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Management Customer Service

Location:
Bronx, New York, 10471, United States
Posted:
June 01, 2010

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Seble Nebiyeloul

**** ********* *** # **, *****, N.Y., 10471

Home: (718) ***- **** Cell: (347)***-****

E-Mail: abmqhq@r.postjobfree.com

To provide leadership in a healthcare setting and position the organization

to meet today's health care challenges while at the same time initiating

expansion and growth. To develop and foster a highly effective

professional staff, forge collaborative linkages and create an environment

that genuinely contributes to improvement of the quality of healthcare for

the patient population.

PROFESSIONAL OBJECTIVE

More than 19 years of practice management leadership experience with

significant accomplishment in developing managed care strategies,

developing and deploying information systems and streamlining quality

utilization management programs and reporting.

HIGHLIGHTS/PROFESSIONAL ACCOMPLISHMENTS

* A track record of results in healthcare management and operations:

. Reduced patients waiting time increase patient satisfaction by 15%;

. Developed audit tools to monitor and capture incomplete

registration and in accurate insurance information reduced denials

by 30%;

. Improved efficiency by redesigning the workflow of patient care

services which increases provider productivity by 15%;

. Developed and Standardized appointment visit types and booking

visit procedures. This has increased patient retention by 20% and

increased new patients by 15%;

. Maximized revenue gained by expanding clinic hours, adding urgent

care service and specialty services;

. Improved claim accuracy and collections by working with claims and

information systems staff;

. Increased base revenue by 15% by cross-training staff in the A/R

process and improving the submission of "clean" claims and

collecting co-payment at the time of services.

* Improved financial and operational procedures in clinical areas:

. Improved the quality care of patients in key strategic clinical

areas through collaboration with other key members of management;

. Managed operations in manner which successfully met compliance

levels set by the JCAHO accreditation survey several times;

. Developed clinically integrated delivery system on care delivery in

relation to evidence-based medicine protocols, standards and norms

to improve the outcome of clinical documentation, coding, payment

and quality of care;

. Designed and implemented an automatic referral authorization

process that accelerated patient referrals from two months to less

than two weeks.

* Negotiated and renegotiated contracts as appropriate based on utilization

with 25 health plans:

. Compared internal data to established industry standards to gauge

areas that needed improvement;

. Tracked and monitored the top ten denials by insurance carrier to

improve quality of healthcare and coding;

. Signing a delegation credentialing agreement with most of our major

payers has reduced significantly the wait time to get credentialed

with the plan from three to six months to 45 days;

. Identified and implemented the ECHO credentialing system,

significantly reducing unnecessary paper work, errors and

submission of delay information.

* Directed the setup and implementation of the Centricity Practice

Management system:

. Interfaced with IT to create center-wide reporting systems of

operational data for performance analysis, revenue cycle, and

management and performance improvement.

* Expertise in medical administration business finance, personnel

management, strategic planning, and physician relations.

* Lead operational implementation of Electronic Medical Records system,

including redoing workflows such as patient intake, document management

and referrals based on the new technology.

* Oversaw unit-by-unit phased rollout of the Electronic Medical Records

system training schedules and coverage.

* Executed a post-EMR implementation review and made changes as needed to

workflows and processes, as well as worked with EMR IT staff to modify

application screens and data points to match the needs of the providers

and patients.

* Worked with the EMR IT staff to develop new management reports based on

the now-available data from the EMR system including referral management

reporting and lab reconciliation

EDUCATION

M.S. Health Care Administration, December 1995

University of Maryland University College, College Park, MD

B.S. -Allied Health, December 1989- Minor: Psychology

Cumberland College, Williamsburg, KY

PROFESSIONAL EXPERIENCE

Vice President of Patient Accounts & Network Development

Morris Heights Health Center -Bronx, NY

September 2006 -Present

Responsible for aligning overall financial objectives with business by

providing operational and financial reporting including a financial

analysis of billing and receivables. Work collaboratively with COO, CMO,

CNO, CFO and internal plan management to determine the direction of the

organization and develop, implement and monitor a commensurate strategic

plan to improve care delivery models and reduce expenses. Continually

assess and refine operational processes to promote system-wide best

practices and validate full implementation of programs. Incorporated New

York State billing requirements into practice management software to

capture and collect all appropriate insurance payments. Renegotiated payer

agreements to maximize reimbursement and benchmark coding profiles of

physicians to increases profitability. Increased receivables through the

development of improved performance standards for billing. Redesigned work

flow with an emphasis on quality of care and patient satisfaction and

utilized electronic claim submission to significantly reduce claim denials.

