Provide mitigation and corrective actions for significant clinical compliance and billing issues including complaints, survey findings and payor issues. Develop, implement, and maintain oversight of a coordinated and comprehensive pre/post pay audit process and tracking system. Provides interpretation of regulation, manages audit projects and a be an active member of the internal compliance committee. Responsible for clinical risk management and patient/employee safety programs including managing the incident tracking system, clinical peer review/root cause analysis functions, just culture implementation.

Provide regulatory and quality support to six hospices. Monitor trends and identified opportunities for improvement. Evaluates quality improvement plans for compliance, assist in development of the quality plan. Facilitates creation of quality dashboards and score cards. Leads rapid improvement projects. Provides education and over site for processing additional documentation request. Lead /directs sites to do mock surveys and use of standards of practice

Serves as the process improvement specialist for the organization working closely with regional leaders and teams to ensure implementation of consistent and comprehensive process improvement strategies to ensure the high level of quality performance in accordance with regulatory guidelines and strategic plan goal achievement. Current project reduction in HME held revenue

Home Care, Hospice and Palliative Care)Identified opportunities for improvement; coached the team in creating, implementing and maintaining action plans for those identified opportunities; oversaw dashboard indictors, including but not limited to infection, fall data, occurrences, re-admissions, timely start of care, patient satisfaction, HHCAHPS and reportable outcome measures; assisted with Joint Commission accreditation. AccomplishmentsImplemented Hospice Medicare Part D regulationRefined process for Post Mortem Modifier regulationImplemented reporting of injectable and non-injectable drugs on Medicare billLed the implementation of the Hospice Item SetLed the Adaptive Design Project for intake to admission process

Clinical documentation review to prevent denials and RAC Audits, ICD-9 coding, understanding of regulatory and compliance issues that impact practice; innovative coaching and education on Horizon computer program to improve organization effectiveness and efficiency; development strategies to drive and sustain culture change. AccomplishmentsSuccessful initiation of Unit Practice Council in 2013Successful orientation of new Project Coordinator, Insurance Coordinator, and Medical Records personnel in 2013Implemented electronic OASIS C assessment tool in 2009 Implemented electronic wound advisor and care maps in 2009Successfully educated the staff on completing the electronic Plan of Care in the Horizon system in 2010Home Care Elite Award /2010 Top 500 AgencyCompleted RFP to secure United Way funding for low income populationJoint Commission Lead 9/2002 and 9/1999 Converted from paper forms to Horizon computer programDeveloped education tools for orientation using Casper Reports and Outcome dataStepped in as Interim Director twiceSuccessful local roll out and education to physician on Face to Face regulation

Provided overall direction of home health clinical services; established, implemented and evaluated the goals and objectives of the home care services; evaluated clinical staff performance; oversaw the maintenance of patient clinical records, statistics, reports and records; ensured that patient care was coordinated and managed; organized, developed and coached the management and administration of the professional staff in accordance with federal, state and local regulations; provided mentorship and guidance of clinical guidelines to team, including nurses, physical therapist, occupational therapist, medical social workers, speech therapist and home care aides.AccomplishmentsLead Joint Commission Accreditation Implementation of policies and procedure using VNA-A guidance to standardize care deliveryNavigated the team through three month prepay audit by MedicareSuccessful implementation of a Quality Program