Revenue Cycle Operations
to Fullfill the Mission
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 UTMB system.
Our Mission
To optimize revenue and reimbursement through strategically driven initiatives contributing to the organization’s financial health and patient satisfaction.
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 under the billing team’s department home page. If you do not find the information you need, please contact one of our Customer Service Account Specialists at (409) 747-1099 or (800) 435-1871.
Historically known as separate entities: Physicians’ Billing Services, Hospital Patient Financial Services and Admitting, have integrated into oneRevenue Cycle department, with the welcome addition of the innovation and support from the Solutions and Strategy Teams. Together, these areas leverage processes, technologies, relationships, and business structures to heighten the financial performance of UTMB Health. Through our proficiency in the Epic billing system, we are gaining efficiencies in our collection and billing processes while maintaining compassionate customer service with our patients. The amalgamation of these separate entities under one, unified department has ensured cohesion in mission and action toward achieving our goals and endowed us with innovation and adaptability through our diversity.Our History:
Revenue Cycle Operations Departments
Patient Access Team
Commitment
The Revenue Cycle Patient Access team has the most contact with the patient out of any of the RCO departments, as they are most involved with the pre-care patient treatment. Patient Access is responsible for patient registration, surgery planning and eligibility. Spread over two locations and with a staff of over 75 employees, this team, with the guidance of Director Gretchen Hall, successfully establishes a positive point of contact for the patient to receive care and begin the revenue cycle process. This team is also engages the patient in financial counseling in order to maximize not only their quality of care, but their quality of life after medical treatment has been received.
Contribution
UTMB Health was founded on the principles of compassion and charity by which we reach our indigent or underserved population; therefore we believe that it is our responsibility to assist that those who qualify to receive aid for medical billing in obtaining the support they need, which our Eligibility team is responsible for. This team is also the home of our Registration Specialists, who work on campus to initiate the patient care experience by utilizing innovative solutions and welcoming staff. This team also maneuvers scheduling surgeries with an emphasis on optimizing both the patients' and providers' time, in order to streamline the function and fluidity of our care services. In this way, Patient Access team provides access at every point in the patient care process. Our Patient Access department is working together, with all of RCO, to work wonders and motivate excellence within all of UTMB.
Contact
Director Getchen Hall
Phone:(409) 772-6991
E-mail: glhall@UTMB.EDU
Please find a detailed organizational chart and more information about our Patient Access Team and financial assistance on their homepage under the Departments page.
Coding Team
Commitment
The Revenue Cycle Coding team of over 80 individuals supports UTMB Health and UTMB clinics in encounter documentation and data interpretation. Through our innovative information systems and our diligent coding specialists, with the management of their Director Melody Dowler, we 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, in order to encourage accessibility, productivity, quality and ease for our valued team. During training periods, our coding team will also visit campus and clinics to assist in clinical documentation training.
Contribution
The Coding department relies on their sense of detail, prioritization and patience in order to maximize their efforts in coding and submitting all aspects of medical care received through UTMB Health. This team is constantly training each other and others, as they continually look forward and stay active in their commitment to the most current coding systems and effective coding processes. Specificity and accuracy reflected in the codes from this department has resulted in clean claim rates between 97%-99% through FY14, with the instrusty target at 90%. The suscess of this team helps to ensure the security of our facility and the safety of the community we serve, which is why our Coding team is guided by the aphorism: Persisting in Precision. Our Coding department, together with all of RCO, is working wonders within all of UTMB.
Contact
Melody Dowler
Phone: (409) 266-8929
E-mail: mrrogers@UTMB.EDU
Please find a detailed organizational chart and more information about our Coding Team on their homepage under the Departments page.
Billing Team
Commitment
The Revenue Cycle Billing team is responsible for timely billing and processing of denials for all of our hospital and professional claims, as well as the fiscal mitigation of our special contract relationships, the financial management of our UTMB research accounts and provider enrollment to all payors. 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 for our providers, 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.
