Project Manager Revenue Cycle

June **, ****

I have over ** years of healthcare experience, with 15 years in management

and finance, including revenue cycle management and billing operations.

Currently Finance Administrator/Revenue Cycle Director for a Multi-

Specialty Clinic with treatment facilities in Guam, Saipan and the

Philippines, and treatment relationships with hospitals in California,

Japan, and New Zealand, this position encompasses management, vision, and

direction for the entire revenue cycle; include billing, A/R containment,

process improvement, coding and compliance, credentialing, provider

education, and client services. Specific responsibilities include leading

teams to deliver high quality service and operating results, to local and

international clients; developing a staffing model for the changing needs

of the business, and leading process improvement initiatives to create and

build on existing efficiencies within the company. I am responsible for

directing all accounting and business office functions including the

revenue cycle, financial analysis, budget, and A/R for multiple physician

practices at multiple sites, as well as managed care contracts, with

oversight of performance and contract compliance of the latter. I have

redesigned the revenue cycle processes, policies, and procedures to

maximize revenue by implementing best practices and creating benchmarks to

achieve and/or exceed quality metrics.

Prior to this, I spent five years working in revenue cycle management for a

clinic and hospital revenue cycle and practice management in the department

of Patient Financial Services for Mayo Clinic, a multi-specialty, multi-

site integrated 400+ physician ambulatory clinic and hospital. In this

capacity, I managed from a revenue standpoint, multi-specialty physician -

more than 130 physicians, residents, mid-levels, and nurses. In addition

to extensive knowledge of various clinical departments (clinic and

hospital), I have a Master's degree in Public Administration with a

concentration in Healthcare Administration and Finance, and am pursuing

Six Sigma training, and FACHE. Additional experience has involved

developing revenue cycle enhancements, and a quicker return on payment of

claims through implementation of electronic billing/remittance, and

implementation of electronic medical records (EMR) for both the hospital

and the clinic. I have provided and directed staff education, continuous

quality improvement, and regulatory compliance including HIPAA, as well as

participating in .third party payer contracting. Furthermore, I have

worked with key stakeholders to identify, implement, and monitor quality

metrics to ensure Revenue Cycle Management performance goals are achieved

and/or exceeded.

Throughout my career, I have participated or taken the lead in the planning

and implementation of strategic and operational goals for outpatient,

inpatient and managed care organizations including leading cross-functional

process design teams to develop and implement solutions to various

operational problems. My education and past employment has provided

insight and a working knowledge of medical terminology, MS-DRG, ICD-9-CM,

CPT and HCPCS coding, as well as extensive knowledge of electronic billing

functions and office systems from both a provider and payer standpoint,

giving me a unique prospective not experienced by all.

There is now, more than ever in this competitive healthcare market, a need

to identify methods to maximize process improvements, cost reimbursement

and minimize expenses for patient services while ensuring the accuracy and

appropriateness of Medicare, Medicaid, Managed Care and other contractual

allowances. Developments in the measurement of quality have been

implemented to promote making payment depend on quality, such as P4P and MS-

DRGs. Now, add healthcare reform, the development of ACOs, and the need to

achieve meaningful use with the implementation of EMRs to the mix - these

changes and more to come will have sweeping effects on how health care

payment is made and we in healthcare need to implement policies now to meet

these expectations.

I feel certain your client will benefit from my dedication to seeing a job

well done as well as the varied experiences I would bring to this role. In

every management position held, my teams have consistently exceeded goal

expectations as I openly respect the experiences that each member brings to

the table and I strive to support and mentor those people in the

teams/departments I am leading through continuous research and visionary

process improvements. I would therefore welcome the chance for an

interview to outline my strengths in detail.

Sincerely,

Wendie J. Hill

Wendie

Hill

1922 Indian Springs Drive

Jacksonville, FL 32246

Phone: 904-***-****

Cell: 671-***-****

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

PROFILE:

Senior Operations Revenue Cycle Management and Finance Executive -

Accomplished business executive with extensive experience leading

operations and revenue cycle for diverse healthcare organizations,

generating significant growth to top and bottom lines. Strong track record

implementing cost-containment / revenue enhancement strategies and process

improvements to maximize service delivery and profitability across

operations. Highly effective in leveraging key relationships, project

management and negotiation skills to competitively position healthcare

facilities for growth in rapidly changing environments. This is visualized

through networking and continuous research of best practices.

MAJOR ACCOMPLISHMENTS:

. Found 483K in revenue not previously posted for FHP Clinic January-

July 2010. File audit projected to increase revenue an additional 200K

for 2010 totaling 683K in previously missed revenue

. Decreased A/R by 25% in the first 12 months leading to an increase of

200K collected compared to previous year.

. Increased revenue for multiple departments through documentation and

billing education - averaging 250K annualized for each of nine

departments in the Clinic.

