Project Manager Revenue Cycle

DR. SHARMIL KURIAN Phone: 314-***-****

Memphis, Tennessee Email:

*************@*******.***

SUMMARY

Accomplished healthcare executive with over 15 years experience in clinical

operations and end-to-end revenue cycle management in widely diverse

environments. Extensive experience with managing teams, lean & six-sigma,

project management, strategic planning, cost management and increasing

productivity. An efficient, self-motivated & sharp-minded administrator

with an extremely thorough understanding of achieving results through

teamwork while effectively navigating organizational challenges.

PROFESSIONAL EXPERIENCE

Express Scripts/Medco Health Solutions, Memphis, Tennessee 2011-2012

Largest Pharmacy Benefit Management Company-Fortune 25 company with

revenues over $100 billion

Vice President: Reimbursement (Revenue Cycle Management)

Process Owner for the specialty pharmacy front end revenue cycle business

processes including prescription intake, insurance verification, benefit &

medical necessity, prior authorization, patient pay, co-pay assistance,

call center.

. Directed a department of 450 clinical and non-clinical associates located

across multiple geographical locations both nationally and offshore.

. Consistently met and exceeded business targets related to timely Rx

processing and customer satisfaction.

. Represented the department to pharmaceutical manufacturers, physicians,

clients and provided strategic direction on reimbursement activities

associated with new drug launches.

. Overhauled business processes to increase productivity and decrease

turnaround time using lean techniques and process automation.

. Led the Patient Access Integration team that designed the front end

revenue cycle process for the new combined Express Scripts/Medco

Organizations.

IOWA HEALTH SYSTEM, Des Moines, Iowa 2010-2011

Iowa's first and largest integrated health system with 15 hospitals and

revenues of over $2.8 billion

Director: Revenue Cycle

Directed the identification, implementation and communication for end-to-

end revenue cycle best practices across the health system. Led the revenue

cycle project portfolio and teams consisting of hospital CFOs, revenue

cycle leaders, consultants & vendors.

. Achieved a system wide initiative to reduce top 3 denials by 22% in 2

quarters and late charges by 7%.

. Led the implementation of web based insurance verification (Passport

OneSource) along with policy administration/training resulting in

reduction of eligibility denials by 26% in 2 quarters.

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. Led an organization wide multidisciplinary team to redesign the Medicare

RAC process along with standardizing the tracking and reporting

activities.

. Automation of the Charge Description Master resulting in FTE savings and

turnaround time.

. Coordinated Medicare Underpayment Recovery project resulting in

recoveries of over $ 2 million.

. Implemented the Clinical Documentation Improvement dashboard and

financial tracker to monitor program success.

. Led a Kaizen event aimed to boost point of service collections.

. Recommended conversion strategies for AR migration during transition to

EPIC EMR.

. Audited numerous workflows and redesigned them to achieve business

results.

. Facilitated the IHS Revenue Cycle Governance Council.

BJC HealthCare

2006-2010

St. Louis Children's Hospital, St. Louis, Missouri

BJC HealthCare's 250 bed premier pediatric teaching hospital ranked among

top 5 children's hospitals

Manager: Revenue Management (Patient Financial Services), 2007-2010

Managed the patient accounts department to ensure timely billing &

collections while meeting weekly and monthly revenue cycle targets.

Developed department policies and procedures and promoted excellent

customer service.

. Led a multi-disciplinary team to implement workflow for Observation bed

status patients to be in compliance with clinical and billing

requirements.

. Project leader for the hospital wide conversion of the electronic

eligibility system from HDX to Healthvision (Lawson) along with

integration into Siemens Invision (SMS).

. Implemented a structured work from home program increasing employee

productivity and satisfaction.

. Redesigned manual outbound calls to automated system thereby decreasing

abandoned call rate and accelerating cash flow by 20%.

. Reduced the transplant account receivables that were greater than 90 days

from 57% to 21%.

