Kimberly McCoy
McDonough
Summary
Dynamic healthcare professional with extensive experience at Piedmont Healthcare, excelling in revenue cycle management and team leadership. Proven track record in optimizing accounts receivable processes, utilizing EPIC and Microsoft Excel to enhance operational efficiency. Adept at mentoring teams and driving performance improvements, ensuring timely collections and compliance.
Overview
28
28
years of professional experience
Work History
Commercial/Managed Care Follow-Up Manager
Piedmont Healthcare of Atlanta
08.2018 - Current
- Responsible for managing the Managed Care/Commercial AR for ten separate healthcare systems, ensuring all follow-up items are responded to timely and in appropriate detail.
- Responsible for managing a team of 15 with 2 Supervisors and leading a team, including interviewing, hiring, training, developing, directing work and processes, managing performance, recognizing, and rewarding employees.
- Participates in internal meetings to explain trends and find a root cause with outstanding issues.
- Facilitate monthly conference calls for two contractual payors.
- Negotiate settlements with payors.
- Weekly complete no adjustment reports.
- Work high dollar and aged account meetings.
- Monitor employee workloads daily and reviewing work queues to ensure accounts are worked appropriately.
- Evaluate, analyze, and monitor days in A/R every month.
- Month – End reporting on potential reserves for bad debt and payor issues and KPI.
- Monitor outstanding issues and report impacts as needed.
- Mentor team members to encourage personal and professional growth.
- Encourage ongoing skill development by providing opportunities for continued education.
Medicaid/CMO Manager
Piedmont Healthcare of Atlanta
01.2016 - 07.2018
- Oversee the billing functions for assigned Medicaid and Managed Medicaid payors, including resolving all EPIC and Emdeon claim edits assigned.
- Oversee follow up on claims to ensure prompt and accurate payment on claims — reviewed underpayments and overpayments to determine if valid or EPIC contract build was an issue.
- Ensured collections were pursued on underpaid amounts from the payors and worked to resolve and EPIC contract issues — processed correct overpaid amounts for refunds.
- Reviewed denials and ensured the appropriate actions to appeal was taken.
- Reviewed and approved adjustments daily and provided the root cause of denials were identified.
- Oversee all Government Shared Services between other contracted facilities.
- Ensure EPIC processing of late charges/credits and rebilling of claims with late charges/credits where appropriate.
- Daily monitoring of the Watchlist for DNB, Stop Bill, Claim Edits, Open Follow-up, Outstanding Insurance, and Late Charges not on a work queue for assigned financial classes to ensure billing and follow up of accounts occur.
- Daily monitoring of applicable candidates for billing such as account edits, claim edits, DNB, Stop Bills, and unbilled claims to ensure they are processed timely.
- Monthly review of age AR to expedite collections accounts.
- Review, validate, and prepare quarterly Medicaid Credit Reports and file with the government within established reporting timeframe.
- Capture accounts with outliers, monitor for the initial payment and then ensured processed with appropriate medical records for outliers to receive additional outlier payments.
- Track and report on all stages of outlier processing monthly.
- Oversee Add Insurance/Coverage Updates reviewing add insurance requests in assigned work queues and requests from vendors (C & E, Hollis Cobb, Medlytx, etc.…) and internal hospital departments to determine if accounts need to be updated and rebilled.
- Handled requests for internal audit departments or external government agencies and payors to provide requested documentation on EPIC and legacy systems.
- Performed daily and weekly reviews on staff productivity and QA accounts.
- Manage and assist vendors with the request, questions, and concerns to obtain resolution. Which can involve, rebilling, process improvement, training, and correcting process issues in EPIC for Connance, Harkins, C & E, FFAM, EnableComp, HFRI, eReceivables, Medicare, and Triage.
Patient Account Supervisor
Children's Healthcare of Atlanta
Atlanta
04.2013 - 01.2016
- Supervise individuals, including but not limited to hires, trains, assigns work, manages & evaluates performance, and conducts professional development plans.
- Reviews and propose all adjustments to accounts receivable balances.
- Provides management reporting with results of findings to the Department Manager.
- Audit accounts to ensure trends are identified.
- Work very closely with the CMO carriers, Peachstate, WellCare, and Amerigroup, conducting payor calls bi-weekly referencing payor issues.
- Ensures that my direct reports' productivity and actions meet and support the department's overall operational goals as established by department leadership.
- Supervise the department's day-to-day operations, ensuring timely billing of all product or service line accounts.
- Assist in the identification, analysis, and resolution of reimbursement, compliance, and internal audit issues related to the revenue cycle promptly.
- Assist Manager in establishing production measurement systems and reporting.
- Payroll/Reviewing Time Call daily.
Intake Administrator
Golden Living
Conyers
06.2011 - 12.2012
- Evaluated, processed, and maintain all resident admission information and documents necessary to ensure accurate and timely billing and collections.
- Admitted all new residents inputting all demographics and insurance information into the system.