EXPERIENCE:

TakeCare Asia/FHP Clinic Finance Administrator Tamuning, Guam

January 2010 - Current

Primarily responsible for the strategic planning and effective leadership

of the revenue cycle management business unit including all financial

planning and reporting, financial analysis for resource use, regional cost

control, and management information reporting for a multi-specialty, multi-

site clinic, including primary care, pediatrics, oncology.

. Manage a multi-specialty revenue cycle operation with all accounting

and business office functions including data and financial analysis,

cost reporting, budgets (both capital and annual department), and

ensuring Revenue Cycle performance metrics are achieved.

. Redesigned, developed, and implemented strategic and operational

revenue cycle processes, policies, and procedures to maximize

revenues, including implementation of new debt collection process.

. Designated Clinic Compliance Officer - making certain the Clinic is

and continues to be compliant with changing regulations/legislation,

including appropriate coding and documentation.

. Work with appropriate key stakeholders to identify issues related to

revenue cycle performance and consult with TakeCare executive

leadership to develop and then manage appropriate action plans.

. Identify areas for improving financial controls, and key revenue cycle

and cost indicator metrics to improve general business decision

making, budgeting, and long-term strategic planning processes.

. Provide information, suggestions, and advice in the resolution of

various general business problems and decisions, and in attaining

short-term and long-term profitability goals and return on investment.

. Design, develop, and implement short and long term financial planning

tools and reports to provide comprehensive financial translation of

business strategies and the affect of various alternative strategies.

. Investigate, design, review, negotiate, and approve contracts with

providers, new insurance companies, and vendors to generate

significant growth for the facility leading to enhanced revenue.

. Work with IT to identify a vendor and implement EMR and electronic

billing and remittance - EPIC is possible.

. Responsible for setting and administering an annual budget exceeding

$1.2M.

Mayo Clinic Financial Analyst II/Manager Jacksonville, FL

January 2004 - December 2008

. Provided analytical, as well as financial and accounting analysis and

support to department and institutional leadership including the

Finance Committee and CFO, in such areas as clinic operations,

hospital operations, administration, facilities, research, education,

and finance.

. Developed advanced queries and reports to analyze departmental

financial and operational trends and variances using Oracle, Excel,

Access, and Business Objects for revenue cycle management.

. Prepared detailed reports on financial, human resources and

administrative matters.

. Participated in the provision of effective strategic, financial and

human resources planning and information.

. Established and maintained internal controls to ensure compliance

with revenue cycle and financial legislation, policies, and

procedures for the hospital and the clinic.

. Run, quarterly, monthly, weekly, daily reports as needed to monitor

external and internal conditions of the company revenue.

. Created and presented custom revenue/financial reports (pivot tables,

graphs, dashboards, etc.) to physicians and multiple levels of the

organization including the Finance/Revenue Cycle Committee.

. Managed clinical practice by assuring billing/documentation

compliance and revenue recognition for the departments with 130+

physicians/residents in the clinic/hospital at multiple sites.

CitiStreet Senior Operations Manager Jacksonville, FL

January 2003 - January 2004

. Tasked with creating and implementing a new department in the Call

Center to support (initially) employees of one client company, with

intent to ultimately sell package to other clients.

. Purpose of the department was to handle all PHI information as part of

HIPPA regulations as well as other benefit issues and claims

processing. Initial staff of nine with plans to expand when other

customers were added.

. Timelines and metrics were created for each staff member. Aspects of

Six Sigma were utilized including process flow chart, check sheets,

fishbone analysis, and thought process mapping.

Humana Healthcare Operations Manager Jacksonville, FL July 2002

- January2003

. Managed a staff of 48 involving member and provider appeals and DOI

complaints, as well as eligibility and front-end operations in

accordance with all mandates.

. Implementation of financial, statistical, and related insurance

reports for the Florida State Office of Insurance Regulation.

. Performed corporate financial analysis and presented findings to

senior staff with recommendations for improving the bottom line.

. Developed specific objective and performance standards for each area

of responsibility, then audited files to document increase in

compliance with processes and procedures.

. Developed measurement tools to track and trend operational efficiency

on an ongoing basis.

. Presented best practices to Medical Directors and VPs within the

company in order to engage them as champions of the change regarding

the best way to achieve success including staff and member

satisfaction, as well as improved revenue for Humana.

. Performed staff reviews and prepared performance documents for direct

reports.

NOTE: Humana closed its service center in Jacksonville nine months after I

relocated for this position.

Aetna US Healthcare Grievance and Appeals Department Manager Largo, MD

January1998-July 2002

. Tasked with managing the Grievance and Appeals department for the

combined Aetna/NylCare forces (after merger) creating a cohesive

integrated team.

. Tasked with developing and implementing a streamlined process to

resolve the extensive backlog of appeals from NylCare when merger

occurred saving the company an estimated 250K in the first quarter

after implementation.

