Genaro Grajeda, Mpa, Chfp Email and Phone Number

Providing strategic oversight and direction for clinical revenue cycle operations to help organizations enhance financial performance while maintaining exceptional patient care. Oversee all aspects of the revenue cycle, including patient access, billing, coding, claims management, and cash collections, ensuring alignment with the broader financial objectives of healthcare systems. Spearhead process improvement and revenue optimization initiatives aimed at enhancing key performance indicators (KPIs), leading to increased collections, faster cash flow, quality enhancements, and higher patient satisfaction. Specializing in Medicaid Managed Services, delivering targeted leadership to optimize direct payment programs by identifying key success drivers and metrics, ultimately improving positioning and maximizing recovery of supplemental payments.

Pleased to present our Healthcare Consulting Services, underpinned by over 14 years of dedicated experience in optimizing revenue within public hospital systems. With a deep understanding of state-based supplemental funding streams, my focus remains steadfast on enhancing patient access, retention, and quality.I specialize in providing personalized support to healthcare providers engaged in a variety of state-based value-based care initiatives, including QIP, EPP, GPP, EPT, and P4P. Whether you represent a hospital, healthcare system, primary care practice, specialist, CBO, health plan, or technology company, my aim is to offer tailored assistance to meet your specific requirements. Together, we will navigate state-led initiatives, alternative payment models, value-based care, population health, and HEDIS-based quality initiatives, all with the ultimate goal of achieving shared savings.Central to my approach is a commitment to innovation and the development of solutions that resonate with Medi-Cal-based populations. I leverage my expertise to drive meaningful change, refine technological solutions, and deliver impactful programs and services that drive positive outcomes in healthcare delivery.

Led and directed leadership and management efforts encompassing Patient Scheduling, Patient Access, Financial Clearance, Admitting, Health Information Management, Patient Accounts, and Revenue Integrity. Oversaw all revenue-related functions for a 456-bed Hospital system, spanning Acute, Behavioral Health, Burn, Stroke, Cardio Vascular, Outpatient Specialty Care, Ancillary Services, and Primary Care. Orchestrated revenue cycle operations through supervision of 6 direct reports and management of over 450 FTEs. Managed both traditional and non-traditional revenue cycle functions, supporting initiatives for Medi-Cal Managed Care supplemental funding and fee-for-service revenue cycles. Provided oversight for over $1.6B in gross receivables, constituting over 70% of the hospital's revenue budget surpassing $700m. Spearheaded revenue-related executive agendas for hospital administration and clinical integration teams, driving improvements across all receivable categories and achieving the highest monthly collections in ARMC history.

Offered leadership and direction while serving as the lead for Access and Revenue Cycle Readiness during the Epic implementation, ensuring readiness from go-live to full implementation. Provided guidance to Epic clinical and support teams, facilitating the integration of a population health Medi-Cal-based electronic health record. Provided direct oversight of Patient Access, Admission Clearance, Insurance Eligibility, Financial Assistance, Health Information Management, Call/Referral Centers, and Patient Accounts. Established Go-Live Key Performance Indicators (KPIs) and spearheaded all revenue initiatives during go-live to ensure stable cash flow and accurate data capture. Pioneered the establishment of the Revenue Integrity unit and associated teams, ensuring clinical capture alignment with best practices. Achieved system stabilization within the initial 90 days of go-live. Successfully met all Revenue Cycle KPIs within six months, resulting in enhanced gross and net revenue while maintaining alignment with the approved budget. Selected as a member of the inaugural ARMC Future Leader Program cohort and received mentorship from the CEO.

Led and directed a dynamic business office comprising over 90 budgeted FTEs and 70 staffed FTEs, achieving remarkable growth from approximately $240m to over $360m in net patient collections over a five-year span. Spearheaded managed care contracting, comprehensive policy and procedure development, and oversight of all billing and encounter submission processes. Managed Financial Assistance Programs, collections, and cash posting, optimizing operations for enhanced efficiency and financial performance.Successfully renegotiated all payer contracts, securing improved terms and rates, resulting in year-over-year increased recovery and reduced denials. Orchestrated the optimization of Meditech Billing and Accounts Receivable, transitioning from paper-based to fully electronic processes, including claim transmission and 835 ERA. Implemented electronic data storage solutions for paper documents, streamlining business office functions to minimize staff costs and boost efficiency, resulting in a 50% cash improvement despite a 25% claim increase.Managed revenue, claim, and data reporting functions for QIP, EPP, and GPP, playing a pivotal role in state-level program rollouts. Coordinated comprehensive encounter projects with local health plans, achieving a 97% claim acceptance rate at the state level. Completed financial training with the California Association of Public Hospitals, leveraging insights to refine billing practices in alignment with Medi-Cal cost reporting, leading to a significant increase in CPE and stabilizing hospital per diems with an 8-year threefold increase.Served as a key witness and hospital finance subject matter expert in three major health plan settlements, resulting in over $24m in recovery. Recognized as the 2018 Arrowhead Regional Medical Center Employee of the Year for outstanding contributions and dedication to excellence.

Directed commercial, workers' compensation, and Medi-Cal Managed Care billing and receivable management, overseeing the transition of receivables from ACA Pilot Low-Income Health Plan (LIHP) to Medi-Cal Managed Care and managing retention reporting for approximately 70k lives. Facilitated billing transitions during ACA expansion, establishing internal reporting mechanisms to aid facility retention and maximize MCE reimbursement for receivables based on aid codes.Collaborated with the California Association of Public Hospitals to interpret federal legislation and provided guidance to the hospital CFO on contracting and Designated Public Hospital language to optimize revenue sources. Orchestrated the implementation and reporting of Hospital Presumptive Eligibility statistics for self-pay conversion necessary for claiming.Certified in Meditech data reporting, served as the primary point of contact for revenue cycle reporting, supporting executive teams and program development initiatives. Achieved a 300% increase in clean claims for Medi-Cal managed care IPA claims by integrating claim rules and logic into the EHR system. Additionally, certified in Meditech Billing and Accounts Receivables, I created initial GPP reporting and trained GPP analysts, bolstering the state-led initiative and enabling the hospital to draw down 100% of eligible funding in the first year.