About
Highly accomplished Healthcare Revenue Cycle and Operations Executive with over 20 years of expertise in medical billing, coding, credentialing, and contract negotiations. Proven leader in optimizing financial performance through strategic accounts receivable management, cost savings initiatives, and implementing robust compliance programs that meet JCACHO standards. Drives profitability and operational excellence by developing high-performing teams, negotiating favorable physician fee schedules, and enhancing billing and coding quality.
Work
Physician Fees First LLC.
|Medical Billing Department CEO
Marietta, GA, US
→
Summary
As CEO, Kelly Shea strategically directed comprehensive revenue cycle management, compliance, and operational strategies, ensuring robust financial health and regulatory adherence for physician practices.
Highlights
Directed end-to-end accounts receivable analysis and collections, consistently optimizing cash flow and significantly reducing outstanding balances for physician practices.
Developed and implemented robust staff training programs on financial policy, billing procedures, and compliance, elevating team performance and accuracy.
Managed all aspects of insurance verification, denial management, and contract guideline updates, enhancing revenue capture and minimizing claim rejections.
Spearheaded physician credentialing and fee schedule negotiations, securing favorable terms that directly impacted practice profitability and financial stability.
Established and enforced comprehensive compliance management protocols, ensuring adherence to Medicare, Medicaid, and JCACHO standards across all operations.
Atlanta Gyn and Associates
|Accounts Receivables Department Director
Atlanta, GA, US
→
Summary
As Director, Kelly Shea led all accounts receivable operations, optimizing financial performance through strategic analysis, collections, and comprehensive compliance oversight for a specialized medical practice.
Highlights
Led accounts receivable analysis, collections, and month-end reporting, consistently achieving financial targets and providing executive summaries for strategic decision-making.
Implemented targeted staff training initiatives on payment posting, charge entry, and insurance denial resolution, improving operational efficiency and reducing errors.
Managed complex insurance verification and physician credentialing processes, ensuring accurate billing and maximizing reimbursement rates.
Conducted detailed fee schedule analysis and contract negotiations, securing advantageous terms and staying current with local coverage determinations.
Developed and enforced financial policies, procedures, and compliance management frameworks, enhancing regulatory adherence and fiscal integrity.
Pinnacle Ortho/Georgia Pain Management/Samson Surgery Center
|Reimbursement Director
Marietta, GA, US
→
Summary
As Director, Kelly Shea restructured and optimized healthcare reimbursement processes for multiple facilities, ensuring compliance, driving significant cost savings, and enhancing revenue cycle efficiency.
Highlights
Spearheaded the restructuring and implementation of healthcare reimbursement processes, significantly improving efficiency and compliance for multiple medical centers.
Achieved substantial cost savings through expert negotiations of all facility and physician credentialing, contracting, and fee schedules.
Ensured stringent compliance with current payments, rules, regulations, and legislative initiatives impacting physician, surgery, and specialty billing processes.
Managed and trained staff within a robust quality assurance structure, fostering a high-performing team focused on revenue cycle excellence.
Contributed to business growth through strategic marketing initiatives and effective off-site management of operations.
Medical Accounting Consultants
|Consultant/Account Manager
Marietta, GA, US
→
Summary
As Consultant/Account Manager, Kelly Shea managed full-cycle billing and accounts receivable for diverse healthcare clients, ensuring accurate financial operations and optimizing revenue collection.
Highlights
Directed comprehensive billing and accounts receivable functions, including auditing, A/R analysis, and payment posting, for multiple client accounts.
Implemented efficient lockbox setups and refined accounting procedures, streamlining financial operations and improving accuracy.
Provided essential staff training on charge entry, payment posting, and auditing, enhancing team capabilities and operational consistency.
Facilitated referrals and managed pre-authorizations, ensuring seamless patient access and appropriate reimbursement.
Education
DeVry Institution of Technology
→
Bachelor of Science
Healthcare Data Analytics
DeVry Institute of Technology
→
Associate of Science
Health Care Information Technology
Certificates
Modifiers for Physician Reporting
Issued By
AHIMA (Health Info Management Association)
ISIS Practice Management
New Reimbursement Rules for ASC's
Georgia Workers' Compensation Rules and Regulations
Issued By
Board of Georgia Workers Compensation
CPCS Certified Professional Biller and Coder
Issued By
DeVry University
Skills
Revenue Cycle Management
Accounts Receivable Management, Medical Billing, Medical Coding, Collections, Payment Posting, Charge Entry, Insurance Verification, Denial Management, Pre-authorizations, Reimbursement Processes, Fee Schedule Analysis, Contract Negotiations, Lockbox Setup, Patient Accounting.
Compliance & Regulatory Affairs
JCACHO Standards, Medicare Compliance, Medicaid Compliance, Regulatory Adherence, Policy Development, Procedure Implementation, Workers' Compensation Regulations, Physician Reporting Modifiers, ASC Reimbursement Rules, Local Coverage Determinations.
Operations & Financial Management
Business Operations, Quality Improvement, Cost Savings Initiatives, Profitability Optimization, Strategic Planning, Executive Summaries, Financial Reporting, Budgeting, Month-End Reporting, Scheduling, Financial Policy Development.
Leadership & Team Development
Staff Training & Development, Team Leadership, Project Management, Customer Service Team Development, Goal Setting, Performance Evaluations, Cross-functional Collaboration.
Healthcare Administration
Physician Credentialing, Facility Expansion, Auditing, Off-site Management, Human Resources, Certificates of Need.
Healthcare Technology & Analytics
Health Information Technology (HIT), Healthcare Data Analytics, ISIS Practice Management.