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Nikiya
Nikiya.Tucker@outlook.com
646-299-7238
325 NW 33rd Terrace
Deerfield Beach, FL 33069
Revenue Cycle Manager
15 years experience W2
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Summary

Experience
Information Technology
Jan 2021 - present
on Medicare Quality Payment Program and MIPS program to identify qualifiers for PET to reduce negative impact to Medicare reimbursements for year 2021 & 2022, and increasing interoperability metrics through implementation of system software. Collaborated with Nursing Team and won recognition in hospital wide Process Improvement Committee top pick for 2017 for Improvement Initiative that increased surgical service volume by 25% and reduced errors by 60% per quarter, and further increased Surgery Volume by 5% in 2018. Coordinated the implementation and training of ePrescribe and EPCS Project in Allscripts for faculty of Surgeons, Nurse Practitioners and Physician Assistants for NY State Controlled Substances mandate. Coordinated Go Live for Surgical Practices in electronic booking for automation of surgical requests and launching work queues for routing requests to interdepartmental teams in order to reduce wasted time, errors and efficiencies in clearance processes throughout the NYP Brooklyn Methodist Department of Surgery. Facilitated mass enrollment project for Medicare and Medicaid Ordering and Referring Physicians and Clinicians for Medicare, Medicaid to decrease denials and increase payment from insurance carriers.
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Revenue Cycle Manager, Contract Hire
Apr 2020 - present
  • Serves as Liaison and channel of communication between Partnering Hospitals, Referring Physician Offices, Health plans and regulatory bodies on matters regarding medical necessity, financial clearance and authorizations for patient pet scan appointments.
  • Oversees daily operations and workflows for insurance verifications, coordinating rescheduled appointments, and billing & collection activities across 3 pet scan centers including recommending, developing and implementing processes and identifying revenue opportunities.
  • Monitors and distributes Account Receivable workqueue to billing and collections staff ensuring that follow-ups are done timely for positive reimbursements and appeals are submitted with required documentation.
  • Collaborates with Marketing Team on advancement opportunities to increase patient volume through expansion of imaging services for existing and new customers while meeting interim guidelines.
  • Creating informational packages for referring Faculty Group Practices to build communication pathways, providing in-network participation information for contracted payors, and financial budgeting options for patients' benefit.
  • Identifies and implements payment options and budgeting tools for upcoming services, and incorporates tools as part of the payment structure, increasing time of service collections by 30%.
  • Negotiates rates of reimbursement and contract negotiations for Advanced Isotopes for contracted Health Insurance Providers and coordinates single case letter of agreement for out of network cases.
  • Monitors and assigns staff to Billing Call Center to facilitate patient billing inquiries, explanation of benefits and recurring payment plans for existing balances.
  • Trained staff on billing and claims remediation for timely processing and payment reimbursements.
  • Creates and implements strategy plans for improving revenue cycle practices by streamlining patient registration and screening practices for medical necessity to increase cash receivables, insurance reimbursements while decreasing volume of aging accounts.
  • Identifies Key Performance Indicators and challenges within cash collections and current trends to facilitate policy making and process improvement initiatives.
  • Identifies, evaluates, and implements related policies and procedures in compliance with related standards and regulations in collaboration with the Quality Management and Compliance regulations.
  • Interviews, hires and coordinates training of new staff in accordance with human resource guidelines, recruitment, training and onboarding.
  • Oversees and maintains managed care relationships, including monitoring reimbursements, understanding payer negotiated rates, compliance and performance measures, value-based reimbursement programs, provider credentialing, and maintenance of contracts.
Appeals Budgeting Compliance PET Scans Process Improvement
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Patient Financial Counseling Manager, Patient Financial Services
Banking/Financial
Sep 2016 - Jan 2019
  • Assisted AVP and CFO in all matters regarding patient admission notification and financial clearance for elective scheduled surgeries across all disciplines and service types.
  • Implemented Process Improvement Initiative for financial clearance processes for Medicare and Medicaid FFS, Managed Care HMO and Commercial insurance carriers utilizing appropriate ICD-10 and CPT coding for maximizing reimbursement and appropriate processing.
  • Generated weekly outstanding AR reports to track trends in payments from insurance payers to determine if accurate and appropriate claim processing processes and implement changes.
  • Monitored Revenue Cycle, workqueues, and denial reports to determine change in practices and workflow for authorizations and insurance clearance across all payor types and lines of services for surgery and Inpatient Admission notifications.
  • Determined self-pay eligibility and advised patients of payment options and financial planning including recurring payment plans, sliding scale and self-pay package rates for planned, elective surgical services and hospital services.
