Seble Nebiyeloul
**** ********* *** # **, *****, N.Y., 10471
Home: (718) 432- 8688 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.