Quality Documentation Speciality Company specializing in ICD10 physician education and hospital throughput.We help you prevent seepage of money due to ICD-10 requirements, length-of-stay, patient flow bottlenecks, physician documentation opportunities, undercharging and missed charges. With very little time investment you can not only reduce lost dollars but increase your reimbursement substantially by investing in developing internal programs within your hospital.As an executive… Show more Quality Documentation Speciality Company specializing in ICD10 physician education and hospital throughput.We help you prevent seepage of money due to ICD-10 requirements, length-of-stay, patient flow bottlenecks, physician documentation opportunities, undercharging and missed charges. With very little time investment you can not only reduce lost dollars but increase your reimbursement substantially by investing in developing internal programs within your hospital.As an executive leader with over 30 years in the healthcare industry I have extensive knowledge of hospital operations. I have built and maintained CDI programs in Level 1 and 2 trauma centers, redesigned case management/utilization review programs and launched readmission programs. I was also able to successfully transition a newly placed " home based " revenue integrity team from one of the lowest performers to one of the highest performing teams in the company.Will gladly review a set amount of inpatient cases to see if we can help your hospital make a positive impact! Dont hide your successes through inaccurate documentation! Show less

Specializing in the development and Management of Case Management and/or Clinical Documentation programs. Specific contracts have included: Co-partnering with the AVP of revenue cycle conducting system- wide (21 Mercy hospital- system) providing a denial -management assessment specific to the Case Management and Patient Access departments. Supplied root-cause denial analysis, utilization review and patient care transition opportunities and compliance opportunities, etc to the… Show more Specializing in the development and Management of Case Management and/or Clinical Documentation programs. Specific contracts have included: Co-partnering with the AVP of revenue cycle conducting system- wide (21 Mercy hospital- system) providing a denial -management assessment specific to the Case Management and Patient Access departments. Supplied root-cause denial analysis, utilization review and patient care transition opportunities and compliance opportunities, etc to the regional and facility administrative team of each facility to include Case Management and Patient access directors and managers. 2) Interim Director of Case Management for San Leandro Hospital (Alameda system 93–bed). Implemented a unit-based model department, instituted weekly meetings with CM physician to review all in house patients > 3 days with staff 3) Implemented/developed a Clinical Documentation Program for Level 2 hospital (Highland hospital) increasing the CMI, while LOS and re-admissions decreased. Participated in 3 Kaizen events focusing on follow- through and time opportunities related to discharge opportunities, LOS, and outpatient management. Presented needed documentation with clarification of current cases at weekly resident meetings and presented documentation opportunities in the monthly Mortality/Morbidity meetings. 4) Co- partnered with a company to overhaul a 4- hospital system case management and SW department. Developed on-line structure guide for the CM SW role providing rules and regulations needed to be successful in their specific roles. Developed /redefined policies and procedures, analyzed individual staff follow- through etc providing insight during observation and throughput analysis/assessment opportunities to executive hospital members (contract was up for renewal in March (due to COVID project ended April 1st) 5) Remote contract working providing medical necessity appeal letters as needed for stay of service “not covered”. Show less

Regional accountability for 14 hospitals in two markets (San Antonio/Austin) and 17 FTEs. Responsible for the daily management of revenue initiatives designed to reduce financial risk/exposure. Work closely with billing and HIM to improve billing/compliance and coding practices to protect revenue and decrease unbilled account. The San Antonio/Austin billing process moved from 8th position to # 1 in the company in 2012 mid-year! Designed a process to report "no cost or discounted replacement… Show more Regional accountability for 14 hospitals in two markets (San Antonio/Austin) and 17 FTEs. Responsible for the daily management of revenue initiatives designed to reduce financial risk/exposure. Work closely with billing and HIM to improve billing/compliance and coding practices to protect revenue and decrease unbilled account. The San Antonio/Austin billing process moved from 8th position to # 1 in the company in 2012 mid-year! Designed a process to report "no cost or discounted replacement devices" to avoid legal-risk and increase financial gain. Decreased payouts to a contracted outside agency by 42% from 2011 to 2012 by developing and implementing an internal process in May of 2012 to review lost hospital revenue specifically with implant procedures. • Redesigned external audit process decreasing fte usage and overpayments. Show less

Led team responsible for hospital’s inpatient utilization, treatment process, discharge plan and LOS. Performed utilization reviews, lead utilization management team and interdisciplinary rounds. • Decreased total inpatient LOS from 3.16 to 3.05 while CMI increased.• Reduced self-pay LOS from 3.01 to 2.88 and increased Medicaid conversions • Increased observation conversions by 8.5 % while, overall inpatient and observation referral volume fell by 15% patients• Decreased… Show more Led team responsible for hospital’s inpatient utilization, treatment process, discharge plan and LOS. Performed utilization reviews, lead utilization management team and interdisciplinary rounds. • Decreased total inpatient LOS from 3.16 to 3.05 while CMI increased.• Reduced self-pay LOS from 3.01 to 2.88 and increased Medicaid conversions • Increased observation conversions by 8.5 % while, overall inpatient and observation referral volume fell by 15% patients• Decreased OBS cases > 23 hours over a 6-month period by 50%• Reduced readmissions by pulling community discharge referral leaders together weekly for 7 weeks and developing an action plan to circumvent unexpected issues. • Developed a self-pay ER program designed to decrease % of self- pay patients utilizing ER as primary care provider while decreasing social admits and decrease returns w/ community support Co-partnered with patient access department and physician offices successfully decreasing inpatient denials. Show less

