Management Service

Michael H. Kim

*** ****** ******, ***. **, San Francisco, CA, 94118; 415-***-****; *******@*****.***

EXPERIENCE

Sinaiko Healthcare Consulting, Los Angeles, CA

Senior Consultant, 02/2007-05/2009

• Assessed a multi-facility healthcare system and physician network revenue cycle to identify

areas of opportunity for coding, documentation, charge capture, billing, collections, Charge

Description Master, and Fee Schedule.

• Conducted specialized focused reviews of the charge capture, contracting and revenue cycle

processes in Orthopedics, Cardiac Cath Lab and the Emergency Department.

• Evaluated Emergency Department Charge Capture effectiveness for multi-facility healthcare

system that includes a comprehensive assessment of a facility’s Charge Description Master

(CDM), charge ticket, charge capture processes, charge entry processes, coding, documentation

and billing effectiveness.

• Facilitated claims release project covering 270,000 Professional charges for over $25M and

34,000 Hospital accounts for over $34M.

• Led team in restructuring of custom EPIC implementation for PFS for Hospital and

Professional Billing.

• Created the Charge Description Master and Uncaptured Revenue Evaluation (CURE) product

and worked on 3 projects resulting in potential revenues of over $250,000.

• Directed a retrospective audit and systems review for an 18 facility dental practice to determine

compliance risks with billing and documentation guidelines established by Medicaid for the

purposes of acquisition by client.

• Conducted two due-diligence risk assessments of billing, compliance structure, and

performance for durable medical equipment companies with revenues of $133 M and $10.8 B.

• Performed over 10 Fair Market Value (FMV) assessments for Professional Service Agreements

to determine appropriate provider compensation rates, service types, and service payments for

over 40 different specialties covering in-patient, outpatient, and ancillary services.

• Participated in several FMV assessments of healthcare facilities ranging from $300k to $12M.

• Created a payor reimbursement tool based on raw data and used the tool to analyze different

payment levels for procedures based on site of service and geographic zip code.

• Provided an Information Systems Security Audit for national Dialysis Center covering 30

locations for 1000 users

Health First, New York, NY

Senior Healthcare Analyst, 05/2005-1/2007

• Devised strategies and tools for performance reporting, forecasting, and monitoring for 39

owner hospitals which accounted for 2006 revenues of $1.5 billion and 4.6 million member

months.

• Conducted overpayment analysis of capitated services that led to a recoupment of over $4

million.

• Led cost savings initiative team across various departments that set and tracked targets on a

monthly basis using SAS.

• Calculated shared risk arrangement models including newborn, maternity, and aggregate stop

loss using SAS.

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• Evaluated cost-effective reimbursement structures for Medicare, Medicaid, Child Health Plus,

Family Health Plus, and Healthy New York

• Automated cost and utilization reports for hospital and physician group performance reporting

using SAS

Manhattan Vision Associates/Institute for Vision Research, New York, NY

Research Associate, 02/2004-05/2005

• Designed and implemented vision research projects in partnership with Vistakon

• Constructed and maintained Access and Excel powered databases for various clinical studies

• Augmented efficiency and effectiveness of analysis and data processing

Visiting Nurse Service of New York, New York, NY

Senior Data Analyst, 09/2003-04/2005

• Provided statistical analysis expertise to determine validity and significance of results on

projects such as Complaints Reporting and the Quality Scorecard.

• Analyzed data and produced comprehensive quarterly analysis reports using Hyperion Analyzer

and Oracle Discover for Quality Management Services Department and Learning Collaborative

Initiative

• Increased patient satisfaction ratings by analyzing Press Ganey satisfaction data and

communicating findings to senior management

• Designed and implemented quality scorecard that tracked indicators across several departments

to measure efficiency and performance of agency.

• Maintained department website for report distribution using Sharepoint

EDUCATION

Yale University, School of Public Health, New Haven, CT

M.P.H. in Health Management, May 2003

• Management Program in conjunction with Yale School of Management

• Co-authored paper on Micro-grants Project while working at Yale Griffin Prevention Research

Center

University of Michigan, College of Literature, Science and Arts, Ann Arbor, MI

B.S. in Sociology and Biopsychology, April 2001

Sociology Honors with specialization in health, aging, and populations

Co-authored paper on deep-vein thrombosis while working at Consortium for Health Outcomes,

Innovation, Cost Effectiveness Studies (CHOICES)

SKILLS

Languages: Fluent Korean; conversational Spanish

Technology: Proficient in Microsoft Office, SAS/Base, SAS/Macros, SQL, SPSS, Hyperion Essbase,

Analyzer, Oracle Discoverer, MapInfo, PeopleSoft, McKesson Financial Profiler, Patterns Profiler,

Sharepoint, Citrix, EPIC, Thomson Medstat Marketscan Payor Database, Thomson Red Book, and

working knowledge of OLAP tools.

References Available Upon Request

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