Responsible for all aspects of revenue cycle operations for laboratory and pathology clients billed by Change Healthcare.Revenue Cycle, Analytics, Provider Credentialing and Enrollment, Managed Care Contracting

Managing all aspects of the revenue cycle operations for the anesthesia division of Envision Physician Services located in Plantation, Florida.

Directly responsible for all account receivable for Anesthesia business in Florida and 26 other states with over 300 employees and 8 direct reports.Oversee cash posting and reconciliation teams that are responsible for over $1.2 billion in cash receipts annually.Manage all aspects of the Customer Service Team who take inbound customer calls related to billing, collections and coding questions.Manage relationships with external vendors for claims processing and automated data feeds.Work with practice locations across 27 states to improve data from various systems inbound for billing and collections.

Brought on board to reduce outstanding accounts receivable (AR) balance stemming from numerous inefficiencies in billing and collections; initially built new team and collaborated with external AR firm to develop and execute strategy to collect old balances. Also revised clinic policies/procedures, collections processes, and reporting protocols. • Managed operating and capital budgets, overall accounts payable (AP) and AR, cash management, payroll, and financial operations functions, cash-related activities for 26 corporate urgent care centers, and a team of 14 direct-report staff; oversaw opening of three new centers and capital spend of clinics averaging $200K per site. • Increased bad debt collections rate 30% while reducing AR balance of $4.8M in four months. • Improved AR days sales outstanding (DSO) 67%, from 91 to 30 days, while enhancing corporate cash flow and predictive modeling and enhancing accuracy by standardizing processes, programs, and trainings across all clinics. • Altered the claims submission process by implementing new means to review claims, ensuring accuracy of information, billing, and timely payment and enforcing best practices across all clinics. • Increased reimbursements $300K per year by analyzing contracts and Medicare/managed care rates to achieve $120K annual savings and secure a new collection agency contract and extension of AR company contract.

Managed financial functions impacting 55 staff physicians, including overseeing the billing team, maintaining and reporting monthly financials, and engaging in budgeting, collections, bonus calculation, and analytics reporting activities. • Led migration from paper-based billing and medical records system to a new electronic system, serving as part of team which researched, reviewed, and selected the provider and implemented new system. • Drove efforts to integrate new EMR to improve cash flow and added medical lockbox to secure critical documents. • Collaborated with CMO to illustrate value of in-house physician model, using extensive analytics and measuring drug cost per patient/per day to prove cost savings and clinical advantage for patients to operate under staff model. • Formulated and introduced new performance and clinical outcome-based reporting structure, integrating monthly reporting package that assessed and summarized productivity metrics, patient outcomes, and cost reductions.

Appointed to new role to correct $31M in out-of-control pharmacy costs; acted in consultative capacity, reporting directly to company president, devised a comprehensive formulary to be used in admission practices, developed non-compliant process reporting strategy, and identified means to reverse trend where facilities struggled with high-cost patients. • Leveraged expertise to reduce costs and improve outcomes at nursing facilities, formulating comprehensive monthly reporting package illustrating improvements distributed to senior executive team. • Managed relationships with servicing pharmacy, contracts, and pharma vendors, including Lilly, Pfizer and others, addressing client/family pharmacy related issues while serving as resource to advice staff members. • Renegotiated pharmacy contract providing incentive to pharmacies to reduce costs and adhere to formulary while maintaining patient outcomes; reduced non-covered charges via process improvements and staff training. • Developed business case to determine potential duration of specific high-cost medication usage, implemented process to track and monitor off-label use, over utilization, and unnecessary length of use, and generated reports.• Facilitated completion of University of Louisville study after creating extensive system of data analytics around utilization management and outliers to formulary management, using data to assist with outcomes studies.

Recruited to help launch mail order pharmacy in Phoenix and Cincinnati while containing costs, monitoring pharma purchasing contracts, and maximizing profitability and efficiencies. Managed a 20-member team in handling acquisition and business modeling initiatives; served on committees that reviewed new contracts and Medicare pricing proposals. • Captured $2M in cost savings and a large rebate within one year, after identifying pricing issues with drug supplier related to contract loading and uncovering the fact that employer had been billed incorrectly for several months. • Gained substantial Medicare Part D market share, leading team to create predictive models used to drive pricing and bidding process involving other payers, completing all aspects of organizational pricing and drug formulary modeling based on utilization, patient mix, and demographic information. • Selected and implemented McKesson paperless mail order pharmacy system responsible for increasing workflow by filling 500,000 prescriptions monthly through use of conveyors within warehouse environment. • Formulated design and concept for mail order pharmacy for Humana beneficiaries, conceptualizing process from beginning to end, selecting all components, and collaborating with operations group to launch initiative.

Managed 12 direct reports across customer service, IT, reporting, data analysis, and special projects for pharmacy data and metrics; directed rebates, purchasing, contract negotiations, utilization management, and revenue reporting. • Brought onboard to grow the pharmacy division which was comprised of 50 pharmacies providing drugs for company-owned hospitals/nursing facilities and external nursing facilities; expanded customer reporting offerings and educated the client base on drug spend and strategies for cost controls. • Helped clients reduce pharmacy costs and end over utilization/off-label use by developing utilization management reporting application for top 10+ long-term care facility customers. • Collaborated with IT team to develop ROI strategy for new pharmacy division system and directed the operations team in implementing new software across 50 closed-door, long-term care pharmacies. • Completed RFPs for new pharmacy clinical consultant software, designing and deploying a reporting platform that provided pharmacy clients with comprehensive online reporting features. • Launched Medicare Part D across 50 pharmacies and 125,000 nursing home residents, working with Medicare Part D plans to ensure that patients continued to receive drugs while completing submission/claims payment processes; proved vital in cooperating with CMS to identify core implementation issues and devise long-term solutions.