Revenue Cycle Operations

UTMB Health Revenue Cycle Operations creates a culture of excellence built by providing outstanding service. We do this through accurate verification of patient eligibility and timely billing of services. 

Our objective is to secure optimal reimbursement while maintaining excellent customer service. As a world-class revenue cycle organization, we will continue to be proactive and innovative through the integration of our diverse departments. Unified, yet independent, our teams collectively maintain the momentum which moves the mission of  the UT Health system.

Our Promise

Based on our extensive experience, we will cultivate a culture of trust, perpetuate patient care, analyze revenue, encourage efficiency, identify performance trends, communicate objectives with clarity and develop customized solutions across the entire revenue cycle.

This site addresses a number of common financial and billing questions.    If you do not find the information you need, please contact one of our Customer Service Account Specialists at (409) 771-8811 or (800) 994-0363.


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Our Mission

To optimize revenue and reimbursement through strategically driven initiatives contributing to the organization’s financial health and patient satisfaction.

External Resources

Emily Goertz, VP
Emily M. Goertz, MBA
Vice President
Revenue Cycle Operations

Emily M. Goertz, MBA, joined UTMB in February 2016 as Vice President of Revenue Cycle Operations. Emily came to UTMB with more than 17 years of experience in healthcare financial management. She obtained a Master of Business Administration from Texas Woman’s University and holds several professional certifications including CPAM, CHFP, and CPC-A.

Today, her leadership encompasses oversight of UTMB’s Single Billing Office, Patient Admitting and Registration, Coding Services, Billing, and Denials Management. As an integrated billing system, for both Hospital and Professional services, Emily believes that the revenue cycle is an essential component in delivering a world-class patient experience. Emily specializes in resolving long-standing challenges that improve operational efficiency and enhance the customer service experience. Before coming to UTMB, she served as Director of Patient Financial Services at Texas Children’s Hospital. Her extensive experience working with EPIC systems and history of demonstrated leadership equips her to provide UTMB’s Revenue Cycle Team with the guidance to implement best practices across the billing cycle and enhance revenue.


Revenue Cycle Operations by Department

Teams

Coming Soon

RCO Registration Team

 

Teams are located at Shearn Moody Plaza, Rebecca Sealy, Galveston Campus, Angleton Campus and League City Campus with many teams working 24/7.  Responsible for arrival registration, bedside registration, resource identification, Point of Service Collections, eligibility verification, transplant registration, off-site and special account registration, notification for admission, pre-authorization for day surgery and most ancillary procedures.  Patient contact is face-to-face and telephone.  Over 100 employees, this team with the guidance of Director of Gretchen L. Hall, successfully establishes a positive point of contact for the patient receiving care and begins the Revenue Cycle process.


Contact

Gretchen L. Hall, Director 
E-mail: glhall@UTMB.EDU
Melody

Coding Team


The Revenue Cycle Coding team of over 80 individuals supports UTMB clinics in encounter documentation and data interpretation. Through our innovative information systems and our diligent coding specialists, with the guidance of their Director Melody Dowler, the coders are able to ensure quality assurance in the capture of all healthcare encounters throughout the fiscal year. Our coders operate both in house at Shearn Moody Plaza and remotely. During training periods, our coding team will also visit campus and clinics to assist in clinical documentation training. 


Contact

Melody Dowler, Director 
E-mail: mrrogers@UTMB.EDU
Ejay

System Reporting Team

The System Reporting team provides data analytics for the School of Medicine and other internal/external stakeholders. By providing data trends the team is able to work collaboratively with different departments within the Revenue Cycle to ensure clean claims and prevent denials allowing UTMB Health to provide world class healthcare to our patients. 

Contact

Ejay Birkmeyer, Director 
E-mail: ejaybirkme@UTMB.EDU
Kara

Revenue Cycle Claims & Solutions Team


The Revenue Cycle Claims & Solutions team is responsible for timely billing and processing for all of our hospital and professional claims, as well as the fiscal mitigation of our special contract relationships and the financial management of our UTMB research accounts. Our Billing team, understands the time sensitive nature of processing reimbursement for the UTMB enterprise and executes their contribution to RCO with prompt diligence; however, they do not lose sight of customer service or patient sensitivity. Our billing department works as much for our patients as our providers do, and assists with all payment options and queries, redirecting potential candidates for financial assistance to our esteemed customer service specialists or eligibility team in order to ensure quality care without compromising quality of life. The Solutions team identifies opportunities for efficiency discovered in our operations and develops lean process solutions. As our billing systems become more sophisticated and notation becomes more specific and critical to claim success, our technological solutions increase in demand. In order to guide these process driven initiatives, we have asked our PMO to guide our projects to success.



