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Medical Project Manager

Location:
Atlanta, Georgia, United States
Posted:
February 15, 2018

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Resume:

Albert Berry, Jr.

**** **** ***** *****, ** Acworth, GA 30101

678-***-****

ac4hoh@r.postjobfree.com

QUALIFICATIONS AND SKILLS SUMMARY

Hospital and Healthcare Professional Consultant with more than 20 years of financial experience leading business operations in acute care settings as a Director, Consultant and Interim Advisor. Successful change-agent with the ability to assess and implement positive fiscal functioning including revenue cycle processes, EMR conversions, and Health Information Management (HIM), and 10 years’ experience working remotely.

Offers hands-on strategic, financial and technology solutions, and thrives in helping companies navigate critical points throughout the business life cycle, amplifying their resources, efforts and productivity

Skilled in assessment of clients’ revenue cycle processes and has over 20 years’ experience provided systems training, implementation, optimization, testing, conversion, and clean-up of: EPIC, Meditech, Cerner, McKesson STAR, McKesson AS400, CPSI, OAS Gold, ePremis, SSI, Caremedic, Webcare (EPIC Certification: Resolute Hospital Billing and Resolute Professional Billing Insurance Follow-up)

Available immediately to interview and start a new assignment.

PROFESSIONAL EXPERIENCE

Warbird Consulting/Atlanta, GA (September 2017 – Present)

Exists to help hospitals, physician practices and other healthcare providers identify and solve their most urgent financial and operational challenges. Warbird Healthcare consulting deploys customized teams of subject matter experts through our proven OnDemand business model in the areas of finance, revenue cycle and IT.

Projects at Warbird:

Palmetto Medical Group/Columbia, SC (August 2017 – January 2018)

87 physician practices in 100 locations. More than 600 physicians and advanced care providers (including nurse practitioners, physician assistants and other providers who will care for patients)

Revenue Cycle Analyst

Cerner Millennium, One Chart, Power Works, Horizon Plus systems; Billing through Relay Health

Analysis of entire revenue cycle process, systems, and policies and identifying bad-debt reserves

Assigned 12 physician practices, 6 different specialties, billing on HCFA 1500 forms

Billing, Re-bills, Follow-up, and Appeals

Assigned Medicaid and Medicaid CMO accounts aged 181 and greater

Increase Medicaid and Medicaid CMO collections by 30%

Decrease of 10 days in AR days, from 51 - 41 Medicaid and Medicaid CMO

Tatum Consulting/Atlanta, GA (February 2014 – August 2017)

Offer hands-on strategic, financial and technology solutions, delivered by proven executive leaders and consultants. Thriving in helping companies navigate critical points throughout the business life cycle, and do so while plugged into an organization, amplifying their resources, efforts and productivity.

Projects at Tatum:

Piedmont Healthcare/Atlanta, GA (April 2017 – August 2017)

A private, not-for-profit organization serving nearly 2 million patients across Georgia, Piedmont is transforming healthcare, creating a destination for the best clinicians and a one-of-a-kind experience that always puts patients first. Piedmont is known as a leading health system in cancer care, treatment of heart disease and organ transplantation with 7 hospitals, 19 urgent care centers, 94 physician practice locations and 1615 Piedmont Clinic members.

Specialty Biller

Research and Transplant Billing, Government, Non-government, and Sponsored payers

EPIC system, Emdeon Billing system

Increase in cash collection, from $3 million to $8 million per month

Managing 8 work queues in EPIC and all error claims in Emdeon

Managing and resolving all unbilled claims

Review of clinical trials and implementing billing process for all payers, applying NCT and IDE numbers for devices.

Identifying and trending $0 pay remits. Appropriately applying contractual adjustments, write-offs, non-covered and patient liability.

South Georgia Medical Center/Valdosta, GA (February 2014-January 2017)

A 330-bed acute care hospital, SGMC provides area residents with broad services through our growing medical staff of more than 300 physicians and 2700 staff. It is a growing healthcare enterprise, SGMC, encompasses four hospitals, South Georgia Medical Center (Valdosta, GA), SGMC Smith Northview Campus (North Valdosta, GA) SGMC Lanier Campus (Lakeland, GA) and the SGMC Berrien Campus (Nashville, GA); also SGMC Cancer Center. These facilities serve a large, diverse population with a wide variety of inpatient and outpatient services.

Revenue Cycle Consultant (Project Manager)

Guaranteed increase in cash collection 20%

Decrease in Net AR days, 68 to 43 days

Improve clean claim rate from 53% to 84%

Assessment of clients’ Oncology revenue cycle process

Review of Oncology CDM and update

Systems (implementation, optimization, testing, conversion, and clean-up): McKesson to EPIC

EPIC (Build and implementation team) Certification class EPIC Resolute Hospital Billing

Performing a complete analysis of the entire revenue cycle process, systems, and policies

Identify bad-debt reserves

Oversee EBO vendors, for outsourcing of self-pay accounts

Oversee Bad-debt placement, recalls, and Medicare Bad-debt Report

Review and resolve of credit balances

Charge Master Review: CDM review for all departments that generate revenue.

