Management Manager

Peter Rodrigues

*** ** ***** ******** ******, Port St Lucie, FL 34953

904-***-**** (cell)

abnzmo@r.postjobfree.com

PROFESSIONAL SUMMARY

• Reimbursement – Comprehensive understanding of Medicare, Medicaid and commercial product billing

requirements allowing for substantial reduction in claim reprocessing and denial. Design, implementation and

management of patient responsibility collection processes resulting in decrease in associated receivables,

reserves and DSO.

• Claim Processing – Extensive knowledge of ANSI and NCPDP claim submission formats enabling reduction of

claim processing costs and associated SG&A. Able to increase efficiencies while adhering to P & L expectations.

• New Business Development – Led strategic planning and design for new business initiatives, integration into

existing business as well as coordination of operational and technical functions and interfaces. Strong ability to

guide team through complex and challenging initiatives while maintaining budget guidelines.

• Financial – Experience in budget planning and creation for multiple projects and departments. Designed and

implemented Sarbanes / Oxley SEC controls that adhered to regulations while containing costs.

• Compliance – Designed and implemented compliance program which included training, audit and documentation

of policies, procedures and process flows.

CAREER HIGHLIGHTS

AMERICAN DIABETES SERVICES, INC.

Compliance Officer July 2010 – Present

• Responsibilities include implementation of comprehensive companywide compliance program. Design and

implementation of processes and procedures that adhere to federal, state and local regulations. Oversight of

document retrieval and review to insure compliance with set guidelines. Processing of all document requests

from all payer sources. Performed internal process audits to ensure compliance with set procedures. Obtain and

maintain active Durable Medical and Medical Device permits where required by state law. Oversight of all

company functions during absence of senior management which included setting / achieving goals for sales,

shipping, document management and billing departments.

• Goals attained include but not limited to successful transition of patient base from TIMS / CU billing software to

MedAct billing software, reduction of audit failure by 50%, increased accreditation review score from 91% to

100%, crated policies and procedures for all departments and processes, created training program for entire staff

to insure understanding of federal, state and local regulations. Maintained an ADR pass rate above industry

benchmarks through implementation of electronic response process and high document retrieval success.

SUPPORT PLUS MEDICAL, INC.

Vice President

Administration and Analysis Aug 2008 – July 2010

Revenue Cycle Management Feb 2008 – Aug 2008

• Responsibilities include oversight of IT group, financial reporting, new program/process implementation, claim

processing, receivables management and revenue reconciliation. Design and maintenance of programming used

for compliance with Federal, State and Local collection and billing regulations. Negotiation of contracts with

outside vendors for collection of delinquent customer and third party receivables.

• Goals attained include but not limited to implementation of systemic processing for all payer type claims,

automation of posting process and automation of front end benefit verification process. Integration of acquisition

customer demographics and documentation to current software platform database.

LIBERTY HEALTHCARE GROUP (Port St. Lucie, FL)

Vice President

Account Services – Liberty Medical Supply Apr 2007 – Jul 2007

Account Services – Liberty Medical Supply Pharmacy Jul 2004 – Jul 2007

Third Party Operations – Liberty Home Pharmacy Aug 2003 – Apr 2006

Assistant VP Third Party Operations – Liberty Home Pharmacy Dec 2001 – Aug 2003

Director Accounts Receivable - Liberty Enteral Products Corp. Apr 2000 – Dec 2001

• Responsibilities encompassed entire front end revenue recognition processes for $750MM DME and pharmacy

divisions. Lead multiple teams of directors, managers, supervisors and staff whose duties include patient

coordination of benefits, order entry and edit, payment adjudication, claim submission, remittance application and

accounts receivable management. My teams’ responsibilities included coordination of benefits via telephony and

electronic interfaces, claim submission to governmental and private plans via electronic and hardcopy formats,

denial management as well as manual and systemic payment application.

• Goals attained include reduction of aged accounts receivables by 10%, reduction of bad debt reserve by 1.5%

and reduction of DSO by 15 days. Streamlined and automated online adjudication, remittance and payment

application processes thus reducing payment timeframe by 25 days while reducing SG&A expenses by 15%.

Created patient responsibility collection team which increased patient payments by 35%, commercial remittances

by 20% and reduced Medicare and commercial denials to 1% which contributed to the reduction of outstanding

receivables and reserve requirements.

• Additional accomplishments include senior team member of Medicare part D implementation program which

resulted in increasing division revenue by $100 MM over a twelve month period. Implemented denial

management and posting processes for Liberty Enteral Products and Puerto Rico divisions. Team leader for

design and implementation of new product development for oxygen product line.

TRANSWORLD HEALTCARE (Jacksonville, FL)

Director Accounts Receivable Jul 1997 – Apr 2000

Sr. Business Financial Analysis May 1996 – Jul 1997

Manager Customer Relations Jan 1995 – May 1996

Asst. Manager Customer Relations Feb 1994 – Jan 1995

• Responsibilities were management of patient coordination of benefits, order processing, denial management,

collections and dispute resolution teams. My teams utilized written, telephony and electronic methods to increase

collections of outstanding receivables from Medicare, Medicaid, commercial and private payers.

• Goals attained included maintaining a 95% customer satisfaction rating, increase outstanding receivable

collection by 25% and implemented product return and processing procedure reducing return credits by 50%.

• Additional accomplishments include responsibility for completion and submission of provider applications and

renewals for Medicare, Medicaid and commercial provider numbers, internal procedure audit, new business profit

analysis and management reporting.

INTERNAL REVENUE SERVICE (Jacksonville, FL)

Tax Service Specialist Jan 1992 – Feb 1994

• Responsibilities were resolution of individual and small business tax underpayment balances. Additional

responsibilities included interpretation of tax law requirements for individual and small business tax payers.

• Goals attained included maintaining greater than 95% performance and accuracy rating for both years.

Successful completion of Internal Revenue Service tax law training level I and II.

• Additional accomplishments included team building and scheduling on VITA programs for low income and

elderly tax payers. Obtained a solid understanding of federal tax law and collection regulations.

EDUCATION and AFFILIATIONS

West Georgia College

Bachelor of Business Administration (Finance and Accounting) 1981

• National Medicare Prescription Drug Congress

• Madison’s Who’s Who Member

• Florida Healthcare Financial Managers Association Member

SOFTWARE APPLICATIONS

• Microsoft XP Office Suite Applications (Access, Excel, Word, PowerPoint)

• CU TIMS 3.1 and TIMSRx, MestaMed, QS1, Envoy, AHDS, Availity, Medicare CSI, MedAct

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