Medical Management

ZIV FARAJUN

** ****** ********, **** ****, N.J. *7410

Home: 201-***-**** Mobile: 201. 993.6599

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

SUMMARY

Healthcare professional with more than 15 years of management experience in

both hospital and physician practice operations. Areas of expertise

include:

. Revenue cycle management

. Third party reimbursement/regulations

. Compliance/audit

. Financial analysis

. Strategic planning

. Staff management and development

PROFESSIONAL EXPERIENCE

NYCONN ORTHOPAEDICS & REHABILITATION SPECIALISTS PLLC, New York &

Connecticut

Director, Billing and Operations

2005 -2009

Direct entire financial and billing operations of a large Orthopaedic

Surgery group practice employing 16 physicians and 80 support staff at six

different offices located in New York and Connecticut with an Annual Net

Revenue of $16 Million. The company also includes an MRI Suite, Pain

Management, Podiatry and Physical and Occupational Therapy services. Major

responsibilities include directing overall billing activities and A/R

management to maximize company profitability; negotiating managed care

contracts, vendor contracts, procurement of new systems and other high tag

items; implementing and maintaining new scheduling, registration, EHR and

billing system; creating and maintaining new fee schedules; identifying

third party trends to properly adjudicate provider claims; analyzing

financial data to pinpoint revenue enhancement opportunities; strategic

planning; overseeing corporate compliance including implementation of HIPAA

guidelines; negotiating company's new benefit programs such as Major

Medical and Dental benefits as well as 401K plan; staff training and

development.

. Revamped entire revenue cycle from point of service through denial

management including implementation of charge posting and collection at

time of service policies.

. Transitioned practice to EDI, EFT and ERA.

. Achieved 100% charge capture of all activities throughout practice sites

and offsite surgery locations.

. Increased net collections by over 80% and doubled partners' overall

profitability.

. Improved days in AR to 76% between 0-60 days.

. Reduced average charge lag to 2-3 days.

. Seamlessly transitioned to billing with NPI.

. Successfully implemented paperless environment by converting to digital

technology throughout the practice.

. Started up new practice sites.

INTEGRITY MEDICAL BILLING & CONSULTING CORP., Fair Lawn, New Jersey

2003 - Present

Owner/ Consultant

Provided audit, consulting, reorganization and long term management

services to:

. Mount Sinai School of Medicine - Hematology and Oncology, Derald H.

Ruttenberg Cancer Center

. Mount Sinai School of Medicine - Division of Medicine FPA Billing Office

. Radcode Interventional Radiology Inc.

. Atlantic Health System (Mountainside Hospital, Overlook Hospital and

Morristown Memorial Hospital)

. Monsey Family Health Center

. Consulting services to prestigious law firm and several physician

practices

ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER, Paterson, New Jersey

2001 - 2003

Director, Management Procedures and Controls/ Internal Audit

2002 - 2003

Directed financial/operational/systems reviews as well as special projects

throughout the St. Joseph's Health System offering recommendations and

value-added services through creative and practical solutions.

Responsibilities included evaluating the effectiveness and efficiency of

systems, processes and procedures; developing new or reengineering existing

business processes; identifying economies of scale and opportunities for

cost reduction and revenue enhancement; preparing P&L statements upon

request; gathering, analyzing and interpreting operational, financial and

systems data; developing policies, procedures and internal controls;

creating appropriate tools and providing management/staff training; making

oral and written presentations to all levels of management; collaborating

with external consultants.

. Reviewed cost of outpatient drugs purchased from Hospital's vendor, their

respectful charges on CDM and prospective to actual reimbursement per

payer. Compared data to cost and prospective payment if purchased via the

government's Section 340B Program. Made recommendation to switch to this

program resulting in annual savings of over $900,000.

. Audited outpatient Dialysis Centers' billing cycle from input of data

into electronic clinical system through UB-92 submission and reimbursement

by third parties. Identified over 80% errors on the chargemaster. Offered

detailed recommendations and assisted in implementing corrections resulting

in an increase in A/R and cash while enhancing compliance.

. Performed a comprehensive review of Interventional Radiology department.