. Designed an innovative incentive and employee recognition program.

. Restructured teams to create effective insurance follow up and customer

service agents.

. Member of the St. Louis Children's Hospital Revenue Cycle Steering

Committee.

BJC HealthCare Corporate, St. Louis, Missouri

Non profit 13 hospital system with net revenues of over $ 2.6 billion

Performance Improvement Specialist: Revenue Cycle Initiatives, 2006-2007

Consultant on the BJC corporate revenue cycle team leading revenue cycle

projects using Six Sigma and Lean Methodology.

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. Project Manager for the National Provider Identifier (NPI) Initiative and

successfully enumerated all BJC facilities and employed billable

clinicians.

. Educated patient accounting, medical staff, physicians and allied health

providers.

. Managed a successful system testing strategy as well as a marketing

campaign targeting 18,000 providers.

. Mapped current state process and provided recommendations on the

Inpatient Authorization Denial process at Barnes Jewish St. Peter's

Hospital.

. Created a value stream map for BJC healthcare's corporate and facility

charge master maintenance process. Evaluated CDM vendors and provided

recommendations.

. Member of the Health Information Management Project Planning team.

Washington University School of Medicine, St. Louis, Missouri 2002-2006

Ranked among the top five medical schools

Division Administrator, Sr. Financial and Planning Analyst, 2003 - 2006

Managed the business and clinical operations for Divisions of Hospitalist

Medicine, Rheumatology, and Bone Health. Administered all functions related

to personnel, payroll, purchasing, and accounting.

. Assisted Division Chiefs in tracking physician productivity using RVUs

and provided decision support and forecasting when adding new clinical

sites.

. Identified new vendors and negotiated contracts reducing medical

transcription costs by 50%.

. Led the department's 2004 space audit accounting for an inventory of

500,000 square feet assigning accurate research, administrative and

clinical space.

. Evaluated physician incentive plans with the Department Chair and

executive leadership.

. Conducted the pilot of handhelds for charge capture (Allscripts-

TouchWorks)

. Documentation and Coding Committee Member

Coding Specialist- Internal Medicine, 2002-2003

Audited medical records to capture billable and non-billable charges for 16

specialties by over 400 provides at Barnes Jewish Hospital.

. Assigned accurate CPT and ICD-9 codes.

. Educated physicians and provided feedback to compliance.

. Trained new coders on department policies, application of coding rules,

teaching physician regulations.

Bombay Hospital and Medical Research Center, Mumbai, India 2000-2001

Mumbai's largest for profit hospital and research center

Medical Officer - Hospitalist

. Treated and counseled diabetic patients and their families.

. Managed outpatient clinics, evaluated co-morbidities and risk

stratification.

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EDUCATION / TRAINING

MHA- Masters of Health Administration

Washington University School of Medicine, St Louis, Missouri

MBBS- Bachelor of Medicine & Bachelor of Surgery (Equivalent to MD)

Jawaharlal Nehru Medical College, India

Six Sigma Green Belt Certified, Lean & DFSS Certification, Change

Leadership, Principles of Lean Training and DMAIC, Research Administrator

Series

ADDITIONAL RELEVANT INFORMATION

Professional Affiliations

American College of Healthcare Executives (ACHE)

Healthcare Financial Management Association (HFMA)

American Academy of Professional Coders (AAPC)

Maharashtra Medical Council, India

Presentations

Poster Presentation at NAHAM 34th Annual Meeting, Dallas, May 2008

"Leadership's Commitment to Communication"

Panel Member for HIMSS Midwest Gateway Chapter, St Louis, December 2006

"NPI Deadline Quickly Approaching- Are You Ready?"

Guest Lecturer at Masters of Health Administration Program at Washington

University School of Medicine, November 2006

"Six Sigma Approach to Project Management"

Poster Presentation at UHC-AAMC user group conference, Chicago, June 2004

WUSM- Department of Medicine "Inpatient Charge Capture System"

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