Change Management

Business Modeling

Contract Negotiations

Operations

Six Sigma Methodologies

Quality Assurance

Gap analysis

Cash Flow Improvement

PFS strategies

 

Granger Medical        Sept 2014 – Present

Director Revenue Cycle Operations

Hired to redesign the RCM to accommodate a 20% growth from 86 to over 200 providers

§ Implemented new technology including estimator, receptionist credit card wallet, 2014 server reports and frontend payment plan program.

§ Improved cash flow from 3.5 million to 5.8 million in 8 months. Major improvements in automation and staff training.

§ Redesigned Operations to accommodate at 20% growth from 86 to 140 providers. This included staffing model, technology, enhancing current EMR, PM, P&P, reporting and vendor relationships. 

§ Automated claim creation, auto submit, edit engine and denial tools.

§ Restructured a staff of 50 to improve accountability and daily productivity.  Denial output increased from 50 to 105 claims a day.

§ Restructured patient account inbound calls which increased collections and reduced patient completes.

§ Contracted with new vendors and implemented a payment portal along with an online payment plan tool.  Over a $100,000 dollars were created the first month through online payment plans. 

§ Enhanced vendor relationships to develop an Early-Out Program.  This program increased inbound phone collections and reduce FTE costs.

§ Redesigned credentialing with a new vendor to provide delegated payers. This allowed us to onboard providers and submit claims without a lag time

§ Analyzed denials to improve training programs. This allowed us to reduce frontend billing issues and improve AR days

§ Built a SharePoint site to improve communication and account quality over 12 locations.

§ Reduced bad debt collections through frontend training and reporting.

§ Developed a RC Database, SSRS reports and Power Pivot reports.  These reports allowed the team to work accounts at a global volume instead at one provider at a time.  This increased rebill rate, without adding FTEs.

§ The RC Database also allowed providers to access cycle data and other scorecard data.  This allowed transparency in the account process.

 

 

Kaiser Permanente        March 2009 – July 2014

Director Revenue Cycle Operations (1 hospital, 7 Medical Centers)

Hired to administrate the revenue cycle for a 180 bed hospital and 7 medical centers.

§ Responsible for all registration operations, including IP, OP, ED, OB, OR and all clinics with 200 employees

§ Oversaw Data Accuracy Unit – managed all EMR patient errors.  Responsible for developing procedures to handle and reduce EMR errors. 

§ Remained top 2 hospital in Inpatient collections for 3 years. This was accomplished through team building and developing strong relationships with Nursing and Utilization Review.

§ Developed registration and financial counselor online auditing tool to reduce data entry errors.  I created a SharePoint site that each admitting clerk could access in the patient room.  This created more time for the staff to meet with the patient.  This allowed us to cover more topics and reduce room visits. Over all patient satisfaction and quality increased to the level of exceeding goals.

§ Oversaw Do Not Bill encounter errors identified through Risk and Infection control departments.  This includes working with departments throughout the facility to identify and manage the accounts. 

§ Responsible for 65 employee’s with 5 cost centers including IT Decision Support department, Six Sigma team, Admitting, billing and Central Eligibility Call Center. I also oversee SOX compliance for 215 cash handing staff.

§ Work with finance in developing better financial reporting to reduce cost and improve operations.

§ Improved all goal indicators from 10^th out of 13 facilities in Southern California to top 3 within 10 months.  

§ Designed efficiencies within our tri-central call center to reduce staff hours and improve customer service.

§ Sparked new life in staff to meet administration’s goals regarding: attendance, quality of work, co-pay collections, HIM coding, billing cycle and Admission quality.

§ Worked closely with Compliance Officer to insure all State and Federal rules are implemented and followed.  This included HIPAA, Medicare, Medi-Cal, AB774, AB1302 and educated staff to mitigate risk.

§ Worked with region on developing operational changes to reduce cycle times and improve workload.

§ Decision Report Team reported directly out of the Revenue Cycle Department.  This team is responsible for Information Systems, developing reports, applications and assisting in capturing ROIs for projects.

§ Improved Physician billing cycle time, reduced denials and improved Co-pay collections.  Improved Inpatient collections ranking from 7^th to top 2.   This was accomplished by developing tracking tools, working with HR and developing team building to aid staff in overcoming challenges. 

§ Developed strong relationships with union stewards to improve admitting staff attendance and overall duties.

 

TDL Healthcare PFS Consulting Group       Dec 2006 – March 2009

Director / Advisor

Hired to improve PFS operations and over see revenue cycle responsibilities as a consultant.  

§ Consulted with Administration and Ancillary departments to develop strategic initiatives. 

§ Reduced an outstanding AR of over 3 million dollars of back billing, through improved registration procedures and redesigning daily operations, motivating staff and monitoring production.

§ Implemented financial reporting standards into a managerial decision support tool. This improved benchmarking and isolated areas for improvement.

§ Developed policies and procedures to improve compliance and improve operations.

§ Managed a staff of 30 through daily operations as well as QA changes and a PA conversion to MediTech.

§ Preformed a gap analysis in the PA system this led to a redesigned PA system to better capture Lab billing requirements. 

§ Led Steering committees to help direct strategy in improving overall operations

§ Managed a high volume of staff through new operational changes such as improving QA and implementing a new PA system and policy changes.

§ Implemented an alternative solution task force involving all Directors / Managers and staff from other revenue cycle areas.  This diversified group of skill sets aided the department in quickly identifying areas of change and implementing creative solutions.

