Revenue Cycle
Resume:
Gerald (Jerry) D. Miller II, RN, MBA
Atlanta, GA 30324
******.******@*****.***
Over Twenty (24) Years of Healthcare Experience:
North Highland Worldwide Consulting November 2012-Current
3333 Piedmont Road, Suite 1000
Atlanta, GA 30305
Principal, Content Expert Healthcare
I currently serve as principal content expert, for both clinical and financial operations at North Highland Worldwide
Consulting in the following areas:
Not-For-Profit and For-Profit Hospital Systems
Academic Medical Centers
Integrated Delivery Networks
Health & Wellness
Healthcare New Product Development
As a Content Expert Principal, I leveraged subject matter expertise and business development skills.
•Responsible for driving “tip of the wedge” work across multiple clients
•Contributing to multiple and/or complex consulting projects.
•Driving proactive business development activities, related to expertise
•Ensuring high quality service offering content, business development support and delivery
•Contributing to the continual development and long-term selling strategies of service offerings; as well as their
communication internally and externally
•Developing professional network through association memberships, speaking and writing engagements and
community activities
Quorum Health Resource Consulting (QHR) March 2009-November 2012
105 Continental Place
Brentwood, TN 37027
Associate Vice President Revenue Cycle Consulting (Practice Leader for 150 Managed Hospitals)
Responsible for the management and oversight of all aspects of Revenue Cycle Consulting for
150 managed hospitals in 38 states, as well as, additional external consulting services.
Revenue Cycle Consulting includes:
• Revenue Cycle Assessments/Implementations/Developed Scorecards and Management Action Plans
• Patient Access Services
• Charge Master Compliance and Price Checker/Rate Setting
• Charge Capture
• Coding Compliance
• ICD-10 Preparation Assessments
• Case Management
• Health Information Management
• Patient Financial Services
• RAC Assessments
• RAC Appeals Unit
• Clinical Documentation Improvement
• Interim Management
• Due Diligence Assessments for hospital leasing and turnaround agreements
REVENUE CYCLE ACCOMPLISHMENTS:
• Awarded 2011 “Highest Team Sales” across all consulting practices.
$1.2M – Revenue Cycle Redesign
o
1.2M –Management Agreement
o
$650,000 – PFS and Case Management Implementation
o
$475,000 - Revenue Cycle, Case Management, and Clinical Operations
o
Assessments.
• Successful delivery of presentations for C-Suite, Board of Directors, and State and National Conferences.
• Developed and implemented a 5010/ICD-10 assessment to include IT system validation.
• Developed a review/approval/documentation process to improve the quality of reports.
• Developed and implemented a Revenue Cycle Methodology that is being used within all Revenue Cycle
consulting engagements.
• Developed a Recovery Audit Contracting service line to assess J-codes and multipliers, MS-DRG
Validation, and Medical Necessity.
• Developed a Revenue Cycle and RAC Scorecards to be used by CFOs.
• Developed a charge capture and clinical documentation improvement service line.
• Integrated Revenue Cycle and Clinical Operations to include a Care Coordination Model.
.
Saint Joseph’s Hospital – Atlanta, GA November 2003-October 2008
5665 Peachtree Dunwoody NE
Atlanta, GA 30342
Director Reimbursement Audit Services
Responsible for the management of Reimbursement Audit Services, which performed audits on the Revenue
Cycle, to include Patient Access, Care Management, Health Information Management, Reimbursement, and
Patient Financial Services. Reimbursement Audit Services functions include: Charge Master (CDM), Cost
Reporting, Government Regulatory Monitoring, and Nurse Audit.
REIMBURSEMENT AUDIT SERVICES ACCOMPLISHMENTS:
• Responsible for performing defense audits during a 2 year investigation by the Office of the Inspector
General and the Department of Justice.
• Reviewed statistical sampling of accounts from a 5 year period for potential improper billing of zero and
one day stays, observation, three day SNF, medical unlikely claims, hemodialysis, and carotid stents.
Compiled defense audit reports for the law firm of Alston and Bird.
• Implemented and was the system administrator for Compliance 360 software and MCA Audit Software
within the entire Revenue Cycle.
