Project Manager Management
Resume:
Tonya N. Bowens
Ferry Rd # ***
Suwanee, GA 30024
832-***-**** Cell
abjaui@r.postjobfree.com
HIGHLIGHTS OF QUALIFICATIONS
Payor Reimbursement/Revenue Cycle Management, Collections, Accounts
Receivables, CDM Review Analysis &Update, Benefits, Self pay, Provider
Contracts, Sr. Level Customer Service, Provider Relations, Contract
Modeling and Analysis, Provider Credentialing, Contract Negotiations,
Network Development, and Client Service Operations. Knowledge of ICD-9,
CPT, DRG Coding. Proficient in AS400, Microsoft Applications, and Interlink
Provider Contracting Access based system, WordPerfect, Meditech, Cubs, HBOC
patient account systems, SQL, Crystal Reports, and DOT.NET practice
management systems. Previous Wireless Industry Experience-Houston
Cellular/Corporate Accounts.
ACCOMPLISHMENTS:
United Behavioral Health/UHC-Implement workflow enhancement procedures for
company Appeals/Compliances department.
Reduce turnover by 40% utilizing effective team building skills.
Reorganized team Reimbursement, Billing and Audit procedures.
Received 3 promotions within a given year.
Healthcare Management Solutions-Developed and implement company
administrative procedures.
Initiated internal department audits improving morale and quality work
ethics.
Increased hospital revenue by 85% recovery.
Received promotion as Project Manager within 3 months of employment.
Operations
Increased customer satisfaction level by 45% with implementation of problem
resolution training and follow-through procedures.
Assist with development process training for Reimbursement and Contract
systems.
Consistently maintaining positive deliverables to client stakeholders by 85-
90% in overall project operations, collectability, and inventory control.
EMPLOYMENT HISTORY:
Currently-
Huron Consulting Group Demand, LLC
Executive Project Consultant/CPO
Provide support to the Chief Compliance Officer in the area of compliance
and policies and procedures, to include:
. Policies and Procedures Management, monitoring new and existing
regulations and proposing changes and/or new ethics and compliance
policies and procedures as may be required within Revenue Cycle
Management and Hospital CBO.
. Serve as the "gatekeeper" for the management of all corporate
policies and procedures, client policies and procedures and
integration with parent policies and procedures to include the
organization of policy and procedures (i.e., assignment of numbers
and categories, ensure proper format is used, etc.)
. Interacting at a professional level with others. Proficient in
federal program requirements and hospital compliance program
obligations.
. Uses initiative and discretion in accomplishing duties with minimum
supervision.
. Excellent writing, communication and organization skills.
. Uses systematic approach to problem solving and troubleshooting.
. Strives to exceed goals and expectations.
. Ability to work under strategic deadlines and juggle multiple
projects within a given project engagement.
. Excellent legal research skills and exceptional communication and
drafting skills.
July 13,2009-April 7, 2010 / Engagement completed
Ethos Partners HC Consulting
Committee Officer for the Ethos Partners Advisory Policy and Procedures
HSHS Medical Group Project/Springfield, IL
Project Implementation/Policy and Procedure Development
Piedmont Heart Institute/Atlanta, GA (currently through Ethos Partners)
Revenue Cycle Management Operations
Consultant/Chief Business Operations
Improving Access Management, Acceleration of Cash Collection, Charge Audit,
Charge Description Master Audit, Improve Payer Performance, Network
Development, Manage Care Contract Analysis
. Develop Policies and Procedures for ensuring compliance with HSHS
applicable policies, procedures, laws, and regulations, provide any
new policies and procedures and/or changes in laws or regulations to
the Corporate Compliance Committee for review. Monitoring and auditing
the activities of each department to ensure overall compliance through
departmental self-monitoring plans as it relates to the HSHS Medical
Group Christian Community, and Ethos Partners Best Practice REU/RCU
assessments.