- Maintained ongoing communications with the facility admissions coordinator and business office coordinator to ensure the continual flow of financial information with assigned centers.
- Provided post-admission guidance to residents and their agents.
- Reviewed daily census activity and payer status change notices.
- Updated all financial and statistical changes in Resident Billing Maintenance.
- Reconciled census to billing; corrects billing errors, notifies Nursing of census errors.
- Reconciled census between billing and resident tracking system (by bed and payer source); notifies Nursing of errors to be corrected in the resident tracking system.
- Updated private pricing when due upon facility and update authorizations weekly.
Reimbursement Manager
Walgreens-Optioncare
Clarkston
09.2007 - 11.2010
- Managed a team of 17 professionals. Team, which included Intake, Billing, Collections, and Cash Posting.
- Compiled data to measure department performance against established goals and benchmarks.
- Ensured intake verified coverage, obtained authorization, and proper approval before patient acceptance.
- Ensured documentation was complete, accurate, and authorized when necessary. Also made sure that the documentation information input into the system was accurate.
- Maintained unbilled revenue according to national standards and reviewing every week at a minimum. Maintained this unbilled revenue below 15% of total revenue, which was standard.
- Responsible for accurate and timely submission of all claims and conducted billing audits as defined by all claims' reimbursement policies.
- Monitored all collection activity that generated revenue monthly on an average of 1.5 million. Ensuring that the A/R was managed appropriately by staff and per policies and procedures.
- Ensured cash posting.
- Worked directly and successfully with the Pharmacy department to produce clean claim billings.
- Monitored key indicators in the Reimbursement Area such as AR over 120, Top 5 payers, Top 10 patients to improve cash flow, reducing DSO, and minimizing bad debt.
Billing/Collections Manager
ERMI Inc
Decatur
08.2003 - 04.2007
- Manager for Durable Medical Equipment overseeing all aspects of billing and collections.
- Posted cash daily and monitored cash applications to ensure it was applied in a timely and accurate fashion.
- Managed accurate records of all patient insurance and billing information.
- Processed adjustments daily.
- Participated actively in daily account receivables collection calls.
- Input all daily charges for billing and reviewed all documentation for new patient accounts.
- Established and maintained the necessary billing and collections tracking systems to maximize cash flow and collections.
- Provided the company President every month with required reimbursement reports and statistics.
- Reviewed and analyzed monthly past due receivables.
Accounts Receivable Manager
Visiting Nurse Health System
Norcross
01.1998 - 01.2003
- Managed the reimbursement department staff of 14, which included employees from billing, collections, verifications, and cash posting for both Home Health and Pharmacy.
- Monitored all pharmacy reimbursement daily functions.
- Functioned as a liaison between contract payer, staff, and patient relative to contract issues, eligibility, authorization, and other billing issues.
- Ensured staff compliance, developmental productivity, and provided education training to the pharmacy reimbursement staff.
- Handled correspondence, Medicare verifications, revenue adjustments, bad debt determinations, payment postings, manual and electronic billing.
- Coordinated all accounts receivable for Medicare Pharmacy.
- Evaluated, analyzed, and monitor days in A/R every month.
- Prepared claims for Medical Review, Appeals, and Administrative Law Judge.
- Assisted in billing/collections for various private insurance and on all current and delinquent accounts.
Education
Bachelor of Science - Health and Human Services
Ohio University
Athens, OhioSkills
- Microsoft Excel
- Microsoft Word
- Outlook
- EPIC
- Xactimed
- Qlick View
- Chartmaxx
- Kids
- Tracer
- Availity
- White Stone
- Cognos
- KIS
- AS400
- Zirmed
- Remit Data
- Durado
- MMIS
- MRO
- Medisoft
- I-Emphsys
- E-port
- Daytech
- SCSPLIN
- Atlas
- Dezine
- Mesta Med
- Paces
- DDE
- Advantis Passport
- Emdeon
- Image Now
- Tableau
- SharePoint
Accomplishments
- Within 13 months of employment moved local branch up in national rankings from 69 to 12 which gained the branch benchmarking efforts.
- Also increased cash collections by 42% within the same time frame.
- Surpassed revenue goals in 4 consecutive quarters.
- Promoted from Patient Account Representative to Supervisor within two years of joining the company and preceded to Management within three years.
- Assisted in implementing software program for billing durable medical equipment.
Timeline
Commercial/Managed Care Follow-Up Manager
Piedmont Healthcare of Atlanta
08.2018 - Current
Medicaid/CMO Manager
Piedmont Healthcare of Atlanta
01.2016 - 07.2018
Patient Account Supervisor
Children's Healthcare of Atlanta
04.2013 - 01.2016
Intake Administrator
Golden Living
06.2011 - 12.2012
Reimbursement Manager
Walgreens-Optioncare
09.2007 - 11.2010
Billing/Collections Manager
ERMI Inc
08.2003 - 04.2007
Accounts Receivable Manager
Visiting Nurse Health System
01.1998 - 01.2003
Bachelor of Science - Health and Human Services
Ohio University