Anne Rose Ilarde
Rohnert Park,CA
Summary
Dedicated healthcare professional with over 12 years of experience, including demonstrated success in leadership and supervisory roles within both inpatient and outpatient settings. Proven ability to optimize revenue cycle management, drive regulatory compliance, and lead teams in Inpatient hospitals and specialty care clinics, with a strong emphasis on operational efficiency and achieving objectives within established policies. Results-oriented Revenue Cycle Manager skilled in maximizing reimbursement and streamlining operations. Achieved a 30% increase in cash flow and a 15% improvement in billing accuracy through data analysis and strategic process improvements. Adept at managing all aspects of the revenue cycle, from patient registration to denial management, to ensure maximum financial performance.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Office Program Coordinator
Sutter Santa Rosa Regional Hospital
08.2025 - 09.2025
- Supervising Front Office Workflow, Scheduling Providers, and the back office, as well as managing team members timecards. Responsible for Monthly Reporting of Census, New Patients, and established Patients, ensuring we meet our monthly surgery goal, which is submitted to our Outpatient Surgery Director and CNO. Responsible for interviewing and hiring new employees. Provides financial counseling to patients and their families, assisting with insurance verification and eligibility. Assesses patient financial requirements and insurance policies and obtains preauthorization for all services. Ensures that all patient issues regarding insurance claims and cost of care are correctly handled. Gains confidence and cooperation from the patient, their family, support group, and other healthcare providers through competent job performance, attentive monitoring and care, and effective communication. Adheres to all local/state/federal regulations, codes, policies, and procedures to ensure privacy and safety while delivering optimal patient care. Primary responsibilities include assisting patients in meeting their insurance and clinical requirements in preparation for surgery and submitting the Authorization for surgery. Responsible for Inpatient Coding, Processing Provider Referral and Orders, and Surgery Authorizations. Collection of financial responsibility. Collaborate with ancillary departments.
Revenue Cycle Manager
Marin City Health and Wellness Center
10.2023 - Current
- Supervisor Responsibility: Supervise Revenue Cycle staff & Organization-wide Revenue Cycle. Required to visit MCHW Clinics as assigned, with a frequency of up to once per week, and coordinate with Controller/Administration.
- Summary: Reporting to the Controller, the Revenue Cycle Manager manages all activities in the revenue cycle function across all six clinic services. This position coordinates our appointment registration, eligibility, Billing referral, denial and collection activities, maximizing payments and improving processes. The Revenue Cycle Manager ensures timely claim submission/billing for each patient encounter. Maintains high ethical standards in compliance with
- Essential Duties and Responsibilities: Create and maintain process documentation, routine workflows, roles, and responsibilities. Work to integrate and develop system data to produce reports for operational management and executive leadership, includes revenue, projected revenue, cash forecasts, and denial metrics, among others. Oversee the development and implementation of policies and procedures that ensure timely and accurate revenue cycle functions. Provide reporting feedback to the team to ensure accurate coding and billing of Insurance and patient accounts. Provide feedback to Clinic Managers and the Executive regarding trends, processes, pain points, and areas of improvement. Collaborate with the billing Department to resolve medical billing denials from insurance providers and identify alternative payment sources for treatment. Ensure compliance with HIPAA government regulations, and other relevant healthcare laws and regulations. Assist and monitor the management of cash flow. Analyze and document medical denials from insurance providers. Manage the investigation and resolution of billing discrepancies and errors. Coordinate billing collections and sliding fee documentation and procedures. Maintain system data for coding charges and sliding fee schedules. Management & Monitor accounts receivable weekly/monthly/annually. Monitor provider credentialing & re-credentialing monthly. Oversee monthly close processes, including reporting and account balancing. Assist in monitoring grant programs, revenue, and expenses by service & location. Partner with outside vendors in billing management activities. Interpret and advise on Medi-Cal & Manage Care agreements. Develop internal working knowledge, utilization, and reporting through Electronic Medical Records and Electronic Patient Management systems. Keep the system Charge Master current with quarterly reviews and annual update.
