Lorena Muñoz
Valencia
Summary
Regional Manager specializing in revenue cycle management and financial analysis within healthcare. Achieved recovery of over $10M in lost revenue while overseeing a team of 110 professionals. Proven expertise in managed care contracting and team leadership, driving business process improvements across multiple states.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Regional Manager, Revenue Management
U.S. HealthWorks
Valencia
01.2017 - 01.2025
- Oversaw key matters involving revenue management and payor trends analysis within CA, WA, OR, HI and AK territory, holding accountability for approximately $65M in receivables.
- Developed and assigned regional business portfolios, established interdepartmental workflows to track metrics and KPIs, and ensured regulatory compliance.
- Lead a team of 110+ healthcare professionals, overseeing daily operations in reimbursement efforts.
- End to end revenue cycle management governing the states of CA, WA, OR, HI and AK.
- Managed key personnel activities, including the preparation of employee performance reviews, job interviewing and hiring, and determination of raises, promotions, transfers, and terminations.
Managed Care Contract Reimbursement Specialist
Henry Mayo Newhall Hospital
Valencia
01.2012 - 01.2017
- Provided analytical support and key insights to accelerate pricing for hospital services, and professional services, audited payer reimbursements, and recovered over $10M in lost revenue through research, data analysis, and appeals.
- Develop and implement QA audit tools for critical claims processing, follow-up, and denial management.
- Developed training programs for sales teams, healthcare providers, and billing personnel to improve understanding of reimbursement practices and coding requirements.
Business Representative II
Henry Mayo Newhall Hospital
Valencia
01.2010 - 01.2012
- Collaborated with the receiving department, vendors, and clients to resolve discrepancies and other related problems associated with denial management, overpayment, and contractual reimbursement.
- Verified compliance with terms set forth in hospital contractual liability agreements pertaining to insurance reimbursements, authorizations, referrals, patient co-pays, and deductibles.
- Conduct audits on billing information accuracy and monitor the effectiveness of billing systems to resolve discrepancies.
- Perform regular reviews of transactional activities, ensuring timely reconciliation and resolution of outstanding items.
Accounting Clerk Lead
Medtronic Medical Devices
Northridge
01.1995 - 01.2005
- Prepared comprehensive insurance payment reports, assisted with daily and month-end reporting, and trained new associates on insurance verification, authorizations, and registrations.
- Collaborate with Health Economics staff to assess the economic impact of therapies on payers, including government entities.
- Provide expert reimbursement-related advice to cross-functional teams, including product development, marketing, sales, and clinical leaders.
Education
Bachelor of Science - Business Administration & Management
Mt. St. Mary's University
Los Angeles, CASkills
- Medicare and Medi-Cal reimbursement
- Revenue cycle management
- Financial analysis
- Audit support and compliance
- Managed care contracting
- Payer reimbursement trends
- Business process improvement
- Project management
- Team leadership
- Staff coaching
- Personnel monitoring
- Policies and procedures
Certification
PMI Certification, in progress
Languages
- English, fluent
- Spanish, fluent
Community Service
Former Volunteer, Children’s Hunger Fund
Software Technologies
- MS Office Suite
- Word
- Excel
- Outlook
- Powerpoint
- SAP
- MEDITECH EHR Software
- AS400
Professional Highlights
- Reduced A/R revenue by 20% under goal for 4 consecutive years during tenure with U.S HealthWorks/Concentra.
- Recovered over $20M in uncollectable A/R for Henry Mayo Hospital.
- Collaborating extensively with manage care payors and developing new workflow to reduce unnecessary denials.
- Reduced A/R revenue by 25% under goal for 4 consecutive quarters during tenure with Medtronic Medical Devices; recognized as a Top Account Representative for consistently surpassing performance expectations.
Languages
Spanish
Professional
Timeline
Regional Manager, Revenue Management
U.S. HealthWorks
01.2017 - 01.2025
Managed Care Contract Reimbursement Specialist
Henry Mayo Newhall Hospital
01.2012 - 01.2017
Business Representative II
Henry Mayo Newhall Hospital
01.2010 - 01.2012
Accounting Clerk Lead
Medtronic Medical Devices
01.1995 - 01.2005
Bachelor of Science - Business Administration & Management
Mt. St. Mary's University
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