Mylende Liseski
San Diego
Summary
Adept at driving revenue optimization and operational efficiency, I spearheaded initiatives at Synergy Orthopedics that significantly enhanced revenue through strategic analysis and process improvement. My leadership in financial forecasting and data-driven decision making, coupled with a talent for developing high-performing teams, consistently delivers above-target results.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Director of Revenue Cycle Management
Synergy Orthopedics
San Diego
02.2022 - Current
- Direct staff in developing customer and payer relationships to best manage accounts receivables
- Analyzed denial data, identified trends and implemented solutions to enhance revenue.
- Prepared detailed executive-level financial reports summarizing physician billing and expense data.
- Negotiated contracts with customers to maximize profits while maintaining positive relationships.
- Led billing and credentialing team to ensure maximized operational effectiveness.
- Monitored payer updates to spot potential revenue increase opportunities.
- Assessed existing procedures to enhance organizational efficiency.
Revenue Cycle and Patient Access Manager
Palomar Health Medical Group
03.2018 - Current
- Company Overview: Rebranded previously AKA Arch Health Medical Group
- Manage day to day operations for 35 FTE from charge entry to payment posting
- 160 provider medical group for 18 specialties and primary care clinics
- Provider Credentialing and Payer Enrollment
- Credentialing Payer Delegation process management
- Co-manage compliance program alongside organization attorney
- Responsible for managing charges to collections for 18 specialty clinics throughout San Diego North County
- Partnering with clinic Practice Managers to manage, track and report issues along with strategy meetings to set and meet monthly KPIs
- Managing monthly Physician Operating Counsel Meetings
- Facilitate and oversee administration for Provider Peer Review Meetings
- Lead staff and oversee day to day operations for Patient Access, Denial Management, Charge Entry, Authorizations, Credentialing, CPT Procedure, and Diagnosis Coding Teams
- Managing third party vendor relationships
- 4,000 claims processed with expected revenue on average of 2.6M average monthly
- Manage Payer Patient Grievances
- Structured Performance Management Process - productivity, quality, attendance and behavior
- Experienced in Revenue Cycle Management verifications of coverage and benefits including correct ICD10, CPT and HCPC Coding, claim processing, claim denials, EDI denials, clearing house, appeals, prior authorizations, pre-determinations, referrals, insurance and patient collections, error processing, insurance discovery, payment posting, patient financial assistance programs and collections
- Oversee Patient Share of Cost, Point of Sale and Patient Hardship Program Processes
- Knowledge of payer policies according to specific contractual guidelines with managed care organizations
- HMO, PPO, Indemnity, Workers Compensation, Medicare and Medicaid programs
- Provide Dashboards and Executive Monthly Reporting to CFO
- Rebranded previously AKA Arch Health Medical Group
Senior Revenue Cycle Manager
Millennium Health
05.2013 - 10.2017
- Managed Billing Department 92 FTE
- 220,000 claims processed with expected revenue of 10M monthly
- Structured Performance Management Process
- Experienced in Medical Reimbursement Cycle, verifications of coverage and benefits including correct ICD10, CPT and HCPC Coding, claim processing, claim denials, EDI denials, clearing house, appeals, prior authorizations, pre determinations, referrals, insurance and patient collections, error processing, insurance discovery, payment posting and patient financial assistance programs
- Extensive Problem Solving, Decision Making and Project Management
- Employee Development, SOP Development, Operational, Customer Service and Leadership Training
- Communicate directly with VP, Executive Leadership and external departments regarding KPIs, trends, process improvements and all other information that may impact reimbursement
- Monthly reporting to Executive Leadership
- Partnered with Sales Team of approximately 200 Sales Representatives to obtain missing billing information or resolve other reimbursement related issues including regional challenges
- Assisted trainers to identify and deliver department training needs including staff training materials and compliance training
- Streamlined, created, implemented and re-enforced standard operating procedures
- Quality assurance department for Billing
- Patient Billing Services Call Center
- Department Liaison with Human Resources
