Healthcare Advisory Manager/Director
Toronto, On, Ca
* Built a national Medicare regulatory/compliance team to compete with the other “Big 4” accounting firms in the healthcare consulting space. Financial and operational goals included increasing profit margin, operation efficiency, marketing, budgeting, accounting, proposal writing and sales of engagements. Hired additional staff to meet market growth, reaching revenue goals for FY 2015.* Provided assistance to state DISRIP programs development; fund flow models to incentivize providers in meeting quality based targets, aligning of ACOs to provide clinically integrated patient care coordination for a defined population and modeling a per member per month (PMPM) strategy. * Lead internal executive committee on value and quality based reimbursement models to educate the healthcare advisory group on bundled payments, HAC, HVBP and HRR. * Performed due diligence reviews (M&A) on potential acquired hospitals through modeling and other methods to ensure financial revenue forecasts are consistent, also, provide strategic observations for additional investment value. * Supervised cost report preparation and completion including: MBD, DSH, GME/IME, organ acquisition, 340B, system consolidation, Medicare, Medicaid and TRICARE to reduce audit adjustments, increase revenue and ensure compliant with CMS regulations. * Conducted merged provider analyses for health systems that consolidate multiple hospitals within one provider number, understanding regulatory guidance on physician by-laws, licensure transfer, transfer DRGs, common central billing, medical staffing, and distance requirements that assist with determining if consolidating will add value through efficiency and reimbursement.* Supported the audit team with reviews of contractual models (third party reviews) for Medicare, Medicaid, and TRICARE reserves to ensure compliance with federal (CMS) and state regulations.