• Developed and coordinated a utilization management program• Decreased denials by 45% with 87% overturn rate of denials for managed Medicare.• Implemented a clinical documentation pilot querying MDs and providing education resulting in a CMI increase from 0.862 to 0.938. • Decreased LOS from 4.7 to 4.02 for Medicare patients and 2.82 to 2.34 for self-pay patients while quality ratings increased. • Instituted weekly interdisciplinary walking and daily rounds on nursing units

Led and focused team efforts in data gathering and analysis, data interpretation of reported performance measures, process design and formulating conclusions and recommendations to optimize case-mix-index and accurately reflect severity-of-illness and risk-of-mortality outcomes. Provided on-going Medicare/Medicaid education to physicians and nurse practitioners for MS-DRGs and present-on admission rulings. Generated >3.2M yearly in additional revenue. Recognized by INGENIX, as a “Top 200… Show more Led and focused team efforts in data gathering and analysis, data interpretation of reported performance measures, process design and formulating conclusions and recommendations to optimize case-mix-index and accurately reflect severity-of-illness and risk-of-mortality outcomes. Provided on-going Medicare/Medicaid education to physicians and nurse practitioners for MS-DRGs and present-on admission rulings. Generated >3.2M yearly in additional revenue. Recognized by INGENIX, as a “Top 200 Coding Hospitals in the U.S.” in 2006 achieving higher than expected Medicare CMI. Partnered with cath lab to decrease losses by 1.2 million over a 9 months. In 2005 I initiated a special project to appropriately reflect our public quality ratings focusing specifically on expected mortality outcomes. Recognized by UHC as # 6 in the nation in 2008 for quality outcomes and patient safety on a national level. Implemented an improvement process plan over 30 days resulting in decreased Medicaid denials to less than 50K a year over 2 years (previous year 1.2M). Developed an on-site coding program to improve ER documentation and reimbursement. Show less

Partnered with Shock Trauma, Ortho, Neurotrauma and Coronary Care Unit MDs to support the accuracy and completeness of the physician documentation used for measuring and reporting physician and hospital outcomes.

• Oversaw the discharge plan, treatment processes, interqual criteria and length- of- stay for a 28- bed CCU/CVICU and 42- bed Intermediate Care Unit. • Performed utilization reviews overturning multiple denials.

Responsible for operational and financial managementof 17- bed CCU with 42 FTE’s. • Instituted weekly interdisciplinary walking rounds and daily rounds. • Assisted with the development of the nurse practitioner program. • Decreased vacancy rate from 38% to 2.1 % within eighteen months. • Decreased contract usage in one year from >1100 hours per month to <84 hours per month. • Achieved 92% retention of all employees hired over last 15 months in 2003. •… Show more Responsible for operational and financial managementof 17- bed CCU with 42 FTE’s. • Instituted weekly interdisciplinary walking rounds and daily rounds. • Assisted with the development of the nurse practitioner program. • Decreased vacancy rate from 38% to 2.1 % within eighteen months. • Decreased contract usage in one year from >1100 hours per month to <84 hours per month. • Achieved 92% retention of all employees hired over last 15 months in 2003. • Redesigned structure of internship and orientation manual/process for CCU. • Developed unit scope of practice, admission and discharge criteria for CCU. • Led Memorial HH as co-hospital chair for Get with the Guidelines (AHA) developing standardized order sets, patient education packet and clinical pathways for the cardiology service line • Coordinated and developed a cardiology volunteer program comprised of over 65 members. . Show less

Cardiology service Line

while attending BSN program.

responsible for a 16-bed cardiac, neuro, medicine ICU. Assisted and developed quality control issues. Revised and developed unit/hospital policy. Assisted with hiring and trained of staff. Assisted with the reorganization of the preceptor-internship program. Provided employee feedback, evaluated competencies and counseled staff. Functioned as relief operating administrator 1-2 days a week.

Evening/night OA responsible for overseeing all activity of a 280- bed hospital.

in a 120-bed hospital. Responsible for overseeing all hospital activity including pharmacy needs.

Staff, preceptor and charge nurse in a 16-bed ICU. Provided ACLS certification to nurses' and physicians. RN- circulator in the cath lab for 6 months.

Staff LVN in a 12-bed cardiac and medicine ICU.