• Monitored Emergency Room E&M levels for compliance in maintaining a bell shaped curve.
• Preformed Care Management Audits for the accuracy of both InterQual and Milliman.
• Implemented the “Care Management Protocol” within the Care Management/Utilization Review
Department, as part of a Corporate Integrity Agreement.
• Developed and performed hospital wide education on Revenue Cycle, Reimbursement, and Clinical
Documentation, as part of a Corporate Integrity Agreement.
• Performed J-Code pharmacy audits, as part of compliance monitoring.
• Key player in the development project of standardizing the CDM among all Catholic Health East facilities.
• Performed current state mapping and future state mapping of the Revenue Cycle, as part of a hospital
wide system install from IDX to Siemens.
• Responsible for reporting both under and over payments, as a result of audit findings.
• Developed and implemented a Government Regulatory Specialist position responsible for monitoring and
hospital wide education on Government bulletins and transmittals.
Director Patient Access Services and Care Management
Responsible for the management of Patient Access Services and Care Management.
Patient Access functions included Pre-Registration, Pre-Certification and Insurance Verification, Registration,
Central Scheduling, Financial Counseling, Cashier, Education Coordinator, Collections, Outpatient RN Medical
Necessity Specialist, and dual accountability for satellite registration areas.
PATIENT ACCESS ACCOMPLISHMENTS:
• Developed and implemented a Pre-Registration Department.
• Installed and implemented an integrated insurance verification system (HDX) and
• AHIQA to improve overall insurance verification and accuracy from 65% to 98%.
• Improved up-front collections with the use of credit scoring software to identify credit availability.
• Developed and implemented an Outpatient RN Medical Necessity Specialist position to monitor for Medical
Necessity for procedures and facilitate communication with ordering physicians.
Care Management functions included the management of RN Care Managers, Social Workers, Discharge
Planning Specialist, Payor Specialists, RN DRG Specialist, and Denial Specialists, to oversee the utilization
management of unit-based patient populations to achieve optimal patient and financial outcomes.
CARE MANAGEMENT ACCOMPLISHMENTS:
• Responsible for team collaboration of all utilization management, resource management, discharge
planning, and denial improvement activities.
• Developed and implemented payor specialist model based on insurance plan.
• Developed and implemented a physician advisor program.
• Responsible for strengthening the denials management program.
• Regularly met with payors with statistical data to discuss their denial practices.
Hurley Medical Center January 1991-October 2003
One Hurley Plaza
Flint, MI 48503
Nursing Experience: OR, Critical Care, Emergency, Hemodialysis
Service Access Manager/Pre-Admission Review
Clinical Manager, Genesee County Correctional Facility
Quality Assurance Coordinator
Discharge Planning Coordinator
Educational Background
Baker College Master of Business Administration/
Center for Graduate Studies Concentration in Healthcare Administration
G-1050 West Bristol Rd
Flint, MI 48507
University of Michigan Bachelors Degree
303 East Kearsley St Applied Science/Healthcare Administration
Flint, MI 48502
Mott Community College Associates Degree
1401 East Court St Science of Registered Nursing
Flint, MI 48502
Licenses/Certifications/Professional Organizations
Registered Nurse -State of Georgia
RN Auditor
JA Thomas, Atlanta, GA – Clinical Documentation Improvement
Project Management Training– Global Knowledge, Washington, DC
Project Management for Healthcare Professionals- The Outset Group, Nashville, TN
American Case Management Association
American Association of Clinical Coders & RN Auditors
Georgia Hospital Association
Healthcare Financial Management Association
Special Skills
In depth knowledge of ICD-9, MS-DRG, CPT, HCPCS, Revenue Codes, Clinic Coding, UB04 and 1500 billing,
InterQual, Milliman, AHIQA, Excel, Access, Monarch, Microsoft Project, Midas, Maxsys, Code Correct and
MedAssets CDM,, Compliance 360, MCA Audit, IDX, Invision, Meditech, Siemens-Soarian Clinical and Financial,
CPSI, EPIC, and SMS.
References
Upon Request
Contact this candidate