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VP Revenue Cycle

Location:
Pittsford, New York, 14534, United States
Salary:
175,000+
Posted:
August 29, 2018

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Resume:

Claudia J. Groenevelt ac6u27@r.postjobfree.com 585-***-**** linkedin.com/in/claudiagroenevelt

HEALTHCARE REVENUE CYCLE EXECUTIVE, MBA, CRCR

Committed to Operational Transformation, Decisive Leadership and Performance Excellence VP REVENUE CYCLE PRINCIPAL SR DIRECTOR or related executive-level opportunity that leverages 20+ years of outstanding leadership and achievement, delivering creative operational, system and financial solutions to manage revenue cycle operations and P&L responsibilities effectively. A consummate relationship manager, entrepreneur, negotiator, and leader with extensive payor and provider relationships, MBA. Expertise includes:

§ Revenue cycle operations, scalable strategic plans, system utilization, conversion, regulatory compliance, technical and professional billing, conducted over 150 end-to-end operational reviews of the revenue cycle for all provider types

§ VP Interim Management for all categories of providers in the continuum of care for up to three years

§ Exceeded targets and client expectations in highly competitive, high-change environments, participative, high touch leadership style focused on continuous operations improvement, goal achievement, and cross-functional collaboration, driving team and individual productivity and results

§ Credit balances, DNFB, EMR, HIM; eligibility, clinical, and billing systems, including: Meditech, Cerner, IDX, NextGen, EPIC, eClinical, McKesson (now Change Healthcare), InterQual, Allscripts, Soarian Clinicals, Change Healthcare, 3M, patient tracking systems, HEDIS, Advisory Board Analytics, Relay Health, SSI Group, ICD-9, ICD-10, CPT, Corridor, Zirmed, HomeCare/HomeBase, SSO, AOD, Harmony, PointClickCare, ADL, AccuMed, McKesson Homecare, Medent and MedAssets

§ Lecturer, Revenue Cycle Management, MS Healthcare Management program, Simon Business School, University of Rochester

CORE COMPETENCIES

Change Leadership Continuous Process & Quality Improvement Denials Management Team Development Provider & Payor Relations HIPAA & Compliance Contracting Federal & 3RD Party Regulations RCM Education Patient-Centered Care P&L/Budget Management Leadership Agility Charity Care & Bad Debt A3 Thinking Internal Controls As Interim VP of Revenue Cycle, identified system interface issue for a mid-size academic hospital that resulted in over 5,000 ED denials in 2017 due to lack of physician documentation. After system resolution (which ultimately was not an issue with documentation), worked with payors to resubmit 7,500 denied claims from the past 18 months. Also, the reported number and value of denials on monthly reports was significantly over-stated because of duplicate data that the system erroneously included in the calculations each month. Claims resubmitted: $11.25 million, expected reimbursement: $7.5 million+

Reduced late charges by 42% for an academic medical center after identifying that the outpatient system hold was set very low and was at its original setting from a conversion five years ago. After resolution, a second issue involving the system then arose – with all requirements for billing fulfilled before the bill hold end date, claims remained in unbilled until the claim hold end date, instead of releasing for submission. Simple issues to fix that resulted in significantly less re-work, faster claim turnaround, and a four-day reduction in days after two months. PROFESSIONAL EXPERIENCE

INDEPENDENT CONSULTANT INTERIM VICE PRESIDENT/SR. DIRECTOR REVENUE CYCLE 1/2015 - PRESENT Accomplishments/Sample of Independent Consulting Engagements: Client #1: Large academic health system with multiple hospitals; Interim Vice President, hospital and physician revenue cycle

• Over 300 reports, 12 direct reports, net patient revenue $2 billion, 600+ physicians, 1,500+ acute care beds, >30+ offsite clinics, 390 bed SNF, CAH, home care and trauma center

• Reduced unbilled (DNFB) accounts by 32% after identifying interface issue

• Recorded the highest months of cash receipts for the year in October and November of 2015, the month of and after the ICD-10 implementation

