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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Chestnut Street, 206New Paltz, NY Street Address
EMAIL AVAILABLE / PHONE NUMBER AVAILABLE CellProfessional SummaryOver 33 years of successful outcomes of directing Hospital & Pro-Fees for Revenue Cycle Workflows RACI.Subject Matter Expert in Patient Access, Registration, Eligibility & Verification, Arriving Patient in System, Open & Closing Encounters, Case Management, Clinical Triage, Charge Router, Coding, Charge Master, Charge Posting, Billing, Collections, A/R Management, Reporting of the complete operational RCM.Successfully inculcated all electronic files to increase cash flow and reduce staffing time management to include 270,271,834,837I&P, 835, 276, 277, sFTP, automation, setting up clearinghouse and insurance.Subject Matter Expert with Project Management of Healthcare Operations, Acquisitions and I.T. solutions.Project managed over 15 system conversions covering all stakeholders and departments to Go Live.Successfully created reconciliation workflows utilizing expertise in data analytics for HB and PB.Efficiently train clinical & non-clinical staff on RCM Workflows, CMS, and Medicare & Medicaid compliance.Subject Matter Expert with Data Analytics, Problem Identification, Current State, Future State and Gab Analysis, as well as creating and presenting E.O.M., Financials to the Executive Suite.Successfully, from conception to implementation of a National Cost Estimate Tool.Subject Matter Expert and has successfully reduced rejections and denial via data analytic skills identifying the Root Causes and setting up mitigation through I.T, Training, Workflow Policy solutions.Successfully provided training material for DRG, ICD10, CPT, HCPCs, Revenue codes, modifier coding and billing compliance linkages, RVUs, LCDs, Medicare, coding history.Responsible for of Payer Contracts, Credentialing, EHR systems, Dashboards, Modules & Work Queues.Proven record of successful outcomes of Increasing Cash Flow, Reducing the A/R aging and DSO.Successfully implement and manage electronic files 270, 271, 276, 277, 834, 278, 279, 835, 837 for RCM.Created the Complete Revenue Cycle Management workflow based on RACI for Inpatient, Outpatient & All Specialties.Created Departmental (Stakeholders) Functional Revenue Cycle Management Visio WorkflowNational Subject Matter Expertise in RCM and RI with successful outcomes mentioned on Deutsch Bank.Former Fraud & Abuse Auditor for Program Integrity for Medicare and Medicaid.Expert in Reporting and Analytics of the encounter life cycle for presentations to C-Suite Staff & Stakeholders.Technical SkillsHigh aptitude for medical systems to include SharePoint (Certified), Epic (Resolute HB and PB, Tapestry, Prelude, OpTime, Cadence, RWB), Centricity, Cerner Business Objects, Clarity & ePremis Acuity, Credible, Anasazi, ADS, IDX, SMS, G.E., Meditech, Centricity, McKesson, Invision, Medic (Tiger-Autochart), CBSI, Medical Manager, El-Comp, Versys, Spectra-Soft, Medi-Soft, QMX, HII (Time), EZ-View & P.O.S. Advanced Excel, MS Project, Windows, MS Office Suite, Visio, SBARs, Power Point, Per View.Details of Professional ExperienceMedeanalytics Dec 2021 Present Director Revenue Cycle Management Services Texas / RemoteProvide RCM Consulting with Reporting and Analytics Solutions in reaching National BenchmarksReview Client-Provider data, clinical - financial for quality improvement of Patient Access, Revenue Integrity, and RCM.Conduct Presentations and Demonstrations to Hospital & Physician groups on utilizing DBs Reporting and Analytics.Review of Client-Provider various HERs and modules for data dump and mapping conversion into MedeanalyticsProvide training, KPIs, updates to Provider C-Suite, VPs, Exec. Dir.s and management staff on tools mapped to RCM.HCA (Parallon) Sept. 2018Dec. 2021 National Revenue Cycle Management Director TN, VA & NYProject Managed acquisition, implementation of Epic HB/PB & RCM Workflows of Mission Health 6 Hospital systems.Problem solved and mitigated issues with implementation for various stakeholders and EPIC modules.Provided guidance and leadership with data analytics and resolutions for workflows and encounter tracking.Conducted weekly and ad hoc meetings to leadership and stakeholders on denials management.Created the Project Plan for implementation of systems and trainings to stakeholders for RCMSet up the complete Revenue Cycle Workflow RACI for HB & PB with all stakeholders and departments.Page 1Page 2Community Connections, Inc., Feb 2019 Aug 2019 Director Revenue Cycle Management Washington, DCResponsible for the largest Mental Health / Substance Abuse facility in the District of Columbia, EHR Cerner-AnasaziManage, work, implement, on a director level the complete, I.T., Clinical, Revenue Cycle workflow RACISuccessfully manage the EMR/RCM software builds for Pro-Fees, inculcating the national benchmarksProvide SME leadership to Board Members and leadership staff on increased cash and process improvement.KForce / Inova Healthcare System Oct 2017 Jul 2018 Sr. Revenue Cycle Management Consultant Falls Church, VAResponsible for 60 Clinical applications staffing to include Epic analysts, certified builders, trainers & architects & Boost.Managed the complete Revenue Cycle Workflow for I.T. relating to 247 physician facilities & 11 hospitalsProvided SME to executive staff to increase revenue & set up efficient process improvements workflowsManaged and had oversight of all