Kelly M. Taylor

Management Consultant

**** **** *****, ********* ****, Miami Beach, FL 33141

C 954-***-**** acefno@r.postjobfree.com

SUMMARY OF EXPERIENCE

• Seventeen year record of achievement in the health care revenue cycle sector.

• Extensive knowledge of CPT4, ICD-9-CM/PCS, ICD-10-CM/PCS, Evaluation and Management coding, APC

validation and third party payor rules and regulations.

• Helped design one of the first web-based Chargemaster (CDM) online tool with the only ‘best practice’

benchmark built into the software.

• Assisted in the design and development of an ICD-10 Translation Tool for a US-owned hospital based in

Dubai, UAE for the 3M Co.

• Key Program Director in Cognizant’s Health Solutions practice that conceptualized and assisted in the design

and development of Cognizant’s ICD-10 T-10 platform used by large health plans and academic-based

medical centers.

• Generated $10 million in revenue for Cognizant’s Health Solutions practice in less than two years.

• Access to provider RFPs as well as a vast network of contacts to build a strong pipeline.

• Implemented an ICD10 coding and translation tool in a number of large hospitals in Europe, Canada, Asia and

the Middle East

• Experience in conducting reviews and audits of medical records for accuracy specific to documentation and

coding.

• Responsible for improving the process of patient registration, coding, billing and collection which resulted in

a consistently lower accounts receivable days of an outpatient health center.

• Consulted in the areas of revenue cycle, regulatory issues, coding compliance, billing procedures, accounts

receivable analysis and procedure/policy development.

• Implemented the following provider-based system(s) /coding tool(s) and EMR: IDX, Mckesson, Medical

Manager, Meditech, Siemens Soarian, Misys, EPIC Resolute, Cerner and all of 3M HIM suites. Well-versed

in the following CDM maintenance software(s): 3M, Craneware, MedAssets and The Chargemaster Suite

• Founded a successful third-party billing company.

EDUCATION /CONTINUING STUDIES AND CERTIFICATION

Master Certificate in Advanced Project Management, Stanford University, Palo Alto, CA

Master Certificate in Project Leadership, Cornell University, Ithaca, NY

Master Certificate in Computation and Programming, Massachusetts Institute of Technology,

Cambridge, MA

MBA, Healthcare Administration and Finance, University of Miami, Miami, Florida (in progress)

BA, Speech-Language Pathology/Communicative Disorders, 1999, California State University, Northridge,

Northridge, CA

Certified Coding Specialist, AHIMA, American Health Information Management Association

Certified Procedural Coder, Physician-Based, AAPC, American Academy of Professional Coders

PROFESSIONAL HISTORY

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Growe Technologies, Brooklyn, NY

Client: SUNY Downstate Medical Center

ICD-10 Advisor/Strategist/Project Leader (Contract)

Leveraging on past methodology of Social-Mobile-Analytics-Cloud (SMAC) to bring a different

flavor into a rather typical ICD-10 project engagement.

January, 2013 to Present

• Part of the hospital restructure team reporting directly to the hospital’s CIO and in-charge of the

overall ICD-10 remediation project engagement

• Developed the foundations for the smaller projects under the ICD-10 umbrella in creating project

charters and project scopes utilizing the PMI Methodology.

• Currently introducing new technologies in the HIM department such as coding utilizing the

Computer Assisted Coding powered by the Natural Language Processing for Inpatient records.

Also involved in the ongoing training of the clinical coders and clinical department managers in

the use of the 3M ICD-10 Translation Tool.

• Assisted in the purchase of the chargemaster tool – Craneware for the purpose of automating the

hospital’s chargemaster maintenance.

• Hired and mentored the hospital’s new CDM manager in developing policies and procedures,

instituting a best practice in the process of reviewing and auditing the current CDM via revenue

codes and clinical departments. Assisted in the formation of a CDM committee.

• Working closely with the Allcripts team to implement the product successfully at SUNY

Downstate’s outpatient and ambulatory clinics.

• Providing oversight for the hospital’s compliance team in updating and converting the 75+

encounter forms to be ICD-10 compliant.