§ Maintained daily PFS responsibility in monitoring clearing house edit trends, patient access errors, FC re-class and medical necessity issues, DNFB etc….

§ Prioritized day-to-day operations with mangers and supervisors to improve quality of care and align outcomes to administration’s goals.

 

QUADRA MED (LA County Contract)       Sept 2005 – Dec 2006

Business Analyst / PFS Consultant

Interviewed by LA County (H.S.A) to aid in improving patient accounting operations and implementing a new PA system for 6 facilities.  – Company lost county contract and downsized company

 

·         Project Manager for the implementation of a new patient accounting system.  Duties included full project cycle (project work plan, vendor management, final testing and QA). The project duration is 2 years.

§  Coordinated with PA / IT on Upgrading to the UB04 and the NPI requirements on their Affinity System.

§  Project Manager / Business Analyst on their Affinity Collection Flow upgrade.  Duties included full project cycle (project work plan, vendor management, final testing and QA).

§  Consulted with PA management to document and flowchart all operations of the LA County Harbor Facility for their EDM Project.  This included all of PA, ER, UM, Registration and their PFS Eligibility Division.  The documentation provided IT and Department Directors a clear understand on how to approach the project.

§  Interfaced with the oversight team and prepared bi-weekly status reports for leadership meetings. Prepared MS PowerPoint presentations to illustrate project status to administration.

§         Worked with outside vendor programmers to document new system formats on data files such as data mailers and 4010 file.

§         Helped Patient Accounting staff in writing quires requirements to facilitate action plans.

 

Health smart corp – Long Beach, CaliforniaFeb 2003 – Aug 2005

Director Revenue Cycle

Hired to improve business office operations for seven surgery centers, one hospital and a tri state pharmaceutical billing company. – Left company to be closer to home.  I was driving 2 hours one way.

 

§  Reviewed current operations and implemented a new strategic plan for the Patient Accounting Department, interfacing with CCO and CIO.  Through the new operations we restructured the revenue cycle to increase cash by 42% in 4 months.

§  Head up their PA system conversion for their Tri-State Pharmaceutical Company.  Duties included full project as well as their PA advisor on applying better business practices.   This project last 2 years.

§  Managed IT staff of DBAs and Programmers to aid in upgrading PA systems.  This included aiding them in understand PA business requirements as well as insuring balance forward procedures were done correctly.

§  Assisted the  COO in educating health clinics staff in billing documentation to improve DNFB and to reduce billing errors.

§  Worked with senior management on reporting needs and technology solutions to enhance the revenue cycle and improve data warehousing. Major accomplishments were restructures reporting formats on SQL server and rebuilding metrics

§  Worked with outside vendors to improve the flow of information to different servers.  I also reviewed contract terms to insure that vendors were meeting department needs relating to accurate reporting of accomplishments.   I created an internal audit analysis to balance back to vendor reports. 

§  Instructed IT on how to modify the PA system to track vendor activity and improve documentation.

§  Worked with clearing house vendor to improve monitoring denials and formatting errors.  I also worked with the PA staff and the Clearing house to better implement UB92 edits.

§  Created an internal Managed Care Calculator to aid the department in month-end-close.

§  Rebuild their posting procedures, which included structuring staff and lock box procedures.

§  Rebuilt Medicare and non Government provider billing procedures.  This included changes to the DDE and other Clearing House Services

§  Rebuilt the collection / billing departments through documenting control points as well as implementing financial integrity to regain provider trust in contractual agreements.

§  Standardized patient accounting posting procedures.  Major accomplishments were creating a new application to gave users audit reports and automation in posting.  Goals to achieve were to reduce staff and posting lag time.

§  Redesigned the auditing policies to reduce human errors in daily billing.  This project aided other ancillary departments in cleaning up their errors.

§  Managed an Open AR of $98 million. Improved AR days from 110 to 65.  The main factor was working with HIM and Admissions on improving documentation.

§  Implemented EOB review process to document and improve billing issues. Improved collection efforts by 13%.

§  Improved DNFB from 20 to 7 days.  Main focus was improving finalized charges and staff’s focus.

§  Worked with CFO on patient financial reporting.  Improved Month-end close number from 15 days to 5 days.

§  Improved morale and cohesion within a diverse staff.

§  Structured monthly task focus with HIM, Admissions and other Departments to help clean up billing issues and open a line of communication.

§  Created better financial audit trails to monitor AR accounts, collection efforts, and DNFB. Added new trending reports to better monitor billing and denials. This gave us the ability to focus on specific collection issues

 

 

 

Argosy university2012

MBA Finance

 

SIX SIGMA 2008

Black Belt

 

University of California Riverside1992

Bachelor of Science, Economics

 

 

§  Re-designed operations from the ground up.  This included documenting requirements from different levels of stakeholders as well as researching vendor systems and finally implement project.

§  Developed data warehouse using MS SQL for Health Smart.  Worked with Vendor and CIO to document and flow operations in order to deploy new applications.

§  Involved in facility system changes.  This includes TDS to MediTech (Providence), HBOC 3 version upgrades (Daniel Freeman), SMS to Pbar, (Tenethealth, Inc), TMR to Pbar Affinity implementation for 6 Los Angeles County facilities.

§  Rebuilt 3 PFS – Revenue Cycle Departments.   All facilities included patient accounting system upgrades, system conversions, implementing clearinghouses 837 format. Direct involvement with developing PMP, writing new policies, analyzing data and training staff.