Contribution
Every week our billing team processes 13,000 hospital bill claims with an average rate of 90% acceptance and approximately 20,000 provider bill claims averaged at 98% acceptance. These metrics are consistently above industry standards and are published monthly within our department wide scorecard in order to ensure accountability and the full realization of potential. Our Billing department is working together, with all of RCO, to work wonders and enabling achievement within all of UTMB.
Please find a detailed organizational chart, as well as more information on our Billing Team and bill processing on their homepage under the Departments page.
Denials Management Team
Commitment
The Revenue Cycle Denials Management team, led by Director Sharon Richter, is responsible correcting denials of reimbursement for medical care in order to optimize revenue. After the patient has received care and that 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.
Contribution
With over 9,500 denials for reimbursement of care every two months at UTMB, these types of claims can severely impact how our facility is compensated for the medical services provided. Our Denials Management team equips Revenue Cycle with the optimism, determination and tenacity required to regulate this critical role in the reimbursement process. Our Denials department is working together, with all of RCO, to work wonders and maintain effeciency for all of UTMB.
Contact
Director Sharon Richter
Phone:(409) 747-1038
E-mail: sjricht@UTMB.EDU
Please find a detailed organizational chart, as well as more information on our Denials Management Team their homepage under the Departments page.
Patient Accounts Team
Commitment
The Patient Accounts team has our most interaction with patients outside of the hospital or clinics, as they are responsible for all customer service post care. This team concludes all "back-end" Revenue Cycle responsibilities in payment posting and patient payments.Contribution
This team is charged with processing all payroll, distributing intradepartmental funds, posting cash, verification of clinic payment and working with the patient through customer service. Patricia Ojeda's Customer Service team has the most interaction with patients post-care while completing the financial follow through of reimbursement. This team has the responsibility of prioritizing patient wellbeing beyond the scope of medical care, while sustaining success for all of UTMB.
Contact
Director Patricia Ojeda
Phone:(409) 772-0865
E-mail: pojeda@UTMB.EDU
Please find a detailed organizational chart, as well as more information on our Patient Accounts Team their homepage under the Departments page
Project Management Office
Commitment
The Project Management Office (PMO), led by AVP Blake Sollenberger, is RCO's answer to the opportunities for efficiency discovered in our diverse billing processes. 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 initiaitives, we have asked our PMO to guide our projects to success.
Contact
Administrative Assistant: Sherlyn Dyda
Phone:(409) 747-1130
E-mail: sdyd@UTMB.EDU
Please find a detailed organizational chart, as well as more information on our Patient Accounts Team their homepage under the Departments page
Strategy Team
Commitment
The Strategy team drives innovative tactics to improve process flow and gain efficiencies to simplify and hone RCO operations. In response to the growing complexity of the healthcare revenue cycle, 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 strategic planning, executive and operational support, budget management, employee excellence and strengthening relationships with our customers.
Contribution
This team contributes to revenue enhancement through strategic initiatives that improve staff productivity and customer satisfaction. The Strategy team’s administrative associates provide high level executive support to each team to maintain the balance and excellence of all internal operations through attentive support, seamless time management and adept planning techniques. Our account resolution specialists drive for enhanced productivity and efficiency across the revenue cycle through identifying and championing opportunities to maximize efficiency. The Strategy team’s financial analyst manages the Revenue Cycle Operations’ budget and reconciles operating expenses to assure compliance and encourage leanness while maintaining vendor relationships. Our communications strategist leads employee retention and morale initiatives, internal and external communication, recruitment efforts and stakeholder engagement. Through encouraging transparency, synchronicity and streamlined operational power, this department assists RCO by guiding our mission through to fruition.
Contact
Director: Michelle Cantrell
Phone:(409) 772-7791
E-mail: mdcantre.EDU
Please find a detailed organizational chart, as well as more information on our Strategy Team their homepage under the Departments page.
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.
The Road Ahead for Revenue Cycle:
Our Project Management team is congruously in perpetual development and training mode, building a smarter way to work better. Our Strategy 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 sustaining success across all of UTMB. 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.