• Assisted in the implementation of the T-system EV (documentation and charting solution)

product at the hospital’s Emergency Department.

• Reviewed the process in adherence to the InterQual criteria especially in cases of Inpatient vs.

Observation.

• Working closely with the hospital PM in enhancing the Alpha system for scanning the patient

records and working on the interface with the Alpha system- 3M Clintrac-Eagle system.

• Day to day activities include maintaining project documentation following the PMI Methodology

as well as daily interactions with the hospital execs and clinical staff to document different

processes via workflow

• Connect with the hospital’s vendors for upgrades and generation of new contracts

• Redesign of the current process in the HIM department post-ICD-10

Cognizant, Teaneck, NJ

A global technology firm

Healthcare Innovation

Director and Practice Lead, Healthcare Solutions Practice

The Health Solutions Practice handles both Provider and Payor project engagements

March, 2011 to January, 2013

Responsible for growing the hospital client base from zero to 30 active and ongoing clients in a

span of 2 years generating $10M in annual revenue.

Managed a team of 10 clinical coding experts and software development professionals in the

design, development and continuous maintenance of Cognizant’s T10 platform: a robust ICD-9

Kelly M Taylor Page 3

to ICD-10 translation tool that has extensive features and functionalities able to handle Payor and

Provider data.

Managed several EPIC conversion projects with the main focus on the HIM area which includes

the conversion and build of the Chargemaster, conversion of ICD-9-CM to ICD-10-CM as well

as design EPIC focused training in the EPIC to 3M Encoder interface to the medical coding staff.

Handled several long-term projects for large payor clients in translating current Medical Policies,

NASCO and Facets Benefit Tables from the ICD-9 coding scheme to the ICD-10 coding

environment. Managed a team of 25 SMEs on a day-to-day basis as well as an offshore team

that automated the import and export process of the ICD-9 codes into the ICD-10 translation

tool.

Assisted a large healthcare system in the state of Nevada in the ICD-10 Assessment process that

included the following activities: evaluated the current infrastructure, developed a strategic plan

and method for implementation throughout the organization as well helped the organization

analyze potential ICD-10 mapping tools and determine which solution best meets the clients'

requirements. Assessed the client’s current clinical and financial operation as it relates to the

ICD-10 transition.

Other Project Engagements:

Assisted in the implementation of Cerner’s HIM ProFile solution in a couple of hospitals in the

South Florida area. Provided project management and HIM expertise as well as leveraged on a

‘best practice’ for the successful implementation of the Cerner product.

3M Healthcare, Atlanta, GA

Project Manager (Independent),

HIS Consulting/Revenue Cycle

Ambulatory Services, 2003 – March, 2011

ICD-10 Focused Projects:

Helped design and develop one of the first ICD-10 Translation Tool used in the international

market in 2004

Managed an overall ICD-10 project engagement for a large payor in the state of Maryland from

assessment to mapping of 350,000 claims (forward and backward) to performing a financial

neutrality analysis. Also worked with an offshore team in India to develop a custom ICD-10 tool

for this payor client.

Created tools, templates and artifacts specifically for the ICD-10 Impact Assessment project

engagement(s).

Legacy Systems Conversion:

Managed a number of systems conversion projects for several large academic healthcare

facilities in the Southeast Region as well as in the West Coast specific to the EPIC system.

Assisted and managed the implementation of the following EPIC applications: Clarity, Prelude,

Cardiant, Beacon, ADT, Cadence, HIM and Resolute.

Other projects:

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Part of a team that helped a large South Florida based physician practice design a customized billing system

with a patient-centric concept consisting of 25 modules.

Supported international clients in such countries as Canada, Germany, Australia, Brazil and the UK in the

‘Codefinder’ product specific to coding patient records using the ICD-10 coding classification.

Provided expertise in the most current CMS Drug Administration rules and regulations as it pertains to

several Stem Cell treatment facilities within South Florida. Provided an in depth staff training in coding and

billing specific to IV infusion and the proper way of charging for the medication, assigning the most

appropriate HCPCS code.

