HEALTHCARE OPERATIONS ADMINISTRATION

• Hospital Operations Management / Physician Practice Administration / Strategic Business Planning Revenue Cycle Management / Project Management / Healthcare, Business EHR Consulting / Healthcare Analytics
• Enthusiastic and transformational leader with many years experience in healthcare administration, operations management, project management and revenue cycle leader. Growth-focused, solutions-driven professional with proven success directing all business, revenue cycle, accounts receivables, operations, financial, healthcare analytics, insurance contracting, compliance and risk management functions, as well as, EHR, process and workflow redesign, organizational and professional development.

PROFESSIONAL EXPERIENCE

confidential

Provided operational, financial, healthcare analytics, and IT data services to a Medicare Advantage plan. Project Manager for the design and implementation of a 2012 physician CMS HEDIS / STARS measures reporting tool and process. Accountable for creating and maintaining physician data, as well as, instrumental in the design and implementation of a new 2013 physician CMS STARS / HEDIS reporting tool. Helped develop provider financial incentive models based on HEDiS compliance. Also, managed Provider Attribution project. Assisted in company strategic planning, healthcare analytics and creating executive management reports, Created actionable UM, DM and CM reports. Accountable for project plans and timelines.

confidential

Provided pre-design hospital owned hospital physician revenue cycle workflow. Provided electronic billing, and electronic health record IT management services to hospital-owned physician groups. Participated in nationwide pre-implementation revenue cycle software testing, documentation, trouble shooting and training projects for Siemens Soarian revenue software.

confidential

PA Business Administrator

Maintained full responsibility for all business, operational, financial, HR, legal, billing, compliance, HIPAA, and contracting functions for nine-physician group and physician-owned physical therapy group and surgery center. Also accountability for managing five real estate partnerships. Project management through PQRI and ERX incentives. Achieved debt-free status for MFA. Also, ensured that FAASC passed all AAAHC and PA DOH Accreditations.

Key Accomplishments:

Increased MFA net revenue from 4.9 million to 6.5 million from '06 to '09. During my tenure, I made MFA entity debt free. Also, refinanced and brought in six new owners in the FAASC.

Responsible for holding practice an surgery center accountable for HEDIS measures

MFA practice revenue 6.4 million in '10 despite economic recession, lower physician coverage, and reduced volume of patient visits and surgeries.

Grew FAASC net revenue from less than 1 million in '06 to 2.4 million in '09 while improving share price from 20,678 to 68,434 per share in three years.

Successfully integrated practice into fully Electronic Health Record EHR -based and Practice Management PM systems along with integrating with hospital, hospital and reference labs, and commercial pharmacy systems. Managed these processes, as well as, CPOE PQRI, ERx, HEDIS, Meaningful Use, HIE HL7 interfacing..

confidential

Physician Practice Consultant

Provided expert consulting services to physician practices, surgery centers, hospitals, health systems, insurance companies, and Medicare QIP services. Conducted analyses and audits of workflow, operations, billing, and insurance claims. Recommended and implemented improvements in appointment scheduling, clinical processes, medical records, coding, billing, claims processing, credit, collections, and financial reporting. Performed EHR practice assessments and work and documentation flow analysis and redesign. Created and utilized EHR pre-post-implementation tools and analysis. Prepared and presented training on Electronic Health Records EHR .

Key Accomplishments:

Developed billing and claim audit service and revenue cycle management tools to audit revenue cycles of physician practices.

Assisted clients in selecting, designing, and implementing new EHR and Practice Managment systems.

Instrumental in Medicare DOQ-IT review of EHR RFPs and selection, development, and execution of PA Medicare Quality Insights EHR projects throughout PA physician practices and hospital..

Conducted large physician group workflow and change management redesign on EHR system technology and management. Experienced with AllScripts and Centricity EHR products, as well as, their HL7 interfaces.

confidential

business operations, analysis and reorganization of two outpatient surgery centers. Managed all registration, billing, insurance claim and reimbursement functions. Responsible for insurance negotiations, analysis, claims adjudication, and decision-making,Ensured proper pricing, reimbursement, and payment on all services and contracts.

Key Accomplishments:

Reduced one million dollar debt within five months and generated positive cash flow.

Project manger to Implement internal controls that made facilities compliant with Sarbanes-Oxley regulations.

Helped lead the ASC to successfully pass 2005 JACHO inspection.