- Monthly training and coaching with department supervisors and managers
Reimbursement and Patient Assistance
Shire Regenerative Medicine
04.2011 - 05.2013
- Managed 15 account relationships nationwide - Weekly Strategic Operational Meetings and monthly KPI Executive Meetings
- Key player in Hot Line Department implementation
- Provided Medical Reimbursement support to Hospitals, Physician Offices and ASCs nationwide
- Key player in Patient Assistance Department creation and implementation for patients
- Created and Implemented Standard Operating Procedures to include staff training materials
- Obtained patient responsibility benefit verifications including verification of ICD9 and CPT correct coding initiative
- Obtained prior authorizations, pre-determinations and referrals on behalf of providers to include ICD9 and CPT codes
- Assisted providers with all around claim support - Claims submission, Resubmissions of Corrective Claims, Appeals and Denial Claim Management
- Case Management for Patient Assistance Programs
- Managed Daily Statistic Reports for Reimbursement Operations- Distributed to Executive Management
Insurance Specialist and Cash Posting
CRC Health Group
08.2010 - 04.2011
- Account Management for 5 Behavioral Health clinics - Monthly Strategy Meetings
- Managed Billing services for Clinical staff nationwide
- Benefit liability verifications, prior authorizations, pre-determinations and claim reimbursement
- Supported clinical staff to ensure HCFA 1500/UB04 claim forms are completed accurately with correct coding using ICD9 and CPT codes
- Responsible for follow up and follow through for insurance reimbursement
- Processed claims according to specific contractual guidelines with managed care organizations
- HMO, PPO, Indemnity, Workers Compensation, Medicare and Medicaid programs
- Problem solved and resolved operational issues with clinic leadership
- Responsible for notifying clinics of patient's financial responsibilities
Operations Manager
ACC Consumer Finance
11.2006 - 12.2008
- Managed branch pipeline for Underwriting and Funding functions
- Trained, Coached and assisted staff to meet monthly goals
- Trained staff to identify fraudulent documentation/activity
- Audited loan documents to ensure within state and federal regulations
- Employee Development - 15 FTE
Processing Department Manager
Genisys Financial
05.2003 - 10.2006
- Managed branch pipeline - 20 FTE
- Trained and Coached staff to meet branch goals consistently
- Partnered with Lenders to ensure loan processing was completed efficiently in a timely manner
Credit and Funding Supervisor
Household Finance
02.1997 - 05.2003
- Supervised team of 10 funders / servicing / policies and procedures
- Managed branch pipeline and Audited loan documents
- Corporate Trainer- Responsible for developing operational and soft skill and management training courses - Employee development
Service Manager
Union Bank of CA
02.1990 - 02.1997
- Managed branch exceptions
- Balanced and researched teller shortages
- Supervised teller operations 10 FTE
- Backup to the new accounts and loan officers
Education
Medical Billing and Coding Diploma -
University of Education Institute
Liberal Arts -
Mesa Community College
Skills
- Budget development
- Operational efficiency
- Data-driven decision making
- Revenue optimization
- Financial forecasting
- Budgeting and planning
- Process improvement
- Audit coordination
- Regulatory compliance
- Revenue reporting
- Month-end closing support
Affiliations
- Medical Group Management Association (MGMA)
- Healthcare Financial Management Association (HFMA)
Certification
- Certified Professional Coder Certification
- HIPAA Compliance Certified
- Corporate Trainer for Customer Service and Leadership Curriculum
Accomplishments
- Nominations for Leader of the Year 2023
- Leadership Trainer Award
References
References available upon request.
Timeline
Director of Revenue Cycle Management
Synergy Orthopedics
02.2022 - Current
Revenue Cycle and Patient Access Manager
Palomar Health Medical Group
03.2018 - Current
Senior Revenue Cycle Manager
Millennium Health
05.2013 - 10.2017
Reimbursement and Patient Assistance
Shire Regenerative Medicine
04.2011 - 05.2013
Insurance Specialist and Cash Posting
CRC Health Group
08.2010 - 04.2011
Operations Manager
ACC Consumer Finance
11.2006 - 12.2008
Processing Department Manager
Genisys Financial
05.2003 - 10.2006
Credit and Funding Supervisor
Household Finance
02.1997 - 05.2003
Service Manager
Union Bank of CA
02.1990 - 02.1997
Medical Billing and Coding Diploma -
University of Education Institute
Liberal Arts -
Mesa Community College
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