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Medical Customer Service

Location:
Downers Grove, Illinois, United States
Salary:
negotiatble
Posted:
October 22, 2016

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Resume:

Anne O. Craft, BS, MS, CPC, CPCO

acw6os@r.postjobfree.com

05N601 Hazelwood Trl. Home 630-***-****

St. Charles, IL 60175 Cell 847-***-****

Professional Summary: Health Care Executive with over 22 years of operations and services marketing experience which includes: strategic planning, financial forecasting, revenue cycle management, team and customer focused development in both profit and non-profit health care environments. Health policies expertise at the State & Federal level of regulations, industry standards regarding reimbursement that effect physician recruitment/retention, medical practices in the delivery of care, and managed care contracting.

Professional Experience:

Medical Practice Manager-Rainbow Hospice & Palliative Care Mount Prospect, IL October 2015-present

Onboarding and credentialing of all new hires-APN, MD, and DO’s.

Maintain CAQH database and PECOS for updated licensing and group provider validation

Maintained and implemented IMPACT program on behalf of RHPC for IDPH/FHS

Restructuring of Superbill to improve and ensure adequate reimbursements and timely filling guidelines.

Provide monthly summary of consultation and claims status of all palliative services lines for eight inpatient programs and a Community based palliative program.

Researched cloud based PM/EMR/RCM software solutions for real-time billing capture and documentation for the palliative team prior to Presence merge.

Reports Coordinator- Optum Wellness – United Healthcare Corporation Aurora, IL August 2013- September 2015

Coordination of on-site health screening results for employers and employees wellness (biometric) values.

Assisted in the implementation of training manual and offered solutions to improve efficiencies to meet customer demands and timelines of report data.

Director of Operations- Northwest Orthopaedics & Sports Medicine- Chicago, IL September2011-August 2012

Managed and directed a large independent seven surgeon practice with physical therapy and radiology service. Fifty-two FTE’s, two hospital affiliations and one surgery center.

Transformed the registration process to increase patient flow by automating schedule, evaluating and implementing a new phone system.

Reduced overall monthly expenses equal to the rate last seen in February 2010, approximately an 8% decrease.

Completed an initial needs assessment and referral development strategy after base line satisfaction survey.

Renegotiated their lease with a savings of $42,000 over five years, with renovation expenses included.

Orchestrated redesign and construction to existing space with the addition of three exam room, and privacy compliant x-ray waiting room area without any loss in productivity.

Initiated business agreement with Midwest ROI for record requests with a savings of one FTE.

Developed Employee Manual, job descriptions, patient financial policy and other non-existent documents for consistent procedures. Implementing Studer and other cultural change techniques for service excellence.

Increased medical collection turn around time by ten days, and brought in a new vendor with a 22% savings from former collections service.

Comprehensive Marketing Plan and brand design to include joint ventures with corporations such as ATI, Lifetime Fitness, and Athletics 2000. Website interactive redesign for greater user friendly experience.

Income reached a three year high last two months with revenues over $700,000 through streamlining workflow and more efficient management.

Program Director- Northwestern Lake Forest Hospital Wound Center-National Healing Corporation

May 2009- September 2011

Start-up a comprehensive wound care and hyperbaric medicine program.

Developed a marketing and outreach plan to meet targeted goals and volumes for the center, with 323 wounds healed in first year of operation.

Acquired JCAHO certification for the new service line, only three short months after a flood requiring operations to temporarily move to other location. Loss of only one day’s revenue, had the temporary site up and running in 2 days.

Achieved approximately 90% of first year budgeted goals with heal rates of 92% within 8 weeks, and 65% from referral development efforts from direct practice marketing to community physicians by Program Director

Maintain productivity data on hospital budget variance, patient outcomes, ancillary revenue, patient satisfaction, and clinical pathway participation

Recruitment and retention of physician panel members from private practice within the community, as well as educate their billing support staff on the coding specific to wound care and hyperbaric and CMS compliance.

Maintain constant communication with referring and primary care physicians on patient progress.

Center maintains a 22.1% contribution margin, 35% contribution margin to inpatient revenue and 25% contribution margin to outpatient ancillary revenue.

Practice Manager-Department of Surgery

DuPage Medical Group July 2007-August 2008

Managed and directed daily operations of an office staff of fourteen and six surgeons with two primary locations and three satellite locations. Surgeons with bariatric, oncology, breast, and vascular specialty.

Converted to the EMR system chosen by the group (Epic)

Worked with the physicians to better understand the P&L statements, FTE ratios, and other productivity issues and improved productivity with a 7% decrease to local overhead

Promoted evaluation of site-service differentials on various ICD-9 codes that have better professional yield for in-office procedures while providing better utilization of the ASC for procedures that have better facility charges.

Improved group’s reimbursements by better utilization of modifiers and E&M codes with re-tooling their consultation forms to include more systems.