. Performed financial analysis to determine financial damage and best

solution to resolving NylCare backlog.

. Implementation of financial, statistical, and related insurance

reports for the Maryland State Office of Insurance Regulation.

. Created a policy for appeal review leading to a best practice that

other Aetna sites in Pennsylvania, Georgia, and other States

implemented.

. Managed/coached associates responsible for resolution of critical

inquiries and grievance and appeals - developed/maintained

initial/annual competency scorecards.

. Oversaw and implemented all employee education & training including

fire, hurricane, tornado, evacuation drills and HIPAA training.

. Recruited, interviewed, and selected new employees, as well as

redefining position description.

. Ensured compliance with regulatory agencies and mandates such as

ACHA, Medicare, DOI, NCQA, and HEDIS through intense training and

audits.

NOTE: Aetna elected to consolidate their grievance and appeals process in

Philadelphia and Atlanta and I accepted a position in Florida.

Quality Consultant

Baltimore, MD

. Project Manager for HEDIS Project for the Maryland office. Supervised

a staff of 8 who gathered and analyzed data from physician offices on

the initiatives selected for a given year - also analyzed data to

present to Medical Directors and other staff.

. Researched ways to improve on patient quality of care without

significant increase in cost through Benchmarking.

. Tasked with creation and implementation of various quality improvement

initiatives (QIAs) - improvement in safety and health of members

visualized through analysis.

. Tasked to research, develop, and implement Disease Management Programs

for various chronic illnesses to improve wellness of patients.

. Performed credentialing and insurance contracting processes for

participating physicians.

Delmarva Foundation for Medical Care - PRO Data Operations Manager/Project

Manager Easton, MD

February 1994 - December 1996

This was the Peer Review Organization for several States. The company was a

proponent of

TQM while I was employed there.

. Designed and facilitated quality improvement projects in collaboration

with hospitals, nursing homes, home care providers, doctors' offices,

and managed care plans. These services included collaborative

improvement projects, peer-to-peer learning, training and education on

best practices, and other ways for providers to learn, share, and make

dramatic improvements in care.

. Some of our customers and contracts included: Agency for Healthcare

Research and Quality (AHRQ), Maryland Department of Health and Mental

Hygiene, HCFA, Maryland Healthcare Commission and the Robert Wood

Johnson Foundation.

. Managed a team responsible for data management and analysis on various

projects. Project Manager for various projects involving the

customers/contracts above.

University of Maryland Medical Center/Maryland Institute for Emergency

Medical Services Systems (MIEMMS)

Baltimore MD August 1986 - December 1993

Hospital Planner

. Performed analysis related to strategic planning and marketing, i.e.,

trending and forecasting. Analyzed and presented financial data to

various levels of the organization. Oversight of provider

credentialing.

. Responsible for cost allocation and budgeting for hospital

departments.

. Served as staff for R&D (research and development) Councils for

various departments at this inpatient facility for the purpose of

evaluating what departments should be expanded and serving as a

resource for strategic planning

. Developed and implemented purchasing practices and monitor the

purchasing system.

Senior Research Analyst Baltimore, MD

There was an overlap of several months where I was still working on a

project for MIEMSS (Tertiary Trauma Center), but I had already started a

new position as a Hospital Planner across the street in the hospital.

. Project manager for various federal and state funded studies (grants),

both trauma and

epidemiologically related. Some of those studies included seatbelts

outcomes cycle helmeted vs. non-helmeted (testified before the

Maryland State Legislature regarding the results). Not only did I

serve as Project Manager, but I also analyzed the data, created

PowerPoint and presented findings to customers (both internal and

external).

. Responsible for planning, developing, financial analysis and

reporting, annual and special audits, grant management, and funds

accounting.

. Tasked with developing educational/marketing programs and public

service announcements to educate the public on the importance of using

seatbelts, helmets, etc.

. Served as liaison between MIEMSS and the various funding agencies

including DOT, National Healthcare Traffic Safety Administration

(NHTSA), etc.

Maryland Medical Laboratory Laboratory Manager

Baltimore, MD 1982 - 1986

Ambulatory Facility Manager, Multiple Departments

Beeville, TX 1976 - 1982

SYSTEMS USED: McKesson, Cerner, Excel, Access, Oracle, Word, Project,

PowerPoint, Visio,

MS Publisher, Lawson, Crystal, DocumentDirect,

InfoPac

EDUCATION:

University of Baltimore

Baltimore, MD

MPA Health Policy/Administration/Finance

University of Maryland

Baltimore, MD

BS Emergency Medical Management

This was a new program - the 1st in the United States -

designed to train staff how to support and manage Emergency

Medical Departments throughout the Country and aboard. One

of the requirements was to become a Certified EMT.

University of Maryland

Baltimore, MD

BA Health Administration and Policy

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