Implementation of ICD-10 for patient accounting systems and billing software

Billing and Collection: Assessment of patient accounting systems and billing systems (clearing house), valid claim edits are in place (based on patient type, service, and payer), clean claim rate, DNFB, unbilled claims, denial management, payer contract review, quality analysis of collectors and follow-up, appeals, Medicare RAC, etc.

Frasier Healthcare Consulting/Arlington, TX (February 2012 – September 2013)

National healthcare revenue cycle receivables, management company specializing in business office operations, cash application, accounts receivable, billing, collections, and registration for healthcare providers (Acute hospitals, CAH, Skilled Nursing Facilities, DME vendors, and Physician/Professional services).

Projects at Frasier:

Our Lady of the Lake Medical Center/Baton Rouge, LA (November 2012-September 2013)

Our Lady of the Lake is one of the largest private medical centers in Louisiana, with more than 700 licensed beds. It has been approved by the America College of Surgeons and the state of Louisiana as a Level II trauma center, along with being an education institution. The Lake treats more than 35,000 patients in the hospital and serves more than 350,000 persons through outpatient locations, with the assistance of more than 1,000 physicians and 4,000 team members.

Interim Business Office Manager

Performing a complete analysis of the entire revenue cycle process, systems, and policies

Billing and Collection: Assessment of patient accounting systems and billing systems, (clearing house), valid claim edits are in place (based on patient type, service, and payer), clean claim rate, DNFB, unbilled claims, denial management, payer contract review, quality analysis of collectors and follow-up, appeals, Medicare RAC, etc.

Patient Access Process: (scheduling, registration, admission, insurance verification, POS collection, ABN policy, physician order verification, pre-certs and authorizations)

Implementation and overseeing Centralized Scheduling for all outpatient procedures and departments.

Verifying that a written order is obtained for all procedures.

Minimize scheduling errors.

Review scheduling staff productivity; identify any break-downs within a location, department, or physician’s office.

HIM: Identifying deficiencies for medical records, charts that are incomplete, invalid orders, ICD-9 and CPT coding issues, and auditing of charts along with bills.

Scott & White Healthcare/Temple, TX (February 2012-November 2012)

A non-profit collaborative health care system which encompasses one of the nation's largest multi-specialty group practices. It is a medical education and research organization based out of Central Texas in a 29,000-square-mile service area. The system owns, partners, or manages 12 acute care hospital sites.

Revenue Cycle Consultant (Project Manager)

Clean up project, all accounts 181 days and older, except for self-pay

Increase in cash collection

Identifying write-offs and adjustments needed

Delegating assignments and creating work queues for project team members

Reporting KPI and results to client

Managing project team of 11

Coordinate training and identified training resources for team members

Served as liaison between Vendor and Client

Southern Regional Medical Center/Riverdale, GA (July 2011 – February 2012)

Acute Care facility with 331 beds, inpatient rehabilitation unit, and an oncology department.

Denial Prevention and Recovery Specialist, Temp

Review EOB, validate and ensure patient accounting system reflects correct dispute disposition, Appealable, Un-appealable, Contractual issues, etc.

Write first, second, third, etc. level of appeal letters to ensure all efforts for recovery are exhausted.

Attained expert level understanding and knowledge of contractual/reimbursement assigned payers.

Track and trend dispute data, and inform management of findings

Lead meetings with Billing Integrity Specialist and EOB Analyst for resolution

of payer issues.

Root cause denials to prevent future denials

Provide guidance to the staff, of understanding of reimbursement issues that have been identified.

Assists Revenue Cycle leadership with day to day follow up and collection activities as well as any special

projects assigned

Work Medicare RTP (Return to Provider) via DDE system

Operating patient accounting system McKesson HBOC STAR

Optimization of McKesson STAR

Operating billing system ePremis

Complete Medicare Credit Balance Report

Advise on HIPPA 5010 implementation

Ivinson Memorial Hospital, Acute Hospital/Laramie, WY (October 2007 – November 2010)

Acute Care facility with 99 beds, 50 active physicians, dialysis unit, and an oncology facility.

