Transformed the Houston SSC Prebill Denials department into a high performance team that rose to 1st place national ranking from last place by the end of 2020. The remote work from home team of nurses and analysts obtain Inpatient authorizations for 22 HCA Hospitals in Texas and Louisiana. This success was achieved by creating a positive culture of teamwork with accountability and significantly improving the overall Inpatient authorizations rate which reduced Inpatient claim denials. The PDU team exceeded their goals through an operationally tumultuous year that included a 20%+ staffing reduction and increased inventories by the end of 2020. These accomplishments were achieved by implementing the following strategies:•Instituting a continuous process improvement and re-training program for the PDU team. This included high performance coaching with the team which improved morale and productivity.•Collaborated with hospital CM leadership to reduce denials. Met monthly with hospital CFO’s and Case Mgt. leadership to review denial trends and discuss improvement strategies. Held major insurance payers accountable for case processing delays by meeting with them monthly to discuss processing problems and solutions. •Created new workflows strategies that targeted resources by cases type which resulted in reduced payer authorization processing times. Case review times were reduced from 3 days to 2 days. These new processes shortened observation billing times and accelerated cash collections for the Houston SSC.•Maximized utilization of online applications that reduced case authorization processing times which included utilizing insurance portals to obtain case authorization statuses and upload clinical documentation.

Transformed Revenue Cycle operations for Emergency Medicine based Acute and Freestanding Facilities. Successfully identified operational gaps in follow up, billing and cash balancing which were remedied through automation and resource re-allocation. Redesigned workflows to optimize productivity, create accountability and wrote detailed SOP’s on the new processes. Hired and trained the onsite CBO team and the remote BPO team on new procedures. Currently working in an executive level revenue cycle consultant capacity and also responsible for all of the RCM financial reporting and KPI analytics. Additional accomplishments are below:•Improved average collections per patient by 75% within 3 months in 2017 and 23% overall in 2018 using targeted cash acceleration strategies, actionable reporting and integrating claims management workflows in the CMD software. •Led successful MedHost billing system build and implementation project which included: System Design, Build and Configuration, Workflow Re-Design and Mapping, CDM Build, Patient Accounting, G/L Mapping, Claims Management, Denials Management, Automated Payment Posting, HIM setup and Training for Hospital, CBO and BPO staff. •Designed monthly revenue cycle reports including RCM Key Metrics and an A/R Dashboard using Sequel and CMD report building modules. Developed the logic for custom billing audit reports that initially identified over 100 accounts that had not been coded or billed. The back billing resulted in over $300K in additional 2017 revenues.

Directed the operations of the central billing office for 14 Multi-Specialty Ambulatory clinics with 46 employed physicians and hospitalists. Provided leadership to ensure effective and efficient billing/reimbursement operations, optimizing the performance and continually improving quality to ensure successful financial performance during the Cerner Profit build and implementation for EJPG. Successfully led the CBO team through a Cerner Revenue Cycle/HIM system conversion from Centricity while exceeding performance objectives. Re-designed workflows and procedures of CBO to incorporate new Cerner system enhancements which maximized productivity and revenue. Implemented a new Med Assets Electronic Billing system and 5010 conversion. Created new claim denial and appeal processes that were integrated with the Cerner software. •Led the revised Cerner build and implementation project including: Data Collection Workbook development, Charge services design and mapping for all CPT/HCPC/UB-94 Rev Coding, Modifiers and G/L Mapping codes. Standardized charge descriptions and Developed test scripts for clinical and business office training and testing. •Developed management dashboards and reporting models using the Electronic Data Warehouse to quantify, measure and monitor revenue cycle productivity. Created KPI’s for collections claims billing, claims follow-up, claim denial and underpayments monthly reports. Created Reimbursement Audit reports that identified contract underpayments and executed mitigation plans.

Total Sleep Holdings was the nationwide industry leader in Sleep Diagnostics for 80+ sleep labs located throughout the U.S. and provided sleep therapies through their DME Company located in Boston, MA. Transformed the A/R department and consolidated all sleep service billing offices which resulted in $3.4MM increase in cash collections, a 51% decrease is A/R DSO to 62 days in 12 months. The additional cash collections provided capital for 3 acquisitions and the A/R team reduced DSO for the new businesses by 27%, generating an additional $1.6 MM in cash in 9 months after the acquisitions. •Recruited and trained 17 new department members and reduced employee turnover from 30% to 5% in one year. Reduced overall department staff by 8 FTE's (28%) to 28 FTE’s with successful performance enhancements. Implemented new Centricity Medical Billing system which saved $100K annually. Reduced initial claims submission average collection time from 60 to 20 days through insurance/patient billing EDI enhancements, follow-up process and electronic documentation automation.•Developed consolidated revenue models for Total Sleep Holdings, departmental/individual cash collection goals and revenue forecasting. Responsible for creating and consolidating all the monthly Revenue Cycle DSO, A/R Trending, Payment/Contractual and Revenue Forecasting reporting for the Total Sleep Holdings Corporate Board, the C.E.O and C.F.O. Created an automated J.V. process to book monthly revenue using very complex Excel Pivot tables, the revenue model and monthly productivity data extractions.•Developed and implemented new revenue cycle policies, internal billing/collection audit program and standard operating procedures (SOP’s) including phone scripts that reduced new employee training time from 6 weeks to 2 weeks. Successfully developed underpayment claim cases for OON claims and facilitated litigation for additional reimbursement resulting in an additional $1MM in collections in 2009.