SUMMARY:

• Confidential is a well - rounded, technically astute Epic consultant with a breadth and depth of revenue cycle and reporting experience that’s unmatched.
• Having worked on PB & HB implementations, designing and implementing Community Connect initiatives, enterprise stabilization / optimizations, including multiple SWAT teams, he is well-equipped to tackle any type of project.
• Confidential has an excellent understanding of billing workflows and the integrated design and build in Epic, with particular skill and experience in specialized charging strategies, complex reimbursement processes, alternate reimbursement models, claims/denial management and the ability to partner with IT, clinicians and financial resources to positively affect the bottom-line. Having worked with Epic software, Confidential has a firm grasp on the integration points within Epic and is able to provide valuable insight and input into matters during an Epic project. Confidential would make an outstanding addition to any team implementing or optimizing Epic.

EXPERIENCE:

Consultant/Owner

Confidential, Chicago, IL

Responsibilities:

• Assisting and mentoring reporting staff in Texas (a DSRIP initiative) & Boston (RCM go-live with an RCM reporting focus, including cubes, universes, dashboards, extracts/framework and RWB). Making recommendations for Orion and future wave changes.
• Documenting current state and reporting replacements/tools.
• Assisting client in Kentucky implementing PBB as a requirement for 340B.

Consultant/Owner

Confidential, Chicago, IL

Responsibilities:

• Producing and analyzing large datasets used in regression models for ACA/AHCA repeal/replace and analyzing the potential impact for risk and exposure what-if scenarios. This reporting is being done with a variety of tools, including Power BI, Tableau, arcGIS and R.
• PB & HB SBO break/fix. HB & PB contracts (proration). PB & HB Claims. Charge router review/optimization and maintenance. Collections optimization. New physician SER build. ABN project. Large account, charge review and claim edit WQ re-design and maintenance. all 25-bed Hospital). This includes complete review and optimization of WQs including Charge review, Account, Patient, Claim Edit and Remittance. Working with Relay Health (Clearing house) on issues affecting Epic clean claims that error at the clearing house. Project includes documenting current processes, providing guidance to future state, and mentoring junior staff.
• Reviewing current SER workflows, Payor/Plan setup, reimbursement contracts.
• Working with staff and management on denial management and collections strategies.
• Acting as a liaison between Kadlec Health Systems, Prosser Medical Center and Providence Health.
• Providing visioning and future project deliverables with current CFO and Revenue Cycle Director (PFS director).

Consultant/Owner

Confidential, Chicago, IL

Responsibilities:

• Bundled Episodes and Bundled Payments for Bariatric services (BPCI) and CMS’s CCJR (LEJR) initiative. This includes project charter, project plan, developing week-by-week documents and orchestrating resources across multiple departments to push this mandate through to completion.
• Std Break-fix problem lists (~225 items) resolved across both PB & PB Claims and HB & HB Claims, RWB and Dashboards.
• Involved with Healthy Planet portion of project (req’d for CCJR)
• Designed and built the NM Medicine & Cadence health Community Connect Initiative for Midwest ENT and Delnor Express Care.
• PB front - end and ASAP back-end for Delnor Express Care.
• Split Billing (two Epic instances, billing out of one Epic instance) for Midwest ENT.
• All security, workflow optimizations for both initiatives.
• Provided NM Medicine/Cadence with a standardized methodology (i.e. playbook) to replicate the process for new affiliates.
• Deployed all std, and built all customized, RWB and Radar reports for initiative.
• Participating with Epic in a stabilization capacity (member of an Epic defined team). Issues range from Claims issues, RTE to retro-adjudication stabilization and WQ re-alignment and optimization.