Patient Financial Services Director

Oversee a business office staff of 13 employees and 1 supervisor

Patient access, (registration, scheduling, insurance verification and authorization)

HIM department (ICD-9 and CPT coding, completion of medical charts, auditing for charge integrity)

Periodic training and education of staff

Conversion of systems, McKesson Star to Meditech

Operating patient accounting system Meditech

Operating billing system Caremedic and MedAssets XClaims

Implement revenue cycle policies and procedures

Implement billers and collectors QA

Billing system conversion

Implemented KPI report

Monthly In-service with hospitalists

Credentialing physicians for Professional Billing

Set up and maintain Surgery Clinic and Internal Medicine fee schedule

Increased monthly cash collections from $2.5 to $5.8 million per month

Decrease of days outstanding from 114 to 51

Clean claim rate from 0% to 80%

Create work queues for billers and collectors

CDM monitoring, Update charge dictionary

Review daily billing, UB04 and HCFA 1500

Medicare billing and follow-up, appeals, and denial recovery/prevention

Review and analyze the unbilled report and late charge report

Implement additional edits or delete edits to help bill claims efficiently

Complete the Medicare Credit Balance report, Bad Debt Report, and Cost Report

Review all RAC inquiries, and inform Administration of all RAC updates

D-Med Corporation, Consulting Firm/Dallas, TX (April 2001 - October 2007)

D-MED Corporation is a highly respected company in the area of Accounts Receivable, Business Office, and Physician Practice Management. Our consulting practice assists healthcare providers in the areas of Operational Reviews, Implementations, Interim Managers, Turnarounds, Process Improvements, Staff Training, Implementing Key Indicator Performance Reporting, Quantifiable Registration Quality Assurance Programs, and Policies and Procedures.

Projects at D-Med Corporation:

St. Francis Medical Center, CAH/Breckenridge, MN (January 2007-October 2007)

Consulting assignment through D-Med Consulting Corporation. Critical Access Hospital with 120 beds and a long-term care facility.

BusinessOffice Director, Interim

Review all patient accounts with outstanding balance, 60 days and greater

Evaluate the patient financial services operations

Insurance follow-up and rebilling (Medicare, Medicaid, and Commercial) onoutstanding accounts.

Analyzed the medical coding, ICD-9 and CPT, making sure that they were validand supportive of each other, as well, medical documentation to support coding.

Collected an estimate $8.3 million for accounts 60 days and older

Mariner Healthcare, Corporate Office/ Houston, TX (March 2004 - January 2007)

Consulting assignment through D-Med Consulting Corporation.This is one of the largest providers of long-term health care services in the United States. Mariner has 291 skilled nursing facilities in 23 states with an estimate of 36,000 licensed beds.

Project Consultant

Testing, converting, and implementing company’s new patient account software

System conversion, McKesson Star to Webcare

Centralizing A/R activities for all facilities to the corporate office

Provide procedures and all other information for training manuals

Assist 16 skilled nursing facilities with their back-office A/R activities.

Insurance verification, admission, payer sequencing, charge entry, billing, collections, payment posting, and

appeals

Increase revenue by $5 million per month

Decrease days outstanding from 61 to 42

Lowered bad debt by $2 million

Mariner Healthcare, Skilled Nursing Facility/ Atlanta, GA (January 2002 - January 2004)

Consulting assignment through D-Med Consulting Corporation.This facility has 114 licensed beds,

generates a revenue of about $1.2 million per month, and an estimate of 75 employees.

Business Office Manager, Interim

Overseeing admissions department, payroll department, receptionists, and of course the business office.

Verify census, eligibility, charge entry, billing and collections, admission and discharges, and keep track of

residents’ personal accounts with the facility.

Assist families in the application process for Medicaid

Increase revenue by $200, 000 per month

Decrease days outstanding, 65 to 45, and lowered bad debt by $100,000.

Sierra View Hospital/ Porterville, CA (November 2001 - December 2001)

Consulting assignment through D-Med Consulting Corporation. Sierra’s Cancer facility needed assistance with Medicare billing and collection.

A/R Specialist, Consultant

Medicare billing and follow-up

Was able to collect $350, 000 within one month’s time

Providence Hospital/ Columbia, S.C. (April 2001 - October 2001)

Consulting assignment through D-Med Consulting Corporation. Providence is a non-profit organization that is licensed for 322 beds, comprised of four entities, and has about 1,800 employees.

Billing Supervisor, Interim

Oversee daily billing, UB92 and HCFA 1500, activities

Review and analyze the unbilled report and late charge report

Implement additional edits or delete edits to help bill claims efficiently

Complete or delegate the Medicare Credit Balance report

Review employees daily and weekly productivity reports

Increase revenue by $4 million

Decrease days outstanding, 57 to 41

Centerpoint Healthcare, Consultant / Tampa Bay, FL (October 2000 - March 2001)

Coast to Coast Consulting, Inc., Consultant /Austin, TX (April 1999 - August 2000)

GA Baptist Medical Center, Medical Biller and Coder / Atlanta, GA (February 1995 -April 1999)

EDUCATION

EPIC Certification Resolute Hospital Billing: Billing Readiness

HFMA (Healthcare Financial Management Association) member

CPAM (Certified Patient Account Management) Certification through HFMA



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