Generated average 21 cash increase in 1st and 2nd qtr 2005 compared to same period of 2004.

confidential

Physician Group Operations Manager

Responsible for design, construction, implementation, and management of new multifunctional, 31-member health group providing services at multiple locations. Provided strategic business planning, business system analysis, process and workflow design, and organizational development. Provided leadership in HR, budgeting, financial management, operational, patient-flow and program issues, IT, Charge Master development, billing, claims processing, reimbursement and adjudication. Prepared and administered 14-million physician practice budget. Negotiated insurance, vendor, service, and facility contracts. Cultivated and instituted physical and virtual networks with other hospitals, physician practices, and HMC departments. Accountable for achieving continuous quality improvement measures.

Key Accomplishments:

Developed rural telemedicine technology with other hospitals and physician practices.

Set up, negotiated, and coordinated services and operations at outreach clinics and hospitals.

Project Manager: Physical build of new group practice sites, Project Manager in selecting, designing, and implementing hospital and cardiology network wide Cardiology digital imaging Acuson and Siemens system, as well as, HL7 interfaces and partial electronic medical record system

confidential

Built directed day-to-day operations and strategic planning of newly purchased family and community primary care site located in urban environment. Integrated and transformed sole proprietorship into group practice within an integrated health system. Reengineered office workflow processes including billing, clinical workflow, information systems, laboratory procedures, medical records documentation, telecommunications, and office space redesign. Developed and executed practice budgets. Trained staff in teamwork, provider CME, and quality customer service. Ensured site compliance with JCAHO, local, state, federal, and insurance company requirements. Held additional responsibility for building and oversight of PSGHS Harrisburg Hispanic Clinic.

Key Accomplishments:

Responsible for all practice continuous quality improvement measures

Project Manager for the physical build out of new Physician Group practice site

Overall increased overall payments by 45 , increased average visits per FTE provider by 21 , charges by 39 , and provider work RVU's by 36 while decreasing total expenses by 21 .

Led practice site in exceeding all medical record and JACHO compliance requirements.

confidential

PA Price Quote / Business Analyst

Accurately analyzed, calculated, coordinated, and reported hospital and physician costs, charges, and reimbursements. Ensured proper price estimates through ICD-9, CPT, CDM charge master development, and coding via hospital and physician accounting and financial decision support networks. Developed, monitored, and maintained accountability for 1.9-million departmental operating budget.

Key Accomplishments:

Established 99 accuracy rate between actual and specific estimated charges.

Analyzed patient admission, registration, bed control and patient flow process. Recommended changes resulting in immediate 25 increase in staff productivity while improving data quality.

confidential

Admissions Supervisor

Directed department operations and managed 20-person staff in coordinating inpatient and outpatient registrations and admissions for approximately 3,600 patients per month. Coordinated with billing department to ensure proper registration data entry and hospital claims processing. Responsible for patient bed control. Coordinated patient flow with ER, hospital and utilization review departments. Enhanced manual and information systems and policies to improve processing time, patient flow and hospitals revenue cycle

Key Accomplishments:

Implemented insurance verification policies for out and inpatient surgery procedures.

Commenced up-front collections thus reducing back-end collection problems.

Confidential

Insurance Claims Processing Supervisor

• Managed 95 claims examiners on two shifts while significantly increasing productivity and quality.

Through improved training and quality control measures a 99 claim accuracy rate was achieved and maintained.

Established and implemented new standardized training, quality and performance appraisal programs.

Military Experience

confidential

Transportation Management and Logistics Officer

Commanded an Confidential Corps of Engineers maintenance facility with 35 staff members. Administered an annual operating budget of 2.3 Million. My facility attained 1st place from base Commanding General and runner up in CONUS Confidential Maintenance programs. Coordinated and supported national and worldwide US Army battalion and division level missions. Also worked as an USACE Emergency Operations Staff officer during Hurricane Andrew and Confidential Pennsylvania flood response team.

Combat Corps of Engineers Platoon Leader

Responsible for the training, health and welfare of a 33 staff platoon. Developed training and policy procedures, which led to top honors from base Commanding General. Developed and implemented a special training program for Confidential West Point cadets. Led and managed platoon and company operations in Central America.

confidential

Division Instructor

Trained, conducted and evaluated Confidential personal, Confidential and Navy pilots along with Confidential warship commands in air and naval gunfire operations in the Pacific

Technical Experiences

Healthcare revenue cycle, Workflow-Process analysis and redesign, HEDIS, Healthcare Analytics, Electronic Health Records EHR , Practice Management PM , SMS, Eclipsys, Centricity, Siemens Soarian, Cerner, Allscripts, Medent, AdvancedMD