Jane Gray Email & Phone Number

* Numerous years of insurance & Managed Care experience.* Worked closely with Private Insurors, self-insured, Third Party Administrators Medicare & Medicaid, to accomplish the goals set for specific Insuror’s compliance. * Developed Insuror specific guidelines including individual reporting needs, contacts & pricing guidelines.* Continuously updated knowledge of the changes in these various compliance issues.* Performed In-Hospital utilization & medical records reviews for a 236 bed, acute care teaching facility working primarily with Medicare/Medicaid patients.* Worked closely with physicians, social workers & financial representative to accomplish appropriate documentation to comply with LOS guidelines.* Involved physicians with securing suitable written documentation to justify extended LOS.* Supported pharmaceutical, medical & orthopedic equipment companies with hospital staff development. * Trained clinicians on new products (Critical Therapeutics, Hospira, DePuy, etc.) as the products transitioned into the facility.* Hosted/led meetings & discussions with groups from 5-30 staff for educational purposes.* Worked with physician practices to resolve billing & collection issues.* Reviewed software for capabilities & ease of use & appropriateness for each specific practice.* Trained staff in the appropriate use of ICD-9 & CPT-4 coding to decrease errors & invoice rejections. * Developed Insuror specific guidelines including individual reporting needs, contacts & pricing guidelines.* Developed guidelines for Insuror specific DME, assisted living, hospice & home health care contacts to improve communication & efficiency between physician’s staff, patients & facilities.* Further, coached them in working with the various insurance facilities to decrease conflict. This accounted for a 45% increase in collections within the first 3 months at one physician’s practice.

* Presented key medical information at weekly departmental meetings. Meetings involved 8-12 department heads.* Developed tools to assist the staff in negotiating settlements. For example, created a spreadsheet indicating the difference in EOB charges & actual payments that ‘would be made’ to Insurors’ (based on CMS guidelines). One case resulted in negotiating a settlement decrease by $418, 000. * Trained staff regarding medical issues & terminology including but not limited to quarterly Lunch & Learns for the Atlanta & Tampa offices (i.e., updates on new devices & procedures, medical terminology explanations, etc.). Attendance rate was always 75-100%.* Developed & managed the Peer Review & IME networks with specialists throughout the Region. * Conducted over 150 medical record reviews for casualty & liability cases.

As part of a team, I assisted hospitals throughout the nation in responding to RFP's to the Centers for Medicare & Medicaid Services (CMS). Including instructing and facilitating Department leadership in preparation of proposals.Worked with hospitals & physicians throughout the nation (i.e., Washington Heart, Mayo, Albert Einstein, etc.) in developing cost incentive programs to assist with adapting to cost to revenue Trends.Presented Keynote Address on “The Changing Managed Care Industry" at Indiana Cardiovascular Symposium. Approximately 300 people in attendance.

* Administrator of a major cardiac network.* Interviewed, hired & evaluated staff.* Responsible for the development, management & expansion of satellite offices.* Managed & expanded two established cardiology offices. * Expanded outreach by 33% by establishing a third cardiology office within the first nine months.

* Responsible for all financial & operational aspects of a seven state territory & $2.5 million budget.* Marketed outside business to yield a 64% increase in revenue over three years * Reorganized three offices, turning an original deficit of 15% into a 43% profit over two years. * Chaired the SE Regional Quality Assurance Team responsible for annually reviewing offices in the Region (15 states).* Implemented Quality Assurance Standards in seven state territory including training & education of staff.* Collaborated in designing the Quality Assurance Manual with AIHRS Training Department.* Collaborated with the Training Department to update the New Employee Training Manual.* Established, hired, trained & managed five (5) new offices & numerous staff members in a seven state territory.* Developed, organized, hired, trained & managed three offices from the "ground up."