Management Manager

Lori Frigillana

*** ******** ****., *********, ** 20850

( 240/483-1491 ( abhfp3@r.postjobfree.com

RESUME

SUMMARY OF QUALIFICATIONS

Extensive Experience in all points of Hospital Revenue Cycle:

PFS/CBO Management - - Billing, AR, Cash Management, Denials and Appeals,

Metrics and Reporting

Charge Services - - Chargemaster Maintenance and Standardization, Charge

Capture Monitoring and Training

Billing/Coding Compliance --CMS, State, HSCRC, and commercial payers

Revenue Optimization - - Point of care, system/interface reconciliation,

pricing strategies

Managed Care Consulting - contracting, payer scorecards, negotiations

Service Line Development/new ventures - proforma development,

reimbursement analysis

IT System Management - - Updates, major system conversions, report writing

and analysis

Project Management - IT, special projects and programs

Clinical Dept Operations Management - staffing, patient flow, charge

capture, site and budget management,

Consulting - - Independent and Major National/Internationally Recognized

Consulting Firms:

Hospital Revenue Cycle, Physician Practice Management, Healthcare

Association Management

Clinical/Technical - - Biomechanical, peripheral vascular, OR, Radiology,

Pharmaceutical

Teaching/Lecturing/Public Relations/Government Affairs, Sales and Marketing

PROFESSIONAL EXPERIENCE

Adventist Healthcare, Maryland

October 2004-present

Not-for-profit integrated healthcare system

Assistant Director/Director, PFS and Revenue Management

> Managed Government Billing & Denials Management, consult for non-

government billing and denials

> Developed RAC/MIC/Recovery Audit multi-discipline, cross functional

defense/response team

> Developed denials interim tracking/reporting system and implemented

formal denials management software, and metrics

> Managed Chargemaster and Charge Services

> Implemented and customized ABN software and processes, to include

surgical line as well as standard laboratory and radiology edits

> Optimized revenue in specialty departments and service lines

o Behavioral Health - identified a $2M revenue loss through charge

capture and billing methodology errors, defined remediation process

and led recovery initiative

o Identified compliance risks as well as revenue loss in radiation

oncology, cardiac catheterization/electrophysiology, interventional

radiology, infusion. >>> $4M improvement

o Revised supply and drug billing methodology and systems for

appropriate coding and pricing

> Developed revenue management team, consisting of nurse auditors, analysts

and coding specialists to work medical necessity and OCE/CCI edits

reducing denials, pre-bill write-offs and missing charges by $6M year one

> Established revenue monitoring and QA initiative to reduce interface-

related revenue delays and losses

> Consult for Managed Care, Finance, and Development departments on new

ventures and new lines of business

> Revenue Cycle llead and subject matter expert for implementation of

Cerner Millennium Clinical/Order Entry and Cerner Patient Accounting

conversion from SMS

> Consult for physician and professional billing, home health and SNFs

> Oversee system billing edits, revenue tracking/analysis, report

compilation

> Developing orientation and training programs in revenue integrity for

financial and clinical operations management staff

> Work with Case Management and Coding on medical necessity, coding,

documentation and DRG validation issues, clinical staff education and

training, with emphasis on inpatient vs. observation vs. extended

recovery criteria, guidelines and compliance

Booz Allen Hamilton - 2008

Associate/Revenue Cycle Subject Matter Expert

> Major assignment -750 bed mid-West Hospital - Part of a team of revenue

cycle specialists that implemented complete revenue cycle process

improvement initiative in a 1 year project. Included Patient Access,

charge capture, CBO - facility and professional Coding and Billing,

Collections, Denials Management - - Resulted in $12M bottom line

improvement, year 1

> Consulted on Veterans Affairs revenue cycle-related activities, including

professional and facility billing and coding, analytics and contracting

> Advised on start-up of Medicare Integrity Contract

INOVA Health System, No. Virginia

June 2001 - October 2004

NFP integrated healthcare system

Sr. Manager, Revenue Strategies

> Managed Chargemaster and Charge Practices, multi-entity healthcare.