Plan and lead all aspects of various projects in one or more of the following outpatient services: outpatient

coding and regulatory auditing, training and advisory services, revenue cycle and denial management process

improvement, charge master design/editing, charge capture process, billing processes, charge description,

modifier, CPT/HCPCS code and revenue code assignment/editing, and charge master maintenance processes.

Helped in the design and development of the very first Chargemaster Online tool as well as involved in the

ongoing revision of 3Ms web-based charge master online tool. Also, completed a total of 150 chargemaster

reviews.

Traveled mostly to all of the Triad facilities in the installation, training, audit and review of the chargemaster.

Review included producing a report from the 3M Chargemaster online code per clinical department, checking

to make sure the CPT and revenue codes match, line by line review with the clinical department

managers/directors to make sure that all of the services, procedures and supplies are captured in the CDM.

Worked closely with the Pharmacy department to make sure the drugs are captured accurately and that the

multiplier works properly.

KPMG, LLP, Fort Lauderdale, FL

A professional service firm

Senior Associate, Industry Risk-Based Solutions, Healthcare Practice, 2002-2003

•Performed several Chargemaster audit/review(s) to provider clients from small community hospitals to large

academic medical centers. Identified missed revenues especially in high dollar departments such as

cardiology/cardiac cath, pacemakers and defibrillators are often times inaccurately captured resulting in

missed revenue.

•Served as a consulting analyst supervising a facility-wide project designed to optimize billing and coding

compliance through normalization/correction of item descriptions, payer-specific billing detail and revenue

codes, as well as making structural improvements to the charge master enabling improvement of charge

capture processes and quality of decision support data.

• Successfully identified missed charges, in particular C-Code pass-through devices, critical incremental

revenue opportunities under OPPS. Recovered lost revenue of $300,000 of unbilled C-codes in a 6-month

period in one hospital.

• Handled a Corporate Integrity Agreement Project Engagement that involved reviewing a sample of 100

paid claims within a twelve month period. Claims were reviewed based on accuracy of billing and coding

routine ESRD laboratory tests reimbursed under a composite rate and non-routine ESRD laboratory tests

reimbursed separately from the composite rate. Reports were then generated and relayed to the Office of the

Inspector General.

HEALTHCARE CONSULTANT

Independent consultant, 2001-2002

Revenue Cycle Project Engagements/Clients:

Aeromedical Lifeflight Corp., Costa Mesa, CA

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o Primarily involved in the design, development and implementation of an electronic medical record and

reimbursement department. Responsibilities include the following: reviewed and recommended changes in

the current patient intake form used by the staff in documenting relevant patient information, diagnosis,

procedures and supplies. Conducted staff education in defining and explaining Medicare’s New National Fee

Schedule for payment of air ambulance services. Assisted in the purchase of a new electronic medical record

-Powermed, coding -3M Codefinder and billing -SMS & McKesson HBOC, softwares as well as provided

training to the staff in terms of using the software. Recommended the use of a new Medicare Fee Schedule

Impact Analysis Tool from the American Ambulance Association that estimates the projected revenues under

the new Medicare Fee Schedule. Assisted in the development of a compliance program and in educating the

staff in chart compliance, documentation protocol and adopting the Standards of Ethical Coding issued by the

American Health Information Management Association.

Medium-sized Physician Group Practice, Los Angeles, CA

o Assisted in providing practice analysis, creation of action plan and final implementation of operational

changes to achieve integration of the following processes: charge capture, payer pre-qualification, and

receivables control in a seamless, proactive approach to revenue cycle management. Successfully completed

the implementation of server-based, 18-workstation network incorporating process changes enabling “real-

time” data entry of physician charges, resulting in>97% of all claims being submitted on the date of service to

the patient. Days in AR were reduced from 140 to 43 days within 60 days. Total AR was reduced by more

than $450,000 by project conclusion

DELOITTE & TOUCHE, LLP, Los Angeles, CA

A professional service firm

Consultant, Healthcare Regulatory & Dispute Consulting Practice, 2000 – 2001

• Performed several Grant and Clinical Trial audits for hospitals in Southern California involved in extensive

clinical trials studies funded by major pharmaceutical companies.