  • Worked in continuous collaboration with Nursing, Surgical Services and Operations Management to improve best practices for patient care, quality experience, and redefining staff workflows and processes.
  • Continually developed external and interdepartmental staff resources and training materials for a seamless and efficient workflow that allows high quality healthcare and financial coordinating/planning.
  • Trained and provided ongoing support to staff of 16 union employees and providing periodic staff evaluations, making improvement recommendations as part of staff development initiatives.
  • Worked in collaboration with Cerner Team to develop efficient perioperative tracking system and system work-queues for team communication and patient financial clearance tracking.
  • Maintained HIPAA & JCAHO compliance, and provided educational materials, in-service training to financial, Hospital and Faculty administrative staff to ensure hospital financial policy was upheld.
  • Performed quality assurance audits of staff's daily work to ensure accurate and appropriate data collection documented in the Electronic Medical Record system complete with patient demographic, insurance information, referrals and authorizations were verified for financial accounts and billing records.
  • Reorganized daily work distribution for Inpatient Financial Counselor Team specific to Daily Inpatient Census to ensure all procedures are approved, traceable and payable by insurance.
  • Administered in-service training seminars across all departments' front desk and secretarial staff to ensure the proper knowledge of in-network insurance carriers and authorization requirements for upcoming procedures.
  • Implemented workflow changes and customer service improvements to increase patient access and customer service satisfaction.
Audit C-Level Management Cerner Compliance ICD-10 Medicaid Medicare Nursing Perioperative Process Improvement Surgical Nursing
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Billing Manager
Feb 2014 - Nov 2015
Medical Center Billing Manager, The Center for Women's Reproductive Care Accomplishments: Coordinated the implementation of web-based Payment Authorization Module with Columbia IT Team for cash collection and establishing online budget plans in addition to providing support to other newly-converted departments. Reorganized the Patient Pre-Payment Model and billing operational workflow to maximize monthly collections and minimize outstanding Account Receivables. Helped design billing module Interface for IDEAS Electronic Medical Record System for Patient Billing and Authorization.
  • Directed and assigned tasks to a team of 11 Medical Billers, Authorization Coordinators, Patient Financial Advisors, and provided ongoing training and support to staff for everyday needs, overseeing $22 million in revenue cash collections per year.
  • Organized operational workflow for residual balance capture to reduce account receivables.
  • Worked closely with Faculty Practice Organization (FPO), senior management and insurance carriers to investigate credit disputes, and collection reconciliations in addition to ICD-9 and ICD-10 coding.
  • Negotiated Case Rate charges for infertility treatment services according to reimbursement metrics.
  • Collaborated with Collection Agencies on outstanding patient accounts, providing consent authorizations, financial records, and other documentation for litigation proceedings.
  • Administered charge audits to ensure accurate charge entry, and completeness of claims.
  • Monitored payor reimbursements for treatments, and investigated inconsistencies in payments.
  • Reviewed insurance policy benefits, and provided Patient Financial Counseling detailing financial obligations for outpatient visits, infertility treatment and surgical procedures.
  • Analyzed monthly billing reports, claim payments and denials to make adjustments to billing and verification processes in order to optimize operations and payor reimbursement.
  • Reconciled charge error reports and denials to reduce billing errors, resolve denials, charge submission errors, and physician credentialing issues.
  • Created and updated staff training guides for charge entry and operational materials for new hires and internal staff usage in addition to updating fee schedules.
Audit ICD-10 ICD-9 Surgical Nursing
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Billing Supervisor, Pediatric Fink Center and Vascular & Cardiovascular Surgery
Jun 2006 - Feb 2014
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Administrative Assistant
Feb 2006 - Jun 2006
  • Processed and packaged billing records for outpatient services and procedures.
  • Entered charges in electronic billing system for claims submission and payment collections.
  • Maintained patient and business records in computer database and office filing system.
  • Obtained referrals and authorizations from insurance carriers for physician and lab services.
  • Verified client benefits and eligibility for office visits and outpatient diagnostic studies for self-pay, commercial insurance carriers, and Medicare members.
Medicare
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Edit Skills
Non-cloudteam Skill
Education
Advertising Project Management
Executive Training Program 2019
Certifications
Certificate Cornell University of Engineering
Skills
Audit
2019
4
Compliance
2021
4
ICD-10
2019
4
Process Improvement
2021
4
Surgical Nursing
2019
4
C-Level Management
2019
3
Cerner
2019
3
Medicaid
2019
3
Medicare
2019
3
Nursing
2019
3
Perioperative
2019
3
Appeals
2021
1
Budgeting
2021
1
ICD-9
2015
1
PET Scans
2021
1