Reimbursement and coding consultant and auditor
Resume:
QUALIFICATIONS
CAREER OBJECTIVE
America Association of Professional Coders
Certified Professional Medical Auditor (CPMA) 2015
America Association of Professional Coders
Certified Professional Coder (CPC) Nov 2009
Consultant/Reviewer
Chart Monitor and Billing Consultant Texas Medical Board ongoing
American College of Medical Practice Executives
CMPE- Certified Medical Practice Executive Sep 2003
Certified Member
American College of Medical Practice Executives ACMPE. Lifetime member
CORE COMPETENCIES
Coding Compliance Management
Medical Auditing
Billing Evaluation
Healthcare Consulting
Reimbursement Consultation
Practice Management Consulting
Practice Evaluation
Practice Management
Care Strategy Management
Expense Analysis
Group Practice Mergers
Compensation Analysis
Operational and Financial Reviews
Personnel Management
Administrative Management
Care Strategy Reimbursement
Detail-oriented, Auditing, Coding, and billing professional with years of strong healthcare and practice management background to lead and work with cross-functional teams in Revenue Cycle Management and Coding Compliance Management.
Ability to develop, implement and lead innovative education programs and initiatives that improve practice and healthcare management while ensuring organizational growth.
Earning success through result-focused approach, collaborative, flexible, and adaptive efforts, as well as applying innovative thinking, execution excellence and commitment to follow-through.
WORK EXPERIENCE
Practice Management and Reimbursement Consultant
J. Claypool Associates Inc. Jan 1993 – Present
•Performed auditing and billing analysis, billing evaluation, reimbursement consultation, and assessment of organization policies and procedures.
•Worked with coding staff on process improvement and coding compliance.
•Developed educational seminars on revenue cycle topics including fraud and abuse, compliance and
•Developed business plans and conducted several practice evaluations including supervising business proformas, billing and audit reviews.
•Established and maintained strong client relationships by successfully providing financial, managerial, and strategic solutions to improve client practice.
•Provided interim leadership and management to various clients and physician practices during their corporate personnel transitions.
•Provided consultation services which included assessing organization processes, policies and procedures and coordinating comprehensive analysis of practice performance.
Practice Management Consultant
O’Neal, McGuinness & Tinsley, LLP. Jan 1992 - Dec 1993
•Designed effective business plans and conducted several practice evaluations including supervising business proformas, billing and audit reviews.
Provided revenue cycle presentations to accounting staff.
•Coordinated the assessment of billing and fee schedules to ensure a practice is paid in accordance with the contract.
•Assisted physicians and other healthcare professionals with establishment of practice management systems and protocols for best practices while providing practice oversight.
•Analyzed and transformed healthcare practices and institutions into an effective system with efficient workflow processes.
Director of Practice Management & Development
St. Joseph Hospital Houston Texas Apr 1989 - Dec 1991
•Performed financial and billing analysis, billing evaluation, reimbursement consultation, and assessment of organization policies and procedures.
•Facilitated the development and management of a foundational structure for the organization ensuring a sustainable and effective healthcare organization.
•Provided several consultation services which included assessing new practice establishment, practice evaluation, workflow analysis, operational reviews, negotiation and monitoring.
•Performed highly complex analysis and assessment of processes and development needs with focus on sustainable process improvements.
MEMBERSHIPS & ACHIEVEMENTS
Member
American Association of Professional Coders, CPC Expert Witness Training 2020 and 2021 National Association of Medical Auditing Specialists.
Lifetime Member
MGMA Medical Group Management Association
Adjunct Faculty
University of Houston Clear Lake, School of Business and Public Administration
Advisory Board Member
University of Houston Clear Lake, Health Care Administration program
Member
Texas Medical Group Management Association
Guest Lecturer
University of Texas Medical Branch at Galveston
Guest Lecturer
Texas Society Certified Public Accountants
Guest Lecturer
PHACOM
Guest Lecturer
Texas Hospital Association
Guest Lecturer
Texas Orthopedic Association
WORK EXPERIENCE CONTD……
Practice Management Consultant
The Methodist Hospital Health Care Network Jan 1985 - Apr 1989
•Provided several consultation services which included assessing new practice establishment, coordinating seminar development and managing existing practices.
•Assisted physicians and other healthcare professionals with establishment of practice management systems and procedures for best practices while providing practice oversight.
•Developed business plans and conducted several practice evaluations which included supervising business proformas, billing reviews and all areas of practice analysis.
•Coordinated the development and management of a foundational structure for the organization ensuring a sustainable and effective healthcare organization.
SEMINARS DEVELOPED
10 Tips for Documentation and Billing Compliance
Presented to Resident staff at Corpus Christi Driscoll Children’s Hospital, CPSST
The New Evaluation and Management Coding Guidelines for 2021 Medical Service Bureau Starting a New Medical Practice.
Presented to members of the Travis County Medical Society and clients of the Medical Service
Bureau.
Business Of Medicine Financial Indicators for Practice Success
Travis County Medical Society.
Conducting Your Own Internal Chart Audit.
Presented to Texas Medical Group Management Association Annual Conference, Dallas Texas.
Physician Administrator Relationships.
Panel Presentation to members of the Texas Medical Group Management Association.
Fraud & Abuse: What You Don’t Know Can Hurt You.
Presented to Seton Physician Health Network, Austin, Texas.
Fraud & Abuse: What You Don’t Know Can Hurt You.
Presented to members of Texas County Medical Societies on behalf of the Texas Medical Association.
Coding Errors are Costly.
Presented to the Methodist Hospital affiliate physician and office staff.
Operating in the Future Tense.
Presented to the Texas Medical Group Management Association Annual Convention.
REFERENCES
Available Upon Request
Contact this candidate