SUMMARY:

Extensive healthcare operations background including: lean six sigma/project management/consulting, data analysis, strategic planning, budget, profit and loss/financial reporting, information technology, management/supervision, contract negotiation/management, vendor/client management, education/training, marketing/client services, fraud and abuse/legal/compliance and billing/reimbursement

PROFESSIONAL EXPERIENCE:

Confidential, Houston, TX

Co - Founder and Co-Owner

Responsibilities:

• Facilitated the startup of the partnership including extensive State/Federal Regulations, Legal and Tax issues.
• Manage day-to-day business activity including inventory, contract negotiation/management, vendor/client management, budget, profit and loss/financial reporting.
• Directed the development of products including management of e-commerce, marketing strategies and client services.

Project Manager/Consultant/Administrator

Confidential, Houston, TX

Responsibilities:

• Administration of issues and development of strategies, which include: Advanced Illness, Assessments, Behavior Management Strategies, Home Health, In-Home Help, Long Term Care, Residential Care Options, Hospice Options, Reviewed plan of care with Doctors and Nurses, Managed Vision Loss and General Eldercare.
• Communicate project status and resolve project issues while facilitating processes and improving performances.
• Provide consulting then facilitation of numerous Legal and Healthcare Issues.

Confidential, Rancho Cordova, CA

Business Process Consultant

Responsibilities:

• Managed strategic, innovative and operational projects leveraging project management, change management and process/performance improvement core capabilities of cross-functional teams.
• Collaborated on the design of information technology required to support performance/process improvement system.
• Facilitated resolution of issues/risks raised by the leadership while acting as the primary point of contact across facility for process/performance improvement.
• Delivered high quality outcomes on time and within budget while establishing a continuous improvement.
• Managed overall team productivity, including performance issues, identification of staffing needs, hiring and training.
• Collaborated with Training department to develop and deliver quality and process improvement training modules.

Confidential, Houston, TX

Business Improvement Specialist

Responsibilities:

• Managed process improvement projects using methodologies grounded in Lean Six Sigma principles to achieve efficient, highly productive workflow processes by analyzing data, identifying key issues, removing barriers, designing performance metrics, generating solutions and implementing process changes in collaboration with functional manager(s) and/or process owner(s).
• Supported transfer of new solutions/processes to ongoing operations by developing recommendations and action plans.
• Documented final results and created summary of the project work including performance indicators while ensuring that the metrics are implemented and monitored.
• Provided Lean Six Sigma education and guidance on performance and productivity issues to Staff and Leadership via hands-on project engagement.
• Traveled 75%+

Confidential, Houston, TX

Project Manager

Responsibilities:

• Operational and financial oversight for the City of Houston’s Fire Department's Emergency Medical Services contract.
• Management responsibilities included Emergency Medical Services ambulance transport billing, vendor management, client management, interfaced with remote development/management teams, financial (profit and loss/project budget/staffing) and contract negotiation/management.
• Functional in-depth analyses supporting process improvement and projects regarding operations, legal/compliance, personnel, training, plans and requirements for deployment.
• Effectively investigated/resolved healthcare fraud and abuse including ethical, legal/compliance and HIPAA issues.
• Developed resource allocation levels and directed space/facility-planning efforts to meet client/project requirements.
• Oversight for multiple, simultaneous technology initiatives including ensuring timely delivery of quality products and services; monitoring project cost and performance; monitoring client satisfaction and responding to client concerns.
• Analyzed work flow/assignments to ensure efficient/cost effective operations; developed/implemented process, program or service improvements for multiple locations.

Confidential, Webster, TX

Manager of Reimbursement

Responsibilities:

• Managed all aspects of third party, Medicare and Medicaid payments.
• Developed and implemented quality improvement strategies for the back-end billing department, which included billing, payment posting and refunds.
• Established billing on hold department workload and increased productivity.
• Developed training materials for billing department and trained new employees.
• In-depth knowledge of Medicare, Medicaid, other third party reimbursement regulations and legal/compliance.
• Responsible for budgeting, forecasting, financial modeling including profit and loss.

Confidential, Houston, TX

Responsibilities:

• Strong understanding and demonstrated skill in leadership, strategic/change management, project management, communications, team building, customer service, continuous quality improvement, problem solving, innovation, forecasting, financial management of operations and budgeting resources.
• Estimated project scope and budget, profit and loss, scheduling, materials planning, manpower requirements, monitoring project progress to ensure quality of deliverables and return on investment.
• Strong presentation presence, proven trainer and motivator.
• Extensive research skills on reimbursement trends, patterns and methodologies.
• Developed and delivered Six Sigma Training.

Confidential

Billing Service Representative

Responsibilities:

• Maintained proactive relationship with clients, payers, providers and government agencies.
• Developed training programs for physician’s offices, hospital staff, sales department and phlebotomist on Medicare, Medicaid, Managed Care, Third Party Administrators, Client Bill and Patient Bill reimbursement.
• Provided marketing, customer service and maintained provider relations for over 2,500 physicians and hospitals within defined territory from Katy, Texas to Lake Charles, Louisiana.
• Collaborated with physician and hospital clients, billing and sales to increase speed of receivables and prevent interruption of service to clients.

Confidential, Beaumont, TX

Billing Manager

Responsibilities:

• Responsible for inpatient and outpatient revenue cycle for two major hospital facilities.
• Developed, trained and managed Medicare and Medicaid collection department.
• Restructured inpatient and outpatient billing department.
• Developed, trained and managed customer service department.
• Developed capital/operating budgets and forecasted financial models including profit and loss.
• Managed care contracting and compliance experience.

Confidential, Beaumont, TX

Supervisor Reimbursement

Responsibilities:

• Cross-trained staff, maximized coverage, improved office production and efficiency.
• Extensive managed care experience including contracting and compliance.
• Streamlined patient billing process. Reduced account receivable days from 53. 32 to 39 .8
• Developed departmental policies and procedures.
• Extensive Medicare and Medicaid billing and compliance knowledge.