• Involved in a litigation support project engagement for an Orange County Hospital investigating and

reviewing documentation on coded records for their Lung Volume Reduction Procedure. The hospital was

accused of documentation tampering as well as up-coding. The audit involved reviewing ICD9 procedure

codes and physician documentation as well as DRG validation using a coding software, 3M Encoder for 300

patient records.

• Implemented a Corporate Standard CDM for a large multi-hospital system in the east coast. Initial efforts

focused on cleaning each department’s CDM and then on creating a Corporate Standard by selecting ‘Best

Practice’ departments across the various hospitals. With the standard in place, all facilities were mapped to

the corporate CDM. This process resulted in cleaner claims, improved cash flow and reimbursement levels

and improved compliance levels.

• Conducted a 5-month redesign of the back end of the revenue cycle of a small hospital in Northern California.

Efforts resulted in a reduction in accounts receivable days to 16%, a tripling of account follow-up productivity

and a reduction in administrative, bad debt and charity care write-offs of 30%.

• Involved in a HIPAA engagement for a large managed care company; part of a team that helped in

implementing an organization-wide information security to protect the confidentiality and integrity of

members and employees.

* Part of a team that help developed and tested an automated APC Validation Tool for Deloitte & Touche which

calculates the expected reimbursement for Medicare outpatient services provided on or after August 1, 2000 and

compare payment amounts to the actual payments made by the fiscal intermediary. The tool will generate

exception reports that will help identify opportunities to improve the accuracy of the billed claims and optimize

reimbursement.

TAYLOR & ASSOCIATES MEDICAL MANAGEMENT, North Hollywood, CA

Full service third-party billing and healthcare consulting company

Owner, 1995-2000

Healthcare consulting clients include the following:

• MedOnWeb.com – part of a team of healthcare and software professionals in the design and development of

an Internet-based medical record and billing application. The application allows physician practices to

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transcribe patient records, code, file insurance claims, process payments, manage receivables and bill patients

on a pay-as-you use basis.

• Air Rescue International – assisted in the purchase of the billing department’s software as well as helped in

the process of training key personnel in software usage.

MOTION PICTURE & TELEVISION FUND, Los Angeles, CA

Comprehensive service organization, operating five hospital-based outpatient health centers throughout the

greater Los Angeles area and a 256-bed acute care hospital, a children’s center, a retirement community and a

health plan exclusively for the entertainment industry.

Patient Accounts Manager, Westside Health Center, 1992-2000

• Managed a staff of 10 in patient registration, coding, billing and collections in an outpatient health center

consisting of three internal medicine physicians and one gynecologist.

• Supervised editing of CMS 1500 claims on-line using MedEdge and Edicomm electronic billing systems.

• Supervised the auditing of patient accounts in terms of demographics, correct charges, CPT, HCPCS and

ICD9 codes.

• Implemented policies, guidelines and procedures. Also responsible for coordinating projects for staff.

• Handled physician education in charge ticket/superbill/encounter form use in terms of checking the correct

E&M code and in using specific and clear diagnosis for the purpose of correct coding.

• Conducted random medical record audits and/or charge ticket/superbill/encounter form audits for coding

compliance.

• Member of the Hospital’s Charge Description Master Performance Improvement Team and attended various

in-house APC educational sessions and seminars. Also involved in the audit and review of the hospital’s

correct code assignment in terms of DRG compliance, making sure the codes support the physician document

on the patient’s medical record and match the printed UB92 forms.

OTHER SKILLS/CERTIFICATIONS

• Certified Interventional Radiology Cardiovascular Coder (CIRCC), AAPC, American Academy of

Professional Coders

• Certified Professional Medical Auditor (CPMA), AAPC, American Academy of Professional Coders

• ICD-10 CA/CCI, Canadian Institute for Health Information (CIHI)

• Occasional panelist for a monthly healthcare publication for HIM professionals

• Completed a Greenbelt training and certification in Six Sigma at the 3M Company

PROFESSIONAL AFFILIATIONS

NAFE, National Association of Female Executives

AHIMA, American Health Information Management Association

AAPC, American Academy of Professional Coders

FHIA, Florida Health Information Association

ASHA, American Speech-Language-Hearing Association

HFMA, Healthcare Financial Management Association

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