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Management Manager

Location:
San Jose, California, 95136, United States
Posted:
March 15, 2011

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Shital Patel

Cell: 408-***-****

*** ***** **** ***

Home: 408-***-****

San Jose, CA 95136

abhqqp@r.postjobfree.com

"Seasoned professional whose ability to creatively solve problems can help

drive operational efficiencies and gain financial returns."

QUALIFICATIONS

. Strong leadership and management skills.

. Motivated individual who can drive operations to achieve corporate goals.

. Excellent communication and people skills.

. Exceptional team player who consistently exceeds expectations.

. Thrive in challenging situations.

EDUCATION

MBA, San Jose State University, San Jose, CA 2004

BS, Nursing, San Jose State University, San Jose, CA 1998

WORK EXPERIENCE

Compliance Auditor II

Hospital Billing Integrity Team (Compliance Department)

Stanford Hospital and Clinics/Lucile Packard Children's Hospital, Palo

Alto, CA May'10 - Jan '11

. Conducted audits to determine organizational integrity of billing

hospital facility fees and helped define audit priorities by evaluating

previous audit findings, ICD and DRG utilization patterns, national

normative data, CMS initiatives, OIG work plans and advisories, and

healthcare industry best practices.

. Evaluated the adequacy and effectiveness of internal and operational

controls designed to ensure that documentation, coding, and billing

processes and practices lead to appropriate execution of regulatory

requirements including federal and state regulations and guidelines, CMS

and other third party payor billing rules, and OIG compliance standards.

. Performed DRG, Medical Necessity, ICD-9/CPT/HCPCS validations to ensure

compliance with federal and state regulations and guidelines. Assisted

management with federal, state and other special investigations and

audits; conducted Recovery Audit Contractor (RAC) verification audits.

. Assisted with enterprise risk assessments of potential and detected

compliance deficiencies and made recommendations for corrective action

plans to management as needed.

. Remained current with Medicare, Medi-Cal and other third party rules and

regulations through extensive research; served as institutional subject

matter expert and authoritative resource in these areas.

. Effectively maintained collaborative working relationships with faculty,

physician leadership, hospital management and staff to achieve increased

satisfaction with and participation in the Compliance Program.

CDM Analyst

Stanford Hospital and Clinics, Palo Alto, CA

Jan'08 - May'10

. Generated over $10M in gross revenue thru audits and performing root-

cause analysis to identify and improve the charge capture process for

multiple hospital departments.

. Successfully initiated and implemented changes to the billing and EMR

systems (EPIC) in collaboration with IT, department staff, and vendors to

resolve and improve system related issues which improved revenue

recognition.

. Performed financial analysis and price modeling for service lines

utilizing data from market analysis, cost structuring, government

reimbursement programs, and managed care contracts.

. Ensured the accuracy and integrity of the Charge Description Master by

keeping informed on regulatory guidelines and conducting regular audits.

. Trained and mentored senior management on charge capture guidelines to

enhance their competence in revenue integrity.

Clinic Manager/Coordinator

Gardner Family Health Network, Gilroy, CA

Sept'05 - Apr'06

. Managed the day-to-day operations of the clinic, including coordinating

activities and work assignments for the staff.

. Improved work flow processes which resulted in cost savings as a result

of decreased overtime hours.

. Exceptional team building skills resulted in high employee morale and

increased productivity.

. Increased patient access to additional health resources by collaborating

with community partners.

. Maintained productivity goals based on operational needs and provided

weekly results to COO.

. Participated in development and monitoring of staffing budget in

conjunction with DON.

. Provided nursing services, when required, which include patient care,

case management, emergency response, and follow-up on clinical issues.

Health Services Coordinator/OHN II

El Camino Hospital, Mountain View, CA

Sept'02 - Jun'04

. Managed the On-Site Health Services Program for over 40+ companies.

. Increased the client base by over 2% via marketing efforts.

. Consistently exceeded customer expectations and increased customer

satisfaction.

. Assisted with pricing strategies for projects and made recommendations

based on findings.

. Developed education and training guidelines for staff and clients.

. Revised the health & safety and procedural protocol manuals under MD

supervision.

. Performed supervisory functions including training and scheduling staff

for flu shot program.

. Collaborated with personnel from all levels and maintained excellent

working relationships.



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