Referral Authorization Coordinator III/Office Lead
Sutter Bay Pacific Medical Foundation
08.2018 - 09.2023
- Supervising front desk operations, including scheduling workflow and call center coordination for incoming referrals and patient appointments, ensuring efficiency in day-to-day department processes. Trained and mentored front desk and call center staff, enhancing team capabilities in patient eligibility verification, benefits coordination, and insurance coverage assessment. Ensured accurate coding for urology procedures and maintained precise documentation of appointment and referral information, facilitating timely responses to patient inquiries in billing and authorizations. Responsible for the day-to-day department workflow. Training for the New Hire Front Desk and Call Center Schedulers. Responsible for performing the appropriate process to verify patient Eligibility, coordinate Benefits, ensure insurance coverage, and determine if prior authorization is needed for said order. Coding for Outpatient Procedures about Urology. Facilitate responses to patient inquiries regarding Billing and Authorization with turnaround standards. Document and maintain accurate records of appointment dates and times and referral tracking in the electronic health record and related systems. Responsible for processing Outgoing Providers Pre-surgery Workups.
Intake Referral Clerk
Accent Home Health Care
01.2019 - 08.2023
- Reviewed and processed electronic referrals from various healthcare facilities to ensure appropriate home health services were allocated. Evaluated patient charts to confirm eligibility for home healthcare services and facilitated acceptance of suitable referrals. Managed patient inquiries via email, addressing questions from prospective and current patients regarding home health services. Assisted case managers and registered nurses with submitting and processing referrals, utilizing electronic platforms such as AllScript, NaviHealth, and Enscare.
Financial Counselor
Aurora Behavior Health
07.2015 - 08.2018
- Received an interview with incoming patients or relatives to obtain pertinent data and verify insurance coverage. Ensure timely communication of patient admission to other departments. Insurance Verification Benefits and Eligibility. Responsible for entering patient demographics and Insurance. Provides financial options to patients and authorized family members before admission. Assists in the resolution of routine admitting inquiries. May also interface with medical staff for information required for patient admissions. Process the TAR in charge for unbilled and unpaid TAR to the county and verify it against the STATE Master File through the Medical Website. Posting Outpatient Charges and Bridge charges. Initiate refund for Insurance and private pay review EOB and patient payment. Notify the patient of the county's preparation for tars. Review and process account with credit balances. Promptly and refer problem accounts through the staff issue for manager referral. Prepare customer invoicing in the billing system, Reconcile billing data, Process Refunds for Self-Pay and Commercial Insurance.
Revenue Cycle Coordinator
Adventist Health Care
11.2012 - 07.2015
- Essential Duties and Responsibilities: Bills all primary third-party claims on the electronic billing system or prints to paper, if appropriate, with necessary edits to ensure compliant billing practices. Reports any workload variance to the Billing Supervisor. Resolve rejected claims and perform rebilling as needed for government payers. Use online claims systems, whenever possible, to process rejected claims. Reviews claims for accuracy and verification of diagnosis and procedural coding and provides the necessary documentation for complete billing. Accurately document the claim mail date to distinguish between certified and overnight delivery (for manual claims) then collection audit trail for each account, initiating the follow-up process. Identify recurring errors and make corrections to claims, reporting these to the Billing Supervisor and providing recommendations to resolve problems. As the department requires, checks Medicare claim status online and resolves suspense items and errors. As required by the department, file adjustments or cancellations of claims with Medicare to reflect correct charges, diagnoses, dates of service, and other relevant details, ensuring billing compliance. Handles the Medicare red balance reporting. Completes all secondary billing and rebilling, ensuring that required attachments, such as remittance advice or explanation of benefits forms, are attached as needed. Assists staff members and patients in addressing patient inquiries or billing inconsistencies. Maintains ongoing knowledge of Medicare, Medicaid, and all other third-party billing requirements. Understands billing timelines and urgency in meeting all claims and filing deadlines. Keeps current with knowledge of facility payor contracting agreements. Understand all Medicaid and Managed Care eligibility requirements, coverage periods, and other relevant details. Has in-depth knowledge of the 72-hour rule and inpatient and outpatient overlaps, and how to resolve. Promote a customer service-oriented approach performing position duties and responsibilities and interacting with patients, hospital staff, and visitors. Review the explanation of benefits after payment posts to ensure that contractual posts in the AS-400 system is accurate. Review the patient's claims. Reading EOBs received from the Cash Team Collector's/Biller's write-off and adjustment sheets for patient accounts. Processed and approved by the supervisor. Posting Patient Charges for the Take 10 Program for the Center for Health, Dialysis, and Dietetics. Posting Zero EOBs from Commercial Insurance. Billing and Follow-up for Commercial, Medicaid, Medicare, and Insurance. Identify and investigate incomplete or missing charges.