Site Director & Director of the Managed Care Plan

October 2001- September 2006

Provided day-to-day practice management to ensure that the standard of

care exceeded Federal/State/Local regulations and Joint Commission on

Accreditation of Healthcare Organization standards. Redesigned the

practice model to improve operational efficiency and quality of patient

care and satisfaction resulting in improved collections and increased

revenue. Provided financial analysis of practice operations, including

physician billing, patient utilization and reimbursement, as well as

coding trends. Evaluated procedure and diagnosis codes to develop

applicable disease management programs to appropriately address the

wellness needs of the patient population served. Developed direct

performance improvement initiatives based on continual detailed

monitoring of patient medical records and patient complaints and

suggestions. Negotiated managed care contracts based on patient

utilization and health status resulting in improved compensation schemes.

Trained staff on managed care policy, patient flow and HealthPro

practice management software. Improved coordination of care through the

development of a tracking system that monitors patient compliance with

specialty referrals externally and internally as well as provider receipt

of specialty consults.

Practice Manager

August 1998 - October 2001

Provided administrative oversight of day-to-day operations. Utilized

national and regional standards to establish appropriate clinical and

productivity benchmarks. Monitored and evaluated clinical performances as

related to established standards. Collaborated with Medical Director and

the Executive Management team in providing financial analysis for key

areas of the practice and developing the organization's strategic plan.

Implemented uniform guidelines for accessing specialty care that ensured

compliance with all of the center's fourteen contracted managed care

plans. Designed and implemented system that fosters provider relations

that resulted in increased revenue. Motivated and guided support staff to

ensure high quality of work and patient satisfaction. Negotiated and

contracted with 14 Medicaid managed care plans and monitored practice

integration, regulatory and contractual compliance. Monitored and

evaluated all Medicaid Managed Care Plans for reimbursement and denials

to increase revenue. Instituted high quality customer service program

that included all business functions related to the patient visit, from

point of entry to accurate adjudication of the patient account.

Chief Executive Officer Fellow

National Association of Community Health Centers-Washington, DC

John Hopkins University School of Public Health - Baltimore, MD

Morris Heights Health Center- Bronx, N.Y.

July 1997- July 1998

One of nine fellows selected by the National Association of Community

Health Centers, Inc. (NACHC) to participate in its executive leadership

program. This program prepared competent professionals with a demonstrated

commitment to community service to assume key administrative or clinical

leadership roles within community, migrant, and homeless health centers.

Initiated and coordinated strategic planning, program development,

evaluation, and resource allocation. Collaborated with all levels of staff

to plan and develop programs based on sound needs assessments and initiated

ongoing evaluation of the strategic planning progress in meeting

organizational goals. Responsible for the expansion of the WIC program to

accommodate at least 1500 to 3000 participants. Negotiated expansion and

renovation budget with the State WIC Office, realizing a 15% increased in

program's annual budget. Developed program's policy and procedure manuals

and updated job descriptions. Conducted staff satisfaction surveys and

evaluated results.

Public Health Advisor

Health Care for the Homeless Project, Inc. (HCHP) WIC Program, Washington,

D.C.

May 1992 to June 1997

Planned, coordinated and targeted outreach and other program activities

with clinic staff, local health providers and community groups, resulting

in the identification of 2,500 potential WIC participants annually. To meet

performance standards, targeted outreach activities to the highest priority

groups, such as pregnant, breast-feeding women and infants.

WIC Coordinator

Health Care for The Homeless Project, Inc (HCHP) WIC Program, Washington,

DC

April 1991 to May 1992.

Coordinated WIC service with HCHP's prenatal clinics and provided nutrition

education contacts to high risk prenatal participants. Planned, scheduled

and conducted training programs for WIC and other staff. Established a

closer relationship between HCHP's prenatal clinics and WIC program,

resulting in an enrollment growth of more than 80%.

COMPUTER SKILLS

Computer proficiency includes: Windows XP, Microsoft Office Suite,

SPSS, Crystal Reports, HealthPro Practice Management; GE Centricity

EMR and Practice Management system.

PROFESSIONAL MEMBERSHIPS

* Medical Group Management Association

* National Council for International Health

* American Health Care Association.



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