HIS Medical Solutions

Independent Consulting for Medical Associations & private practices October 2005-June 2007

Implemented E-Donor site and other user friendly Website strategies for independent practices.

Developed 07/08 Budget with practice tools such as: Webinars, EMR pitfalls & Payer analysis.

Joint venture programs with MGMA, InforMed data services & benchmarking tools.

Worked with all gastroenterology associations and their coding addendums & updates for annual implementation in Washington, DC. Voiced the economic struggles & operational climate needs for ‘practicing’ physicians.

Adjunct Faculty-Waubonsee Community College- Anatomy & Physiology/Biology September 2005-2008

Director of Market Development & Planning-Chicago Division

Kindred Hospitals of Chicago- Chicago, IL September 2003-September 2005

Increase visibility and awareness of LTAC position in the continuum of care. Promote "specialty" hospital services in each of the four locations to providers, consumers, and community. Develop strategies and data to support LTAC utilization.

Achievements:

Developed a sales training program for our direct clinical (non-sales) team with MedPar and Compdata to illustrate GMLOS and lost revenue, throughput issues to illustrate LTAC benefits with referral sources.

Created a DVD and other tools to increase conversion rates of referrals to admissions.

Implemented strategies that positioned specialty hospitals as a non-competing resource to medical staff while improving backlogs within primary acute hospital.

Comprehensive Strategic Marketing & Media Plan with adequate reach & frequency specific to LTAC demographics.

Assumptive sales presentation to hospital executives with data that illustrates throughput issues with chronic illness. Length stay/outliers data - DRG

Developed partnership with the American Lung Association of Metropolitan Chicago to jointly deliver our community interests. Committee Member for 2004 Asthma Walk & Hustle Up the Hancock.

Director of Medical Staff Development

Sherman Health Systems- Sherman Hospital - Elgin, IL March 98 to August 1999

Recruited by the Senior Vice President and Chief Operating Officer to return to Sherman Health Systems.

Primary responsibilities included management of 6 staff employees, business development strategies for hospital admission increase goals, the development and implementation of programs to improve and enhance relations with physicians as well as employees and patients. Primary activities included a comprehensive Physician Development and Implementation Plan to increase market share, acquisition of community practices. Compliance Officer for service agreements/physician contracts.

Achievements:

Significant improvements to revenue streams of adjusted patient days, surgical cases, obstetrics and deliveries, and dramatic improvement of outpatient service revenues within a nine-month period.

Increased retention by developing a professional association for physician practice managers

Implemented a customer service/motivation program for employees improving customer relations

Director of Professional/ Physician Services

Alexian Brothers Healthcare Corporation/St.Alexius Medical Center - Hoffman Est., IL

February 1995 – September 2003

Reporting directly to the CEO. Responsibilities included business development strategies for improved hospital admissions and out patient services, physician practice consulting services, physician employment contract negotiations and federal lending “practice guarantee” programs for new physicians, ongoing communications and public relation and marketing responsibilities.

Other responsibilities included monitoring and initiating physician-marketing campaigns based upon CompData & Practice Match software tracking admissions and providing market pattern analysis.

Achievements:

Increased the Medical Staff by 44% with approximately 350 new members.

Improved Physician Satisfaction Survey to 98%, second highest within the Columbia system.

Increased admissions 15% and outpatient services 12% by expanding market share and service area within the six neighboring territories by realigning practices and time-share satellites.

Implemented consultation services to IPA’s, and individual group practices on such issues as: marketing strategies, recruitment techniques, patient satisfaction surveys, NCQA, HEDIS measurements, collections enhancement, and Managed Care contract evaluation and utilization reporting.

Executive level collaboration with external consulting firms and a member of Competitive Intelligence Team.

Developed associations for office managers (PAHCOM-chapter) and Networking Female Physicians.

Manager of Physician Services & Health Services Contracting

MedFirst - Wellsley Medical Management, Inc., Chicago Division February 1990-April 1993

Responsible for the operations, scheduling and physician development of 23 freestanding ambulatory care centers. Primary activities included negotiating physician contracts and incentive packages, obtaining and verifying credentials, references and other documentation necessary for employment, coordinating benefits and malpractice insurance for physicians. Also responsible for occupational agreement & proposals for Employer’s health services to reduce costs & insurance liability. Collaborated with the Corporate Medical Director on quality and utilization issue, and HMO, PPO and IPA contracts.

Education & Certifications:

Bachelor’s of Science- Healthcare Administration-1988 Southwest Texas State University- AUPHA/ACEHSA

Master’s of Science in Management/Organizational Development- Benedictine University-May/02

Nursing Clinical Studies- 1994-1995 (not licensed)

Master’s Certificate-Professional Practice Management-1997 Managed Care Health Law -1996

American Academy of Professional Coders-Certified Professional Coder 2008

Certified Professional Compliance Officer 2015

References furnished upon request



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