Medical Billing Collector
Gragil Associates Inc.
06.2012 - 10.2012
- Manage inpatient and outpatient account collections by processing overdue hospital bills, billing insurance providers, and handling Medicare and Medicaid claims, ensuring timely follow-up on claims aged 60-90 days. Conduct detailed analysis of accounts to identify underpayments, denials, submitted appeals, billed secondary and tertiary payers, and determine patient responsibility while preparing necessary documentation for adjustments and inquiries. Assisted case managers and registered nurses with submitting and processing referrals, utilizing electronic platforms such as AllScript, NaviHealth, and Enscare.
Education
Certification Billing and Coding Specialist -
Cal Regional
Petaluma, CA01.2024
Certification Medical Office Administration -
Certificate
Bakersfield, CA03.2006
Bachelor of Science - Foreign Service
Lyceum of The Philippines
Philippines10.2000
Skills
- EHR Systems: Epic, Cerner, eCW
- Revenue Management Software: Care Flow, ForCura
- Other Systems: AS/400, Home Care Home Base
Accomplishments
- Reduced program costs [number]% through implementation of strategic improvements.
- Conceptualized and developed [name] program.
- Exceeded program revenue goals by [number]%.
- Collaborated with team of [Number] in the development of [Project name].
- Documented and resolved [Issue] which led to [Results].
- Achieved [Result] by introducing [Software] for [Type] tasks.
- Supervised team of [Number] staff members.
Certification
- [Area of certification] Training - [Timeframe]
AREAS OF EXPERTISE
- Revenue Cycle & Patient Accounting: Financial counseling, patient registration, prior authorization (including appeals), claims denials management, and underpayment contract knowledge.
- Significant knowledge of medical terminology, billing & coding: Expert in ICD-10 coding, outpatient professional fee billing, cash posting/adjustments, refunds, and standard insurance claim adjudication practices.
- Compliance & Payer Relations: Deep knowledge of Medicare, Medicaid, and commercial insurance regulations and billing guidelines.
- Administrative & Operational: Strong organizational and time management skills, patient chart reviews, and adherence to standardized policies and procedures.
- A self-starting individual driven by results with the ability to reshape action to achieve desired results.
- An ability to lead teams that provide excellent customer service. An ability to build strong results-oriented teams that excel in a performance-driven environment. Record of accomplishment in meeting performance hurdles for hitting targets, goals, and stretch goals. Effective collaboration with other members of the revenue cycle teams to ensure success in achieving Medical Center, and/or system performance targets. Personnel Management: An ability to supervise 25+ employees and the ability to manage through managers.
Timeline
Office Program Coordinator
Sutter Santa Rosa Regional Hospital
08.2025 - 09.2025
Revenue Cycle Manager
Marin City Health and Wellness Center
10.2023 - Current
Intake Referral Clerk
Accent Home Health Care
01.2019 - 08.2023
Referral Authorization Coordinator III/Office Lead
Sutter Bay Pacific Medical Foundation
08.2018 - 09.2023
Financial Counselor
Aurora Behavior Health
07.2015 - 08.2018
Revenue Cycle Coordinator
Adventist Health Care
11.2012 - 07.2015
Medical Billing Collector
Gragil Associates Inc.
06.2012 - 10.2012
Certification Billing and Coding Specialist -
Cal Regional
Certification Medical Office Administration -
Certificate
Bachelor of Science - Foreign Service
Lyceum of The Philippines