Consultant/Owner

Confidential, Chicago, IL

Responsibilities:

• CLIA edits and rules, SER PATs and PINs optimization, CMS 1500 Provider accept assignment functionality.
• Building a more robust build tracker and WQ and Workflow tracker for HUMG.
• Implementing auditing tools for HUMG, including MAP, RAC, CERT and accompanying auditing workflows.
• Prepping for staggered go-live of multiple clinics.
• Proof of concept for Bill Area in a financial federation arrangement and GL analysis.
• GL Build
• All RWB reporting across all AMB products (Prelude, Cadence, Resolute PB and Professional Claims, EpicCare Ambulatory)
• Claims process revamp: all CDF’s ABF, FDF, Claim Edit WQ modifications
• Complete PB and HB Psychiatry PBB (Provider-Based Billing) design, from proof of concept, through integration, testing and production.
• Manage build from Infrastructure (EAF) including Service Areas, departments (DEP), and locations.
• Assisted with defining the charging strategy, both HB and PB for this initiative.
• Managed and built the GL process for new Psychiatry Service Area build
• Perform Revenue (RCM) optimization and integration with current financial structures (multiple billing areas, multiple taxIDs and NPIs, etc, managed through Identity (MPIs))
• Maintain and optimize Charge Router and Charge Handler (VCT/VCS and CER and VCMs logic and routing for main hospital and multiple clinics including SA-to-SA logic.
• Built and maintained all WQ’s including Account, Patient, Collections, Credit,
• Built the PB Claims and HB Claims for Psych Initiative. Including EPP and EPM build, along with NCC, FSC’s, RMO’s, CDF’s, ABF’s, FDF’s
• Deployed all standard RWB reports and built over 200 customized reports for this project.
• Short duration project to document, optimize and maintain Charge Router
• Short term project to implement Global Billing, bundled episodes
• Mentoring junior staff on HB and PB bells and whistles.
• ICD-10 project
• Working with Multicare on Wake Forest Denial Management Project and revenue optimizations
• Maintained and optimized Charge Router / Charge Handler for throughput for multiple clinics within Wake Forest.
• Claims build and optimization (PB and HB)
• PQRS (GPRO Method) project
• MU Stage 1 and build for MU stage 2
• Interim Reporting Coordinator
• Data Courier
• Crystal, Reporting Workbench, Reporting Workbench (ECi), Oracle SQL, Financial, Clinical reporting
• Clarity Resolute EpicCare Ambulatory and various Ancillary products reporting.
• Working with Executive leadership on major Organizational Clinical initiatives

Consultant/Owner

Confidential, Chicago, IL

Responsibilities:

• Building HB and PB (WQ’s), Producing extracts using RW Extract Framework (include M code, KB-SQL, modified extensions for Collection Agencies, and other 3rd party Vendors).
• Charge Router maintenance and optimization for multiple hospital System.
• Building and sharing Epic-focused templates for pre-implementation planning including Communication Plans, TCO and ROI Models, Status reporting hierarchy templates etc.
• Supplying clients with detailed TCO Models Pre-Implementation planning.
• Building a revenue cycle assessment toolkit to capture a wide range of metrics and KPI’s.
• Regulatory reporting for west coast safety net hospital (UDS, MU).
• Performing Resolute Hospital Billing and Resolute Professional Billing Build activities and mentored staff pre-implementation.
• Performed GAP analysis for HB and PB and Claims and Reporting workflows. Led validation sessions for Claims and Reporting.
• Master file build and maintenance.
• Initial Charge Router/Charge handler design and integration.
• Performed Clarity and RWB (Epic-Clarity integration), custom programming reporting for PB and Ambulatory products

Senior Consultant

Confidential, Cleveland, OH

Responsibilities:

• Epic Resolute HB and PB build 2009/10. Led and participated in validation sessions. Application Coordinator liaison with Epic.
• Provided workflow process improvement, Masterfile build (SER, EAP, SUP, etc.) and integration. Provided Clarity reports (Resolute).
• Provided Resolute security responsibility matrix mentoring. Provided Charge Router initial build analysis and on the replacement of the in-house charge router CASS.
• Provided build and implementation for 4010/5010 implementation using Epic’s standard project plan model