Contact

Kara Campbell, Director 
E-mail: kgcampbe@UTMB.EDU
Cindy

Physicians' Billing Denials Management Team


The Revenue Cycle Denials Management team is responsible for insurance follow-up and correcting denials of reimbursement for medical care in order to optimize revenue. After the patient has received care the claim for care will be sent out to a payor to receive payment. Sometimes, the payor finds that documented claim insufficient. It is the Denials team's responsibility to mitigate the denial and attempt to root cause correct the error in order to prevent any unnecessary loss of reimbursement to our facility or faculty. 

Physicians' Billing Denials Contact

Cynthia L. Smith, Director 
E-mail: clsmith@UTMB.EDU
Nancy

Hospital Denials Management Team


The Revenue Cycle Denials Management team is responsible for effectively managing claim denials which will increase revenue and collection rate while improving patient satisfaction.  After the patient has received care the claim for care will be sent out to a payor to receive payment. Sometimes, the payor finds that documented claim insufficient. It is the Denials Management team's responsibility to mitigate the denial and attempt to root cause correct the error in order to prevent any unnecessary loss of reimbursement to our facility or faculty. 

Hospital Denials Contact

Nancy Sammons, Director 
E-mail: nlsammon@UTMB.EDU
Nina

Single Billing Office


The Single Billing office is the last stop in healthcare billing, as they are responsible for finalizing patient payments among many other things such as payment plans, bad debt,  liens, refunds and customer service  . This team is also the most post-care patient facing area of our department and take their role as customer service champions very seriously. Each interaction with a patient is an opportunity to positively influence our patient's opinion of not only RCO, but of all of UTMB.



Contact

Nina Sinibaldi, Director
E-mail: nksiniba@UTMB.EDU
M Cantrell

Administrative Operations Team



The Administrative Operations team drives innovative tactics to improve process flow and gain efficiency to simplify and hone RCO operations. In response to the growing complexity of the healthcare industry, this versatile team maintains the stability and effectiveness of internal operations and encourages external relationships with our vendors, stakeholders, community and clients. Our areas of responsibility include executive and operational support, logistics and facilities planning, supply order management and processing, kronos time management, event planning, RCO communications, employee engagement, and networking and strengthening relationships with our customers.

 

Contact

Michelle Cantrell, Administrative Operations Manager 
E-mail: mdcantre@UTMB.EDU
Juan

Financial Management Team

The Financial Management team provides financial planning and forecasting. This team provides satisfactory reporting to the institutional budget and finance team and ensures that Revenue Cycle remains in compliance with financial regulations. In addition, the team manages all vacant positions and collaborates with Human Resource's Position Control Board on all replacement positions while maintaining the budget to support fluctuating labor expenses.  

Contact

Juan Guerrero, Business Operations Manager 
E-mail: juguerre@UTMB.EDU

Road Ahead

As we further develop greater cohesion between our diverse departments, our teams are inundated with increased innovation, progressive process enhancement and creativity in effective communication across all specializations in this department. It is with diligence in our daily accomplishments and compassion for our patients that Revenue Cycle excels in its efforts to encourage the function and vitality of UTMB Health. 

Our Projects Management team is congruous in perpetual development and training mode, building a smarter way to work better. Our RCO Leadership team is guiding our mission through to fruition, as they work to encourage daily decision making in closer alignment with future focus. Our Patient Access and Patient Account teams execute our day to day action plans through the full arc of patient care, as they motivate quality and sustain success across the organization. Our Coding team persists in precision as they assure accountability through accurately captured healthcare encounters. Our Denials Management team is our champion of maintaining efficiency while our Billing team strives toward enabling excellence in reimbursement efforts. All teams work in tandem and tenacity with our Administration, driving greatness at the forefront of our united efforts. 

We understand at RCO that excellence is an achievement to be maintained, while greatness must be ever strived after. This department is the embodiment of the guiding principle of UTMB: Working together to work wonders.