> Optimized revenue through identification of missed and incorrect charges,

process improvement, cross-departmental and cross-functional collaboration

> Worked with Patient Accounting on AR improvement through initiating and

resolving pre-bill edits, increasing clean claims and working denials for

documentation, coding optimization, decreasing DNFB via coding expedition

at HIM and chargemaster/point of care levels

> Led revenue/compliance optimization in interventional radiology, cardiac

cath lab, and nuclear medicine, leading to $5M revenue enhancement over

18 months at flagship hospital, initiative copied to other acute care

hospitals within the system

> Discovered IT programming errors leading to faulty claims submissions &

underpayment in observation, radiology, and cardiovascular service lines

recuperating $2M

> Implemented APC compliance and revenue assurance strategies in 2001,

including supply and drug coding and re-pricing and remediation,

Subsequently led recovery due to initial delays in coding supplies and

drugs due inadequate naming conventions

> Provided financial and reimbursement projections for new ventures

> Monitored regulations and coding changes. Implemented and disseminated

information appropriately throughout organization

> Participated in analytical studies of various clinical operational areas

of multi-hospital system

> Developed pricing strategies for annual increases and APC payment

adjustments

> Developed pricing transparency models

> Developed guidelines and training for clinical trials billing

> SME and Lead for system conversions, SMS to McKesson

Children's National Medical Center, Washington, DC

1995 - 2001

Manager, Charge Practices 1998-2001

> Managed chargemasters and charge capture and reconciliation for hospital

and physician practice billing

> Provided billing guidance, policies and procedure development in charge

capture and revenue enhancement for all clinical departments

> Collaborated with PFS on increasing clean claims, reducing DNFB, and

appeals

> Identified and implemented system capabilities for billing Observation

per hour and led Observation training and process improvement at ED, Case

Management, Patient Access and \Coding levels

> Identified best practices in observation, cardiac catheterization, and

chemotherapy/infusion billing

> Lead system implementation of system settings for appropriate billing of

outpatient drugs resulting in elimination of denials for high cost

outpatient drugs

> SMS and lead in system conversions of hospital and physician practice

Patient Accounting systems

> Developed Managed Care payment score cards and tracking systems

> Assisted in development of cost analysis reporting

> Assisted in development of contract management in cash posting

> Provided reimbursement projections and billing methodology guidance for

new ventures and new lines of business

> Troubleshot denial trends in cardiac catheterization procedures and

identified 3M edit for ad hoc assignment of revenue codes by coders to

reduce code mapping problems due to chargemaster default settings

Business Administrator, Hearing and Speech Department and Board` 1995-

1998

> Directed daily operations, clinics and early intervention programs,

including decentralized patient registration, billing and collections,

professional staffing, administrative support, supplies and equipment

> Developed and managed operations, capital, revenue and special project

budgets

> Implemented PC driven speech language therapy and early reading

initiatives

> Developed and implemented homegrown IT system for tracking provider

productivity

> Wrote successful proposals for and managed grants in excess of $5M from

government agencies, district schools, and private foundations for early

intervention, cochlear implants, and newborn hearing screening programs

throughout metropolitan DC hospitals

> Managed fund-raising activities and endowment fund of the Hearing and

Speech Board

Washington Hospital Center, Washington, DC

Department of Dermatology/Dermatology Associates

1982 - 1991

Administrator, Dermatology Associates/ Department of Dermatology

> Directed daily operations and financial management for teaching

department, in- and outpatient dermatology services, off-campus clinics

and private dermatology group practice

> Procured and managed government and industry funding for clinical

research including early PUVA, Accutane and Minoxidil trials,

photopheresis for cutaneous T-cell lymphomas, systemic sclerosis and other

immune system disorders clinical studies.

> Wrote successful proposals for collaborative bench research with NIH in

genetics and dermatology

> Implemented first Local Area Network on campus, including remote access

for patient accounting management and clinical trials database

Other

Clinical - Peripheral Vascular & Plethysmographic technician and

instructor; biomechanical technician

Lectured and taught - Practice and Revenue Cycle Management, community

college, state and national professional associations

Professional Association work in Public Relations, Government Affairs,

Diversity - Recruitment and Retention

Pharmaceuticals - Burroughs Wellcome, Sales and detailing

Journalism and Public Relations; medical scientific writing

Volunteer work - Mental Health, Children's Health, Foot Care organizations,

community organizations.

Education

BA - Xavier University, New Orleans, LA

Coding certified

Coding and Medicare Compliance Bootcamps

Peripheral Vascular, Plethysmography and Biomechanics courses at California

College of Podiatric Medicine, UCLA

ITS Systems and Software

SMS Invision, McKesson HBOC and STAR, EPIC, AFFINITY, Cerner MILLENIUM and

PROFIT/CPA, IDX. Multiple physician billing systems, 3M HIS including

HDM/ARMs, Allscripts Case Management, Aurora Denials Management and Cash

Posting. Proficient in MS Office applications, including Excel, Access,

PowerPoint, Project, Visio.

Above average written and oral communications

References available on request.

Contact this candidate