HEALTHCARE EXECUTIVE LEADERSHIP MANAGED CARE

“Developing and Managing Healthcare Networks to Increase Revenue and Reimbursement Levels”

PERFORMANCE PROFILE 15+ years of Executive Healthcare Management including oversight of managed care account contracting, business development, and financial management. Experienced in negotiating and securing 3rd party contracts/administration with exceptional contractual, legal content knowledge. Record of achievement in profitability and revenue by substantially increasing reimbursements and collecting underpayments. Expertise in healthcare delivery systems/networks to develop working relationships with physicians and hospital partners to address market issues and create business strategies. Unique financial and analytical background with 7 years of public accounting, which attributed to business healthcare analysis. Focused on providing revenue cycle management solutions and performance improvement consulting to facilitate the growth of healthcare organizations and physician services spanning patient care. Strategic vision to execute initiatives in price improvement, program/project implementation, and product rollouts for healthcare.

HIGHLIGHTS

During 15-year tenure at Amita Health, facilitated the development of the hospital from 2 hospital systems to 11; with the purchase and acquisition by Ascension, the largest Catholic Health Care system in the nation.

Delivered total of $453.2M reimbursements for 4 healthcare organizations during tenure at Amita Health; in addition to renegotiating contracts and increasing reimbursements to over $500M

Increased reimbursements by $28M during 1st year of operations by renegotiating contracts for AMITA Health Care.

Boosted reimbursements by $28M and collected more than $38M in underpayments for Ascension Healthcare’s Columbia St. Mary’s Hospitals.

Increased reimbursements by $78M for their Alexian Brothers Hospital System; in addition to improving reimbursements by $318M for Alexian Brothers during direct tenure with Alexian Brothers.

Negotiated a Shared Savings agreement with BCBS that over 12 years increased revenue by $148M.

Negotiated Partial Capitation agreement with BCBS HMO product for 15 years that increased revenue by $52M.

Extensive knowledge and experience in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, managed care regulations, and program metrics and methodologies.

Expertise in healthcare reform with value-driven, patient-centered population health management services and program evaluation as well as knowledge in capitated modeling, rate setting, and risk sharing or risk-transferring entities.

Developed and managed PHO/IPA and ACD entities contracted under capitated and value-based models.

Proven ability as team player in working with Revenue Cycle personnel to collect over $318M in underpayments.

Managed the Amita Health Network’s managed care processes with 12 hospitals, ACO, 2 PHOs, and multiple ancillary provider service lines; in addition to expanding governance over managed care for Columbia St. Mary’s and Ascension’s Senior Ministries subsidiary.

CORE COMPETENCIES

Strategic Planning Process Improvement Financial P&L Revenue Cycle Management Cost Benefit Analysis Financial Analysis Business Development Internal Controls Branding Contract Negotiations Performance Improvement Reimbursement Analysis Training & Development Business Operations Consulting Team Leadership HMO, PPO, Medicare Advantage, Medical, and Medicaid Managed Care Contracts Population Health Incentive-based Contracting Capitation Product Lines MS: Excel, Word, PowerPoint

PROFESSIONAL EXPERIENCE

COMPLIMENT HEALTH CONSULTING, ARLINGTON HEIGHTS, IL 4/2016-Present

Project Consultant Serve clients, such as several large medical groups and hospitals; reviewing managed care services as well as revenue cycle processes and rates.

AMITA HEALTHCARE, INC., ARLINGTON HEIGHTS, IL 2/2015-2/2016

9 hospitals with 847 physicians; combined patient gross revenues of $1.6B. Previously known as Alexian Brothers Health System and Adventist Health System; company was acquired by Ascension and merged with the Adventist system in Chicago to form Amita Health.

System Vice President of Managed Care

Developed and executed managed care strategy, policy, and procedures for new company related to financial and legal standards for managed care contracts for 9 hospitals. Directed contracting with hospital, physician and ancillary HMO, PPO, Medical, and Medicaid Managed Care contracts. Consolidated the managed care operations under the joint operating agreement.

Increased reimbursement by $28M during 1st year of operations by renegotiating contracts.

Negotiated +550 agreements during initial year.