. Developing new and existing business, evaluating contract agreements
for new and existing clients, including preparation of financial
reporting, and analyses against proposed reimbursement, operational,
and market issues. All duties as are not limited to this profile,
additional qualifications available upon request.
. Piedmont Heart Institute duties are management of PHI credentialing
Policy and Procedures in compliance with local, state accreditation,
such as; NCQA, URAC, JCAHO, and licensures within the state of
Georgia. Responsible for providing PHI overall expertise in provider
contracting/reimbursement, credentialing methodologies, and
proprietary system implementation, which includes data reporting,
decision support tools, denial management and revenue cycle management
enhancing tools.
. Engaging PHI staff by sharing business information, solving problems
and identifying solutions as a team.
. Assist with Acquisition of Physician Group and on boarding process
with Physicians being employed by the Group.
. Oversee the pre-delegation and audits in compliance with NCQA, URAC,
and JCAHO.
. Participate in Committee meetings as requested by the firm to provide
leadership and expertise regarding policy and procedure changes,
delegation criteria, and functions.
Contract- July 9, 2008-July 1, 2009
Blackstone Resources/Soliant Health Revenue Cycle Consulting
Client-FTI Consulting, Floyd Hospital/Rome, Georgia
Consultant/Director-
. Formulating and implementing customized performance improvement of the
following service areas: HIM, Charge Capture, Coding Compliance,
Accounts Receivable Operations & Strategy, Turnaround Solutions,
Regulatory & Disputes, and Restructurings. Travel extensively and
solve challenging management problems with close attention to detail.
. Overall responsibility for project management, client management,
solution design and implementation and generation of engagement
results. Working with client project leaders and effectively using
change management strategies, guides the client through transformation
efforts. Responsibilities also include, but will not be limited to,
the following:
. Building relationships and managing client relationships while
expanding the FTI/Floyd Healthcare portfolio.
. Experience with business negotiations and ability to exhibit
leadership skills.
. Strong project management and client management expertise.
. Manage risks and utilize creative problem solving techniques.
. Providing strategic analysis.
. Demonstration of strong facilitation skills.
. Leading client and internal teams and influencing a team direction.
. Understands revenue cycle technologies and associated vendors
. Contribute to strong data analysis focused projects
12/11/2006-09/14/2007
Perot Systems (Account Receivable Strategies)
Multiple Hospital Clients-(Contract)/Madison, Tennessee
Project Director/Revenue Cycle Solutions
. Negotiations, renegotiations of Contract fees with Providers/Hospitals
for Accounts Receivable outsourcing services, and Inventory Data
Control methodologies.
. Act as primary advisor to client
. Creatively sought out new and alternative ways to deal with issues and
opportunities that will benefit the client, as well as, Perot Systems
. Established, implement and monitor operational performance metrics for
both client and project team
. Improved the organizational structure of hospital departments to
significantly raise the level of performance in a changing business
environment
. Recognized opportunities for development of business and IT
strategies
. Anticipated, present solutions and prevent potential financial
liability to the client and Perot Systems
. Participate in and/or lead meetings with executives of client
organizations
. Superior A/R analysis skills and in-depth knowledge of performance
. Expertise in all Revenue Cycle operations and industry best-practices.
. Assist Charge Master Analyst to maintain the hospital charge
description master (CDM) and analyze Hospital utilization using
revenue and usage reports, working with Project Managers, billers to
verify that appropriate charges and procedure codes are used.
. Created service codes for all new billable services and create and
update charge entry screens as appropriate.
. Work collaboratively with information services to ensure the accuracy
of hospital billing logic so that services are reported correctly on
UB-92, 04 and 1500 billing forms.
. Assist Analyst with managing and monthly updating of CDM Focus running
routine reports and analysis.
. Conduct annual charge reviews with revenue producing departments. CDM
charge code updates and/or additions, utilization, charging
mechanisms, and pricing. Audit Reports with CDM line items to
reassure pricing of services, identify CPT and HCPCS codes that are
not comprehensible to staff members who would need to identify those
procedures.
