Stacey R. Gaines
Pacheco,CA
Summary
A versatile healthcare leader with extensive experience in RCM, practice administration, and Healthcare IT, specializing in Epic systems. Proven ability to drive efficiently and optimize operations for independent physicians and healthcare facilities.
Professional advisor with strong focus on achieving results and fostering team collaboration. Skilled in strategic planning, problem-solving, and client relationship management. Known for adaptability and reliability in dynamic environments. Prepared to deliver impactful solutions and drive success in any advisory role.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Sr. RCM & Ambulatory Informatics Advisor
Altais
11.2019 - 02.2025
- Led strategic initiatives to maximize revenue through adoption of clinical application and improve RCM workflow efficiencies for Altais’ Community Connect physician’s network
- Monitored key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write-offs, estimated collections, appeal success rates and other requested parameters
- Served as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS
- Managed end-to-end practice and technology implementations, ensuring prompt completion and best performance
- Tracked metrics, identified trends, and made recommendations for areas of improvement
- Current knowledge of third-party payer rules and regulations
- Created functional strategies and specific goals and developed budgets/policies/procedures to support the functional infrastructure
- Configured RCM reports using the Reporting Workbench and SlicerDicer analysis through the Analytics Library
- Proven ability to provide leadership skills in problem identification and issue resolution
- Collaborated with healthcare providers and IT teams to streamline processes and reduce inefficiencies
- Established and supported provider onboarding, offboarding, and practice decommission SOP standards in parallel to organization guidelines
- Served as SME for Epic’s Resolute Module and primary network support advisor, ensuring system optimization
- Portal Administrator for the Optum/Change Healthcare RPA clearinghouse self-service site including implementation, end-user access, payer enrollment, with 277, 837, and 835 file analysis
- Represented Practice Informatics team in weekly Support Manager workgroup sessions
- Created and supported knowledge-based resolution articles for Service Desk Plus
- Provided guidance on MIPS requirements, ensuring compliance with Quality Improvement and Promoting Interoperability standards
- Led training and mentorship programs for internal team members
- Facilitated the Epic Professional Billing Super User Program
Sr. Provider & Business Integrity Advisor
Health Net of California
06.2016 - 11.2019
- Reviewed and analyzed business and industry data, including KPIs, financial reports and other key metrics using data analytics tools
- Conducted provider claim analysis to enhance practice revenue and operational awareness
- Managed claim appeals based on DOFR, contract, and organizational guidelines
- Led a team of Business Integrity Representatives, ensuring efficient provider issue resolution
- Reviewed and verified monthly eligibility rosters, distributing them to various MSOs
- Negotiated provider contracts while ensuring compliance with health plan and medical group policies
- Spearheaded network growth initiatives to increase provider participation and engagement
- Conducted internal training on Health Net programs and provider education materials
Practice RCM Administrator
Peninsula Urology Center
07.2010 - 06.2016
- Directed and oversaw the overall policies, objectives, and initiatives of the organization’s revenue cycle activities to achieve operational goals and cashflow targets
- Developed and implemented policies to ensure full regulatory compliance
- Managed daily practice operations, including staffing, scheduling, and budget management
- Managed HR functions, including hiring, training, and performance evaluations
- Increased practice revenue through data-driven financial strategies and process improvements
- Ensured compliance with CMS and Department of Managed Care regulations
- Managed the entire revenue cycle process, from patient registration to billing and collections
- Developed strategies to minimize bad debt and improve overall cash flow and profitability
- Served as in-house systems administrator for facility IT needs and Nextgen EHR
Center Operations Director
Concentra Health
01.2006 - 05.2010
- Support day-to-day execution of the medical model by collaborating with and supporting clinicians to drive best clinical outcomes and case closure
- Collaborate with clinicians to support staff competency on all patient care needs
- Create a professional and collaborative working environment with full colleague participation that promotes teamwork, quality, exceptional outcomes, continuous improvement, reward and recognition, and patient safety
- Manage key operations metrics and holds staff accountable on Turn Around Time (TAT)
- Patient Experience Rating (NPER), Pearl and other metrics as determined by senior leadership
- Work with leadership to identify gaps and implement process improvement to ensure optimal patient care
- Ensure compliance with state regulations, reporting and facility/equipment meets the standards for care
- Coordinate scheduling (including patients, clinicians, and staff) with clinical leadership to ensure efficient and effective clinical support, best turnaround times, and exceptional patient experience
- Monitor center status, provide wait time communication, perform 'white board' patient management, and provide service package expectations
- Coordinate and prepare material for Center Leadership Team (CLT) meetings with the goal of improving quality, patient safety, and outlier management
- Ensure ongoing development to achieve the center's business plan
- Maintain and cultivate relationships with center clients and payers while responding to requests within 24 hours
- Collaborate with Director of Operations (DO), Associate Director of Operation (ADO), and CLT to manage clinical and support staffing levels and skills that will improve patient satisfaction, workflows, and efficiencies
Education
Bachelor of Science - Health Sciences
Clark Atlanta University
Atlanta, GADiploma - Paralegal Law
University of California, Davis
Davis, CADiploma - Medical Assisting
Western Career College
Sacramento, CASkills
- Epic Systems: Resolute
- Epic Systems: Ambulatory
- Epic Systems: MyChart
- Epic Systems: EpicLink
- Epic Systems: SlicerDicer
- Epic Systems: Reporting Workbench
- Clearinghouse Platforms: Optum/Change Healthcare RPA
- Clearinghouse Platforms: Office Ally
- OnBase
- Snagit
- Change Management
- MIPS Compliance
- Cross-Functional Team Leadership
- ROI & HEDIS Compliance
- Power Bi
- Imprivata
- Galen Healthcare: Vital Center Online Archival
- Project Management
Accomplishments
- Used Epics Analytic Catalog, Reporting Workbench, Power Bi, Excel, and Visio, to develop inventory tracking spreadsheets.
- Achieved success through effectively reestablishing claim submission through the Change Healthcare clearinghouse after a 5-month disconnection due to a cyber-breach that delayed reimbursement for services to the health plan and network providers costing millions of dollars.
- Successfully implemented 85 medical practices on to the Epic platform including training and ongoing support.
- RCM Advisor to the Director of Revenue Cycle Management and Revenue Integrity Manager.
- Supervised RCM support team of 18 staff members.
- Collaborated with Operation and Technology teams in the development of the Epic Provider Onboarding build process and procedures.
- Documented and resolved service desk issues submitted by physicians and end-users throughout the network.
Certification
- Epic Resolute – Revenue Cycle Operations
- Paralegal Studies – Paralegal Services
- Medical Technology – Medical Assisting
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Sr. RCM & Ambulatory Informatics Advisor
Altais
11.2019 - 02.2025
Sr. Provider & Business Integrity Advisor
Health Net of California
06.2016 - 11.2019
Practice RCM Administrator
Peninsula Urology Center
07.2010 - 06.2016
Center Operations Director
Concentra Health
01.2006 - 05.2010
Bachelor of Science - Health Sciences
Clark Atlanta University
Diploma - Paralegal Law
University of California, Davis
Diploma - Medical Assisting
Western Career College