Primary subject matter expert advising Executive Management on all aspects of federal, state, and commercial payer revenue and reimbursement. Expert knowledge of nuances in urban, rural, MDH, SCH, CAH and LUGAR reimbursement.Reclassified multiple system hospitals through various methods to maximize reimbursement. Re-designation of hospital status was achieved through urban-to-rural, rural-to-urban, rural-to-RRC, rural-to-MDH and wage index reclassifications. Revenue increases valued at $30m+ per year.Plan and budget for strategic expansion of system GME programs. Develop GME Affiliation Agreements between hospitals. Apply for additional expansion of GME residency cap space, whether it be temporary or permanent.Manage monthly third party receivable and payable balance sheet entries across RRH affiliates. Responsible for the validation of the annual financial statement audit of $200M+ in reserves. No management notes in my tenure at RRH.Partner with Patient Financial Services and Managed Care Contracting to maximize reimbursement through strategic approaches in charge master, payment methodology, contracting language and policy strategies. Manage third party contract revenue modeling and forecasting of rate assumptions, trends and market share demographics. Prepared Medicare facility provider enrollment applications, revalidations, and provider attestations. Successfully set-up a new hospital, exempt unit, and CAH.Responsible for leadership and coordination of all financial functions related to accounts receivable and revenue for all hospital and physician related entities within the health system.Monthly revenue analysis, revenue forecasting, statistical reporting, allowance analysis and reserve analysis.Responsible for providing support to Decision Support, Business Planning and Accounting.340B OPA Authorizing Official.Support the annual financial statement audit, Schedule H filing and any additional regulatory reporting needs.

Budgeted for health system annual revenue rate assumptions.Key member of the team that successfully applied and qualified for the 340B drug discount program at four RRH hospitals. This includes initial and annual identification and registration of numerous child site locations with HRSA.Directed and managed the filings, audit, and settlement review of all third party reports, including acute (9), psych (5), rehab (1), dialysis (5), SNF (5), swing bed (2), CHHA (1), CFR (6), ASC (2), FQHC (2), RHC (6), PACE (1), TRICARE CHAMPUS (9), Home Office (1) and Federal Indirect cost reports (2).Filed and opined on advantageous and successful Mediation Hearing, PRRB, PJSO, District Court, Court of Appeals, and Supreme Court reimbursement appeals.Partnered with Corporate Compliance and Legal to resolve confidential Medicare and OMIG audits, self-disclosures, MFCU audits, third party payor inquiries, and OIG assessments.Filed federal and state rate appeals for low-volume facilities, GME, DSH, Uncompensated Care, Bad Debts, Nursing and Allied Health, Wage Index, Occupational Mix, Indigent Care Pools, Outlier Reconciliations, Case Mix, and other reimbursement related matters.Supervised reporting and compliance with state Hospital Financial Assistance Law and federal and state uncompensated care reporting.

Designed and facilitated strategic opportunity and risk mitigation plans to ensure profitable market share growth for Medicaid Managed Care, Family Health Plus (FHP), Child Health Plus (CHP), Healthy New York, and ValuMed products. Provided guidance and support to hospital, physician, and ancillary contracting.Managed Health Plan dental vendor’s FHP and CHP customer service, claims processing, utilization management, credentialing, compliance and audit responsibilities.

Supervised Western New York reimbursement and hospital contract negotiation analytics.Routinely reviewed and reworked contractual language and health system rate calculations with the corporate legal team to align with senior leader’s goals. Partnered with the hospital quality improvement team to incorporate new rate agreements.

Filed and completed the federal and state cost reports and third party balance sheet audits.Appointed member of the hospital GME, Renal Dialysis and Rate Task Force work groups.Developed new reimbursement revenue streams through accounts receivable analytics, cost report review and extensive work with physicians and time study reporting.

Upstate New York regional Medicare liaison for Rochester, Syracuse, and Utica.Reviewed and verified the accuracy of hospital financial information reported on provider cost reports to ensure proper rate setting and compliance with state and federal law.

Lead member of wage index focus group responsible for the introduction, review, and implementation of changes for consistency and efficiency. Final product was approved by the CMS regional office and implemented across the entire MAC.Peer reviewed Senior Accountant wage index determinations.Supervised, mentored, and trained Associate Accountants.

Individually selected by management to create and implement databases and procedures to train team and department on consistent statistical hospital tentative settlement calculations and analytics.Calculated Medicare cost report acceptances, tentative settlements, wage index reviews, desk audits, final settlements, and reopenings for Hospitals, Psychiatric and Rehabilitative Facilities, SNFs, ESRDs, HHAs, and Home Offices. Audited PS&R, DSH, IME, GME, Bad Debt and SNF PPS reimbursement data.Reconciled trial balance accounts, prepared audit workpapers, and audit adjustments. Routinely analyzed, interpreted and applied the annual proposed and final rule Federal Register publication updates.

HCRA Public Goods Pools

HCRA Public Goods Pools