. Responsible for assuring that the CDM is always up to date with
current CPT or Revenue code coding by attending external meetings to
understand the latest changes and keeping current with publications
regarding these changes. Identified as an outsourcing corporate
resource to provide information on billing and coding compliance and
charge structure.
. Utilizes information from internal/external sources that will best
support the client and the needs of Perot Systems
. Motivated team that succeeded in the accomplishment of goals
. Recognized individuals with leadership potential and groom them to
assume supervisory-level responsibilities
. Responsible for rate negotiation with Temporary Employment Agencies
and hiring of associates and/or affiliates
. Ensured that all A/R is accurately accounted for with supportive
documentation and is reported on a timely basis
. Ensured that all corporate reporting is correctly completed and
forwarded to Perot Systems within the mandated timeframe
. Produced all written communication in a highly professional, business-
style format
. Developed team members to improve personal performance, in order to
meet both individual and company objectives
. Demonstrated adaptability when change is required
. Promoted continuous harmony between the clients' team and the Perot
Systems project team; also maintaining positive patient/client
relations
. Motivated Perot Systems team for the length of the project to achieve
team success
. Produced a high percentage of cash revenue in the shortest period of
time while reducing accounts receivable inventory
. Consistently obtain material to remain abreast of industry changes
. Made decisions regarding staffing, policies and resources
. Determined staff schedules and time-off requests
. Originated motivational incentive plan
12/4/2005-12/05/2006
Interface EAP/Interface Behavioral Health/Houston, Texas
Consultant (Contract)
Manager of Provider Relations/Network Development
Asst Director of Billing Operations
. Provided daily management of the Provider Relations staff, department
operations, provider contracting and credentialing activities.
Maintaining a national network of behavioral health specialists that
includes EAP, PPO, and SAP. Qualifying providers who meet company
credentialing criteria through JCAHO, URAQ, and NCQA.
. Developed Provider/TPA payment strategies, share risk to align
provider, payer incentives.
. Payer contract modeling and support, analyze contract terms, and
assess financial performance.
. Data analysis, evaluate utilization, and clinical components.
. Modeled contracts against real patient data; determine which services
are high volumes.
. Modeled the impact of rate changes for Inpatient and Outpatient
Behavioral Health Services.
. Compared modeled rates, and determine the impact based on selected
patient population.
. Modeled proposed contracts against Medicare, establishing a baseline.
. Assisted with training and development of new Network Representatives
as needed.
. Assisted Director of Operations managing billing, Accounts Receivables
representatives.
. Approved negotiations and re-negotiations proposed by Network
Representatives as needed.
. Facilitated the development of fee schedules, and provider
reimbursement modalities.
. Negotiated PPO discount Inpatient and Outpatient levels of care,
maintaining integrity of provider database.
. Designed and structure case base payment systems.
. Planned, implement and monitor group audit timetable.
. Build relationships with Clients Services (managers, reps, support
team) to facilitate recruiting/sales efforts.
. Handled escalated billing issues with providers, resolve complaints
issues as needed.
. Identified billing, AR challenges, and implemented changes to enhance
revenue.
. Trained and supervised new hires, negotiated PPO discounts for
Inpatient and Outpatient levels of care while maintaining data
integrity of provider database.
. Recommend prospective personnel based on ability to perform required
duties of position. Participated in interview and selection process.
. Conducted performance reviews, recommended incentives or disciplinary
action as warranted by department policies and procedures.
. Monitored department work processes to ensure compliance with company
policies, department procedures, and state, federal, industry
regulations; identifies and implements initiatives to improve quality
and productivity. Developed, prepares and analyzes company and
departmental materials, these may include reports, letters, policies,
procedures, audits, data analysis, forms, and other materials as
needed. Used discretionary authority to resolve complaints and
employee relations' issues. Participated in training and meetings,
workshops which help promote PPO Provider Network, and raise the bar
in revenue management.