Identified annual losses in excess of $2.5 Million in billing for

procedures and additional losses due to unbilled supplies at an annual cost

of $2 Million. Built a complete chargemaster with over 880 different CPT-4

Procedures/HCPCS Codes. Created easy-to-follow tools for billing

procedures and supplies. Coordinated changes to all IT systems. Revamped

department's policies and procedures and provided management and staff

training.

. Additional projects included Nuclear Cardiology, Clifton Family Practice,

Pain Management, TMJ, Mobile ICU, Transfer of Self-pay to Bad Debt,

Outpatient OR, Physician and Group Contracts, Health System Staffing and

Program Allocations, Pediatrics ICU Billing and Chargemaster Reviews

totaling over $10 Million in revenue enhancements.

Director, Physician Reimbursement Services

2002 - 2002

Directed all activities related to inpatient and outpatient provider

reimbursement with a volume of $30 Million in gross charges and Annual Net

Revenue of $12 Million. Ensured appropriate distribution of revenues to

all physicians as per individual contracts. Monitored activities of three

separate billing vendors. Monitored practice site, specialty and provider

productivity to ensure continuous profitability of various programs.

Negotiated third party rates on behalf of the Medical Center. Responsible

for compliance with all applicable Federal and State regulations and

policies. Provided ongoing compliance training to physicians and staff.

. Identified significant losses of revenue to Hospital due to

misinterpretation of physician incentive clause in Hospital/Physician

contracts.

. Revamped billing process to ensure proper reconciliation and timely

submission of charges.

. Designed new customized superbills for all providers to maximize

reimbursement.

. Designed new financial/billing reports that enabled hospital and

providers better monitoring of activities and data.

. Negotiated higher provider reimbursement rates with numerous third party

payors.

. Significantly reduced average days in A/R.

. Increased monthly collections from $260,000 to more than $900,000 over a

period of three months.

. Increased average monthly collection rate by over 70%.

. Set new fee schedules for all physician services to ensure appropriate

reimbursement and meaningful A/R.

. Introduced and implemented ANSI codes in billing system in order to

comply with new HIPAA guidelines.

Director, Ambulatory Women's and Children's Services

2001 - 2002

Directed the overall operations of Women's and Children's Services

including one clinic and seven private practices located at eight different

ambulatory sites. Managed a wide variety of practices including OB, High

Risk Prenatal, Adult and Pediatrics Primary Care and sub-specialties with a

total patient volume of over 120,000 visits per year. Responsible for 95

FTEs and an operating budget in excess of $5 Million. Directed site

practice managers in the development and monitoring of quality assurance

and compliance activity as well as appropriate standards of care.

. Played a significant role in overall reduction of net operating costs for

Children's Hospital by $2.5 Million and OB services by $1.5 Million.

. Created individual provider P&L statements in order to assist the

Hospital in renegotiating contracts.

. Spun off satellite practices to PC model.

. Enhanced physician reimbursement through proper coding of patient

procedures.

. Revamped physicians' billing process utilizing new billing software and

vendor.

. Led Hospital initiative in the design and implementation of new

billing/scheduling system.

. Worked with healthcare agencies and third parties on accreditation of

physician sites.

. Reduced FTEs by 25% while increasing providers' productivity and

maintaining/improving patient access and flow.

. Identified significant losses of revenue in Hospital clinics due to

improper billing procedures.

. Initiated and orchestrated change in billing format for outpatient

clinics from UB92 to HCFA 1500 forms.

MOUNT SINAI MEDICAL CENTER, New York, New York

1991 - 2001

Interim Administrator, Diabetes Center

2001 - 2001

Acted as the interim Administrator for a multidisciplinary and

multispecialty Diabetes Center. Monitored Center's activities and

performed continuous staff education.

. Revamped Center's billing model to increase revenue and address both

Professional and Hospital billing requirements.

. Updated encounter forms to comply with current APC guidelines. Also

updated the chargemaster in order to maximize professional component

revenue.

. Developed and implemented new Front Desk/Registration and Back End Check-

out policies and procedures resulting in a substantial increase in revenue.