Converted major contracts to population management/pay-for-performance model agreements.

Reorganized combined departments during initial year.

ASCENSION HEALTHCARE, ARLINGTON HEIGHTS, IL MILWAUKEE, WI 9/2012-2/2015

Ascension is the largest non-profit health system in the U.S. and the world’s largest Catholic health system, appx. 150,000 associates and 36,000 aligned providers; operating 2,500 sites of care with 141 hospitals and +30 senior living facilities – in 22 states and the District of Columbia.

Ascension Senior Ministries, Inc., Arlington Heights, IL 2/2014-2/2015 (Concurrent Position)

A company of long-term care facilities that were combined in January 2014 into a separate Ascension division comprised of 38 facilities in 18 states.

Vice President of Managed Care

Accountable for establishing a contract administrative process for all agreements. Developed and executed managed care strategy. Analyzed and made recommendations concerning each facility’s legal and reimbursement status.

Improved reimbursement by $1.2M after market-by-market review; made recommendations for reimbursement and identified legal weaknesses and/or strengths.

Established national contract data bank.

Ascension Healthcare, Inc., Columbia St. Mary’s Hospitals, Milwaukee, WI 1/2013-1/2015 (Concurrent Position)

Comprised of 5 hospitals and a 959 physician member PHO/IPA servicing Milwaukee area. Combined gross patient revenue of $675M.

Vice President of Managed Care

Developed and executed managed care strategy, department policies and procedures related to legal and financial standards, and contracting for all commercial (HMO, PPO, POS) Medicare Advantage, Worker’s Compensation and Managed Medicaid programs. Served as main interface with hospitals’ outsourced billing office vendor – Accretive.

Increased reimbursement by $28M through renegotiation of agreements.

Collected more than $38M in underpayments.

Ascension Healthcare, Inc., Alexian Brothers Hospital System, Arlington Heights, IL 9/2012 -2/2015 (Concurrent Position)

Comprised of 9 hospitals and employed 437 physicians. Combined patient gross revenues of $900M.

System Vice President of Managed Care

Reported to System CEO. Developed and executed managed care strategy. Instituted policy and procedures concerning the legal and financial standards for contracts. Oversaw contracting with all commercial (HMO, PPO, POS) Medicare Advantage, Worker’s Compensation, and Managed Medicaid programs. Directed litigation support for all claim issues.

Orchestrated transition from solely-owned Alexian Brothers Hospital System, Inc. to national Ascension Healthcare Inc. organization.

Boosted reimbursements by $78M through renegotiated contracts.

Realigned Alexian policy and procedures to conform to Ascension’s standards and created budget efficiency by 28%

ALEXIAN BROTHERS HOSPITAL NETWORK, INC., ARLINGTON HEIGHTS, IL 8/2001-9/2012

5 hospitals; 352 physicians, IPA/PHO: 932 members, and ancillary providers. Combined gross patient revenue of $900M. Company was acquired by Ascension.

System Vice President of Managed Care Operations

Reported to System CEO. Directed, established, and executed managed care strategy. Developed policy/procedures concerning legal and financial standards. Collected unpaid claims and medical denials. Served as President of the PHO/IPA, another concurrent position; executive in charge of the operations of this entity. The PHO/IPA contracted under the fee-for-service and the capitated models.

Augmented reimbursements by $318M by renegotiating agreements effectively.

Successfully collected more than $260M in unpaid and/or underpaid claims.

Established 932 physician member PHO/IPA, as well as the Board and led it through 7 successful years, returning effective bottom line for PHO/IPA as well as bonuses to member physicians.

System Vice President of Revenue Cycle (Concurrent Position) 3/2003-9/2012

Directed and managed collection of unpaid claims and medical denial accounts.

PREVIOUS POSITIONS

Provena Health Inc., Frankfort, IL System Director of Managed Care Operations

United Healthcare of Illinois, Inc., Chicago, IL Director of Provider Contracting

Health Network, Inc., Oak Brook, IL Vice President of General Services

Health Care Management, Inc., Chicago, IL Vice President

Arthur Anderson, Inc., Chicago, IL 6 Years Consulting

EDUCATION

Bachelor of Science in Business, Accounting, Indiana University

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