07/07/03-11/01/2005
Healthcare Management Solutions, (Revenue Cycle Management) Accounts
Receivables/Irvine, California
Project Manager/ Sr. Reimbursement Contract Analyst:
. Critical data analysis of call center operations and system testing,
model office and test environments, multi systems coordination,
management of external interfaces, client business requirements
/specifications, claims workflow reorganization and implementation,
conversion coordination, management of claims maintenance request
logging system. Reviewed maintenance of existing data, and pursuit of
additional data.
. Hired and managed on-site support staff.
. Work with Charge Master Analyst to insure correct pricing of charges
for the hospital.
. Created customized reports on updated CDM codes to insure correct
pricing with payers prior to Audit.
. Abstracted payer contracts, maintenance of the contract file to
enhance payer reimbursement to the hospital.
. Managed Acquisitions of required client documentation for proper
claims audit and document maintenance.
. Managed workflow of regular claims maintenance and production support
tasks as well as emergency request through Help Desk.
. Contract maintenance of 10 hospitals, and 6-7 project direct reports
. Maintained proper auditing for Medicare/ Medicaid compliances, and
successfully implementing Process Improvement strategies to increase
AR, and overall revenue.
. Audited, Reviewed 600-800 claims per day.
Salary Requirement: Negotiable
EDUCATION:
Texas Southern University, Houston TX San Jacinto College,
Houston TX
Criminal Justice General
Studies/ DOS
Tonya N. Bowens
abjaui@r.postjobfree.com
Executive Summary
As part of my job profile, I would like to add additional information
regarding my skill set.
I have previously worked as a Billing Office Administrator, Home Care
Innovations 1995-1997 (Home Health). My job responsibilities were
directing, administering, planning and coordinating all financial billing
activities, Accounts Receivables, and administrative duties. Maintained
professional care, focused on improving patient physician relationships
internally. Maximizing office productivity and cost effectiveness through
the analysis and development of company policy and procedures. Review
billing request for accuracy, generate invoices, communicate with customers
regarding billing questions, and investigate AR/Cash application problems.
I have had extensive knowledge with hands on Reimbursement Outcome Planning
and Development, Accounts Receivables, Audit & Recovery with Account Trial
Balances, Claim Review Production, Charge Master, Claim Adjudication, and
processing experience. I have developed Reimbursement Opportunities that
improved company revenue, and overall business needs, and facilitate
practical strategies to secure effective reimbursement for Hospital and
internal billing departments utilizing various hospital systems, with UB04,
HCFA 1500 provider/hospital forms.
The largest team I have managed is 30 internal employees, along with 10
external corporate accounts, and 27 hospital clients. Hands on
participation with Department Managers, Team Members in the procurement of
comprehensive copies of all documents related to the payment terms of
accounts to be audited, ready for pricing, and claim adjudication. Timely
reviewing client contract with managed care payers and enter their terms in
company system database formatted to implement correct pricing of claims,
and maximize client revenue. Revisiting routine tasks assigned to
Department Heads, Team Members regarding process improvement strategies
according to company policy and procedures, expound on training issues as a
result of system defaults, and productivity, while maintaining our focus on
customer satisfaction, and quality service to client stakeholders,
utilizing technical skills to identify, troubleshoot, and correct problems
that would have an impact on contract interpretation, reimbursement, and
product development. These issues were then identified as technical support
issues, faulty software, or faulty equipment. There was consistently
effective trouble shooting on a daily basis by myself, and company IT
department.
Developing WBS (Work Breakdown Structure) listing each task, associated
task, and schedules, focusing on budget and system deliverables. I have
worked with various software applications specifically designed to enhance
Reimbursement, Revenue, Patient accounting, and effective accounting
methodologies.
I hope the following information within this profile will allow me the
opportunity to secure a lucrative position with your organization. I am
looking forward to future working relationships, and maintaining overall
company satisfaction.
Contact this candidate