. Introduced the global billing method which enhanced the Center's revenues

by more than $300,000/year.

Operations Manager, Primary Care Services

1998 - 2001

Managed the operations of a multidisciplinary primary care facility

consisting of Internal Medicine, Geriatrics and specialty care practices

with combined volume of more than 70,000 visits/year. Responsible for all

staff training and development, oversight of registration areas,

centralized call center, referral coordinators and information systems,

maintaining physician schedules in IDX, development and implementation of

policies and procedures. Special emphasis placed on identifying revenue

enhancement opportunities and resolving billing/reimbursement and systems

issues. Chairperson of the Ambulatory Operations Managers Committee.

Acted as consultant to other areas of the hospital as needed, i.e.

Emergency Department, specialty clinics, Diabetes Center, Hospice Program.

. As a member of the APC Reengineering Committee, interpreted the new HCFA

regulations, identified problems specific to MSH conversion to APC and

developed operational and systems solutions to minimize anticipated loss of

revenue.

. Revamped operations and billing systems of the primary care/specialty

care practices and ED in preparation for APC.

. Developed, custom tailored and deployed the IDX system in Internal

Medicine, Geriatrics, Medicine-Pediatrics practices and Senior Caring

satellites resulting in maximized provider productivity and enhanced

revenues.

. Created a unique billing method for immunizations at Mount Sinai,

recognized by IPRO as the first of its kind in New York State (currently

being duplicated by other hospitals).

. Identified the loss of $1.5 Million in ancillary service charges in

"nurse non-billable" visits over a one year period and developed and

implemented a method for the appropriate billing of such services.

. Identified the cause for a large "charge on-hold" report enabling the

hospital to back bill $4.5 Million in charges.

. Developed a billing method enabling the hospital to appropriately bill

for psychiatric services as well as flexible sigmoidoscopy procedures.

. Developed and implemented the Global Billing concept in IDX for the

Geriatrics and Internal Medicine practices.

. Identified numerous systems interface problems resulting in increased

revenue for the hospital.

. Implemented new cash collection procedures in Geriatrics, Internal

Medicine and Medicine-Pediatrics practices.

. Negotiated enhanced provider reimbursement with numerous managed care

companies.

Practice Manager, Department of Geriatrics

1995 - 1998

Managed the day-to-day operations of a 38 physician, private ambulatory

care practice with 10,000 visits/year. Responsibilities included clinical

resource management, staff recruitment and development, oversight of

registration areas, centralized call center, referral coordinator and

medical records. Managed a staff of 19 employees.

. Successfully implemented the integration of the Geriatrics hospital-based

clinic and the Geriatrics Faculty Practice into one private practice

model (the first of its kind and the prototype for other departments).

. Maximized provider productivity resulting in a 40% increase in patient

volume and 60% increase in faculty revenues.

. Overhauled the department's billing system and identified new sources of

revenue for both the department and hospital.

. Developed policies and procedures to accommodate the department's

capitation and fee for service third party contracts.

. Piloted automated call center handling 15,000 calls per month for both

the Geriatrics and Internal Medicine practices.

. As a member of the IDX Design and Interface Testing Teams, assisted in

tailoring IDX to the needs of the Ambulatory Care Clinics incorporating

various methods to capture all visit and ancillary charges.

Team Leader, Surgical Associates

1993 - 1995

Supervised a staff of 4 senior medical office assistants and performed all

clinical and administrative duties in caring for vascular surgery and

transplant patients.

Medical Salesperson, Mount Sinai Book Store

1991 - 1993

Serviced over 1500 customers per day selling medical and trade books,

medical equipment, computer supplies and software. Processed medical

slides/film and repaired medical equipment. Assisted in design of unique

computerized inventory system.

EDUCATION

INSTITUTE OF INTEGRATIVE MEDICINE, Tel Aviv, Israel

1988 - 1990

Integrative Medicine / Reflexology

MILITARY SERVICE

1985 - 1988

Served as First Sergeant in the elite unit of the Paratroopers Division

of the Israeli Defense Forces.

References available upon request

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