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Senior Operations Manager – Revenue Cycle Management (RCM), Health Care
As a results-driven Senior Operations Manager with over 20+ years of experience in Revenue Cycle Management (RCM), I specialize in overseeing the end-to-end billing and reimbursement lifecycle for Workers’ Compensation, No-Fault (Auto), and Commercial insurance claims. I am well-versed in handling diverse claim forms, including UB-04/CMS-1450, HCFA 1500, and NF-NF3 with precision and compliance, supporting a broad spectrum of medical specialties and care settings.

Throughout my career, I have led multi-disciplinary RCM teams across hospitals, surgical centers, urgent care, and physician groups, with focused experience in specialties such as allergy, chiropractic, dermatology, DME, emergency clinics, gastroenterology, neurology, OBGYN, ophthalmology, orthopedics, otolaryngology(ENT), pain management, plastic surgery, physical therapy, podiatry(Foot, Ankle and Lower Limb), radiology, and urology. Each of these specialties brings unique coding and reimbursement challenges, especially when tied to the complexities of injury-related claims, state-specific regulations, and coordination of benefits.

I have successfully managed RCM operations for organizations handling high volumes of Workers’ Comp and No-Fault claims, ensuring timely and accurate billing in accordance with jurisdictional guidelines. This includes leveraging NF-3 forms for auto-related injuries and UB-04 for facility-based encounters. My teams are trained to detect claim-specific nuances, from identifying the correct insurer to ensuring proper documentation and timely medical narrative submissions critical for maximizing approvals and minimizing delays.

My command of HCFA 1500 billing allows for clean and compliant claims across all outpatient services. In specialties like chiropractic, physical therapy, and orthopedics, I’ve implemented documentation protocols aligned with SOAP note requirements and clinical guidelines, directly contributing to faster claim turnaround and reduced denials.

In the hospital and emergency clinic setting, I’ve optimized front-end processes, insurance verification, incident report documentation, and first report of injury capture, which are vital to Workers’ Comp and No-Fault claim approval. These changes have consistently improved the clean claim rate and decreased average days in A/R.

I have also developed and standardized workflows for DME providers, ensuring compliance with medical necessity documentation and authorization requirements, particularly for accident-related claims. In high-volume specialties like neurology, OBGYN, urology, and gastroenterology, I’ve worked closely with coders and providers to implement crosswalks between ICD-10 codes and injury types to ensure accurate claim categorization and reimbursement.

Technology has played a crucial role in my leadership. I’ve led the successful implementation and optimization of multiple RCM platforms, automating eligibility checks and flagging claim form discrepancies based on payer rules and state-specific workers' comp boards. I’ve also introduced analytics tools to monitor KPI’s such as denial rates, days in A/R, and collection ratios, enabling real-time decision-making and process improvement.

As a collaborative leader, I manage large, cross-functional teams, often distributed across multiple locations, while fostering a culture of compliance, continuous education, and operational excellence. My hands-on approach ensures that front-end staff, billers, coders, and AR specialists are well-versed in both payer requirements and specialty-specific workflows.