• Identified clinic service reimbursed at an incorrect rate, worked with payors to resubmit claims for the past year resulting in $5.6 million in additional cash

Claudia J. Groenevelt, MBA Page 2

Client #2 (smaller scale): Large home care agency, 22 counties; Sr. Director, Revenue Cycle Operations

• Reduced the number of outstanding or incomplete pre-authorizations from 1,800+ to 300+ in three months, resulting in a one-time cash flow infusion and ongoing faster claim turnaround

• Built a team transformed through education, new policies, procedures, reassignments, and encouragement, and who proudly met the challenge

• Audited charity care claims and found that 42% did not qualify for charity care, developed allowance for charity care, bad debt, new policies and procedures, estimated reserves by payor and plan, and educated all finance staff involved PRINCIPAL/DIRECTOR BONADIO RECEIVABLES SOLUTIONS, LLC 5/2006 - 12/2014 Specialized in improving cash flow and operations for all providers in the continuum of care. Expert witness regarding third- party payor regulations and compliance. Full P&L responsibility. Conducted operations reviews of all functional areas of the revenue cycle and peripheral departments (lab, radiology, and pharmacy) from ED/referral/patient access to discharge and final payment, improving scheduling, coding, billing, collections, and third-party follow-up. Conducted hundreds of cash recoveries and collected millions of dollars for clients by simultaneously educating staff in effective claims follow-up, identifying weaknesses in processes, and implementing recommended changes to systems and operations. Offered interim management services for hospitals and medical practices in a VP Revenue Cycle capacity from three months to three years. Accomplishments:

• Assisted a large academic medical center in preparation for a conversion, beginning eight months before go-live, formed teams to follow-up on aged receivables and reduced the number of accounts on the aging by 41%, resulting in a significant improvement in cash flow and fewer accounts to convert to the new system

• Evaluated entire revenue cycle process and provided cash recovery services to a small specialty group that resulted in additional income of $3M in the first year (previously lost due to inadequate internal controls), discovery of embezzlement, and the collection of aged accounts resulting in the disposition of a line of credit that had only 5% of funds remaining

• Identified unbilled services for a mid-size hospital that led to a revenue increase of $4.5 million PRINCIPAL/OWNER GROENEVELT CONSULTING, INC 1/1990 - 4/2006 Responsible for the launch and operation of my own innovative consulting company specializing in revenue cycle management and process improvement for healthcare providers. Built trusting, long-term relationships with healthcare providers and payors and developed new service offerings for a full range of billing, performance improvement, productivity, and educational services. Worked with payors to resubmit untimely claims in mass appeals. Provided outsourced billing services to medical practices. Accomplishments:

• Marketed services for physician practices, clinics, hospitals, nursing homes, DME suppliers and transportation services

• Developed multiple consulting services: operations review, a unique approach to cash recovery, interim management, audit of claims quality, potential fraud, internal controls and ancillary departmental data entry

• Assisted with software selection/conversion, management recruiting and self-disclosures of non-compliant claims

• Earned an outstanding reputation statewide, leading to an offer to merge with The Bonadio Group, a Top 50 CPA firm nationally

Other Experience – KPMG: Director of Patient Accounting Services for the NE US University of Rochester Medical Center – Service administrator, Dept of Pediatrics EDUCATIONAL & OTHER BACKGROUND INFORMATION

THE UNIVERSITY OF ROCHESTER, Rochester, NY

Master of Business Administration, Simon Executive Bachelor of Science, Sociology

Honors: Selected for full sponsorship for the Simon Executive MBA full-time program by the University of Rochester Medical Center, completed BS and MBA in six years while also working full-time as an administrator. CRCR: HFMA CERTIFIED REVENUE CYCLE REPRESENTATIVE 2018 AFFILIATIONS & VOLUNTEER

Healthcare Financial Management Association Medical Group Managers Association NYS Health Facilities Association of Continuing Healthcare Leading Age Volunteer: appointed member of THE Comprehensive Plan Committee by Village of Pittsford Volunteer at large eldercare organization to assist patients and families with their insurance claims



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