Epic personnel on-sight for various modules and enhancementsResponsible for training clinical applications, HIMS and PFS on all Medicare updates and compliance regulationsKaiser Permanente of the Mid-Atlantic States Aug 2013 Aug 2017 Senior Regional Director Project Director Revenue Cycle Management & Analytics Silver Spring, MDIncreased Net Revenue from 2 Billion to 10 Billion dollars in 3 years of Project Management of RCM based on RACI.Oversight of 40 Medical Clinics & Regional Health Plan with over 7K employees & 700K members and ClaimsResponsible for oversight & management of all Clinical, Revenue Cycle, Sox, IT, and operationsProject managed a conversion from the Diamond system into the Epic enterprise system including revenue cycle, reporting workbench, resolute HB & PB and Cadence modulesLeads and oversees concurrent projects from conception through final implementation that are targeted toward specific revenue cycle improvements. Patient Access, Clinical Operations, and Back End workflowsManages all aspects of the development and implementation of assigned complex projectsDevelops and maintains detailed work plans, schedules, project estimates, resources plan, and status reports.Responsible for managing the MAS Denials Management Work Group and Sox Audits reporting MTD & YTDEducationUniversity of Maryland Continuation Edu. of BS Health Services Management (On-Line) PresentMarist College Poughkeepsie, NY Computer Science Sept 1987 June 1988North Carolina A&T State University Greensboro, NC Economics Sept 1982 Jan 1983S.U.N.Y. at Plattsburgh Plattsburgh, NY Economics Sept 1981 June 1982REFERENCE AVALIBLE UPON REQUESTNational SME of RCM, RI, Fraud & Abuse Auditor Accomplishments1: Kaiser Permanente of the Mid-Atlantic StatesA)Prior to hire CEO Bernard Tyson (was my mentor) communicated net review of 2Billion a year needed to go up. After 2.5 years of continuous modifications and system conversions from the Diamond system to EPIC HB & PB, the yearly net revenue went up to 10Billion a year. Surpassing regions, Northern California, Southern California, Colorado, Northwest (Washington State) and Atlanta Georgia.B)KP is a medical provider, Insurance Carrier, and Physicians Groupa.Started with 34 Physician Facilities, on boarded to 40 and 9 Hospital associations.b.3500 Physicians, 1500 Nurses and other providers (MAPMG Physicians Group)c.Oversight of 7.9K employees in MD/DC & VA,d.On Committee for Kaiser Permanente National group for all regions RCM Quality Improvement. Lead on mapping rejections to denials and setting a benchmark for all Med-Atlantic States Denials under 10% of A/R.e.Reduction in DSOC)Conversion from Diamond to EPIC, Tapestry, Cadence, Resolute, ADT, Candance, Enterprise, RWB, Beaker, EpicCare Ambulatory, Caboodle (Cogito Data Warehouse), Clarity and other modules with Go-Live under 14 months, 2 months shy of PP deadline.D)Provided EOM Reports, Analytics and Training to various department stakeholders. Worked close with Medical Training Director for clinical performance, PFS, HIMS, Benefits2: HCA (Parallon)A)Once acquisitions were completed, Healthcare system referred to me for implementation, conversion of the RCM Workflow based on RACI. HCA EHR transition into EPIC by meeting will all stakeholders and acquired transition team.B)Provided PP and stakeholder meetings for the Complete RCM Workflows implementation with Go-Live dates.C)HCA is the largest owner of healthcare systems and management of in the United States (Inpatient & Outpatient).3 Over my 33 years of professional experience starting from George Washington University Healthcare System (Academic Medical School), Oakwood Medical System in MI, Johns Hopkins, and others, to mention, had oversight of all workflows for clinical, residences, RCM, HIMS departments. Performed system conversions into the EPIC EHR.4: Former Fraud & Abuse Auditor for District of Columbia Government with Federal paying 80% of salary under Program Integrity. Set up monthly trainings for all providers in MD/DC/VA on Medicaid & Medicare compliance. Conducted the largest audit recoupment back to Medicaid-Medicare in the amount of $412Million dollars with my findings presented to U.S. Attorneys Office with Attorney General in attendance. I am a national SME of Revenue Integrity and Compliance Program set up and maintenance. (External & Internal Audits)5: Nationally recognized as a SME of RCM by the Deutsch Bank for setting up efficient RCM workflows based on RACI transitioning Dialysis Corporation of American into operating in the black. Inculcated automation of all electronic files, reconciliations along the RCM workflow, trainings, meetings with Dr. Blochachek (Medical Director of Highmark Medicare) for claim resolutions and quality improvement reducing the DSO. (See Attached)6: Through data analytics, created presentations (decks) for various levels of staff for targeted quality improvement of cashflow. Utilized these decks to meet with various departments to motivate to obtain greater efficiency and teamwork.7: National Work Product (The Complete RCM Workflow Based on RACI)8: The one thing that you get with my credentials is, increased cashflow, problem identification and resolutions along the complete RCM workflow with successful outcomes and growth.9: When Oracle purchased Cerner, through Booz Allen, I was contacted to training the U.S. Congress, governance counsel, Cerner and the Veterans Administrations clinical and RCM staff for system conversion and RCM 101. |
