
• Coursework, Credentials, Technical Skills and Billing Applications
• Bryant University – Marketing (course study)
• Nationally Certified Six Sigma Black Belt
• Technical Skills
• AR Oracle, Biscom, IDX, GECentricity, MediTech, EcW, EcW (EMR) Epic (EMR), Athena, MediBill, Fastrack, Emdeon, Anodyne Health Partners, Microsoft Dynamics ERP, Zirmed, SalesForce.com, QuickBooks, Microsoft Office (Word, Excel, Outlook, Access and PowerPoint) and VeriPoint Michael Semiao Page 4
• Professional Experience Continued
Email address: firstname.lastname@example.org