Third Party Reimbursement (TPR) Solutions, LLC provides advisory services to hospitals and health systems on a local and national level. Specifically, our company offers advisory services that focus on Hospital Medicare and Medicaid reimbursement and regulatory issues.I will provide Medicare and Medicaid Reimbursement and Regulatory assistance to hospital clients nationwide. Supervise managers and associates. Review and create final deliverables. I am also responsible for ensuring client's needs are met and for developing new business.Services include:• Preparation of third party cost reports• Appeals and Re-openings• Organ Acquisition/IME/GME• Medicare Bad Debts• Physician Practice Acquisition (Provider-based analysis)• NPI/CMS-855 Preparation & strategy• Impact of new regulations• Net revenue, contractual allowances, settlement entries• Assist legal counsel with reimbursement issues

Anchor Provider Solutions, LLC (“APS”) provides Medicare regulatory, reimbursement, compliance and revenue cycle advisory services to Hospitals, Health Systems, attorneys and selected vendors on a local and national level. Specifically, APS offers individualized advisory services focusing on Hospital Medicare and Medicaid payment and regulatory issues. Anchor Provider Solutions LLC also provides subcontractor support.The overall mission is to help providers thrive in the very turbulent third party regulatory waters.

Areas of expertise:ICD-10 assessment and implementation Responsible for:Assisting with compilation of implementation budgetReviewing billing and denial management process, front end patient access and ancillary areasCreation of deliverable for areas of responsibilityOther areas of expertise:Reimbursement and Regulatory servicesLitigation supportNet revenue projectionsHospital-based analyses

• Project Management: Project Manager on ICD-10 Assessment for hospital system on west coast. Acted as payor subject matter expert for firm by reviewing and preparing all managed care and other payor implications associated with the transition from ICD-9 to ICD-10, providing guidance on net revenue implications and renewal strategies. Identified over $10 million in reimbursement enhancement as project manager for large Midwest teaching hospital by calculating reimbursement impact of moving free-standing practices to provider-based status.• Litigation support: Assisted attorneys to calculate damages based on lost Medicare payment related to Critical Access Hospital.• Charge capture: Performed charge capture/revenue integrity engagements for large clients to ensure proper amounts were billed for services performed.

Oversee financial operations of Autism Society of North Carolina Mecklenburg County Chapter.

Independent Healthcare Consultant specializing in continuous process improvement related to regulatory, compliance and revenue cycle issues.Performed hospital-based analysis for large integrated system in Midwest.

Performs client orientation presentations for non-profit.

Served as AVP Finance responsible for enrollment, regulatory, due diligence, financial analysis, projections, compliance and estimations. Corporate Compliance: Successfully defended hospital during HHS OIG audit with minimal reductions in reimbursement. . Successfully defended hospital in Qui tam investigation related to hospital-based status of several Sleep Clinics.• Continuous Process Improvement/Design: Identified and implemented $60 million in net revenue improvements by assessing current practices, designing and implementing new processes, procedures and approaches such as changes to Medicaid-eligible days, medical education and cost report reporting revisions. Designed and implemented Bad Debt return policy in collaboration with Patient Accounting Department and outside collection agencies. Initiated and monitored Medicare Managed care shadow billing process resulting in $1 million in additional net revenue. Implemented procedures to ensure rates negotiated by Managed care department for Medicare Managed Care plans were accurate and payments agreed to negotiated amount. • Designed and implemented policy and procedure to audit rates paid by governmental payors.• Identified non-covered charges as a statewide issue. This issue was presented to statewide workgroup that ultimately negotiated a settlement with state Medicaid program worth $16 million over four years to system. Established team including Pharmacy, Patient Accounting and Chargemaster that implemented changes to increase cash by over $2 million in first year by changing coding related to non-covered charges.• Physician Integration: Improved net revenue associated with subsidiary physician practice by $5 - $6 million annually by reviewing net revenue associated with various reporting alternatives. • Leadership: Provided thought leadership to system by monitoring and reviewing changes to regulations, laws and state plan amendments, calculated impact, create strategies.

Responsible for selling, managing and performing various regulatory and financial engagements. I was responsible for ensuring client's needs were met and for developing new business. Senior Manager:• Development: Expanded practice hospital regulatory market by developing and implementing models to evaluate compliance with hospital-based requirements and calculate the financial impact. Prepared proposals, participated in pursuits and sold engagements in excess of $1 million per year.• Project management and delivery: Managed realization, utilization, billing and payment for multiple engagements.• Litigation support: Lead engagements acting as Independent Review Organization as a result of federal litigation or in preparation of impending litigation. Supported SNF during litigation.• Participated in team that calculated impact of new regulations for national chain by preparing analysis and deliverable.• Provided quarterly assistance to clients by evaluating allowances for bad debts, settlements and contractual adjustments for hospitals, home health agencies and skilled nursing facilities.• Cross-functional team building: Established and maintained relationships with audit, compliance and other consulting senior management.• Revenue Cycle: Performed analyses of physician group revenue cycle being purchased, ensuring billing agreed to codes from medical records and services provided.• Transaction experience: Performed due diligence related to mergers and acquisitions by evaluating the financial and reimbursement positions, reducing the risk to the client. Performed several pro-forma analyses, valuations and projections for hospitals related to buy or sell decisions.• Recruitment/Retention: Actively recruited, coached and managed multiple direct reports.• Presentation skills: Presented educational and developmental sessions for professional associations, physicians and management.

Responsible for all reimbursement and third party activities of four hospitals in a for-profit Psychiatric hospital system.

Responsible for all reimbursement and third party activities of four hospitals in a large integrated not-for-profit hospital system. Supervised staff of six. My duties included:• Prepared and reviewed month-end third party entries;• Provided regulatory advice as needed;• Monitored activity associated with managed care plans.