MARGARET P. HORAN

** ****** ****

Malvern, PA ***55

Mobile: 610-***-****

Email: ad0iq1@r.postjobfree.com

Revenue Cycle Professional Services with over 25 years of management experience in Healthcare Accounts Receivable, Patient Access Management, and Revenue Integrity. Demonstrated ability to re-engineer and improve operations to meet the changing reimbursement environment. Proven ability to lead and work within a variety of teams to accomplish the department and organization’s goals.

PROFESSIONAL EXPERIENCE

Prospect Medical Holdings, Los Angeles, CA

Prospect Medical Holdings is 17 hospitals and a network of more than 162 outpatient facilities and clinics in Southern California, Connecticut, New Jersey, Pennsylvania and Rhode Island. Crozer Keystone was acquired by Prospect Medical Holdings in July 2016, Crozer Keystone Health went from a non-profit to a for profit healthcare system after the acquisition.

National Director Revenue Cycle Integrity March 2021- September 2023

Facilitate Charge Capture Initiatives, including new service lines of business and new ventures.

Oversight and coordination of operations specific to the Hospital’s Standardized Charge Description Master.

Facilitator of various Revenue Cycle Teams; developed and implemented system wide Best Practices corrective action plans for various department.

Lead with the implementation of NetSmart system for all Crozer Outpatient Behavioral Health services.

Crozer Keystone Health System, Upland, PA 2004 –March 2021

Crozer/Keystone is a five-hospital system headquartered in Delaware County, Pennsylvania. It is a 730 bed integrated health system with $862M in annual revenue, 42,000 annual admissions, and 133,000 emergency room visits. Specialty services include a Level II Trauma Center, the Nathan Speare Regional Burn Treatment Center, Psychiatric and Rehab units.

Administrative Director, Revenue Cycle Operations 2015- March 2021

Reached 101% of Cash Goal or better in 2015, 16, 17 and on track to repeat again in 18. This while changing all banking, provider ID’s, and Tax ID#’s during transition to a new owner.

Successfully negotiated two pre discharge claims receiving payment several months ahead of discharge equaling 17 million dollars.

Oversaw the creation of a metrics driven dashboard for weekly and month monitoring of revenue cycle key metrics.

Director, Revenue Cycle Integrity and EMS Services 2010-2015

Facilitate Charge Capture Initiatives that included new service lines and new ventures for the Patient Financial Services team.

Created a department with Linear responsibilities to Clinical departments for charge capture, which included; root cause of missed opportunity of revenue, internal department audits, claims issues and trends, review and implementation of governmental and Carrier bulletins.

Oversight and coordination of operations specific to the Hospital’s Standardized Charge Description Master.

Chaired implementation of ED Charge by Documentation system (LYNX), with projected additional net new revenue $750,000.00 annually.

Implemented Labor and Delivery Observation services with Compliance department net new revenue $3,000,000.00.

Defense Charge Audits and Payor specific audits.

Implemented a Workman’s Compensation charge review and modification netting over 7 million dollars to the bottom line.

Accomplishments:

Reduced claims that were in a held/rejected status from 62 million in gross charges to 7.7 million in less than sixty-day timeframe for FY15

Implemented a system-wide committee to meet monthly to discuss the Charge Description Master, streamline the process and in sure all departments are in compliance.

Director, Patient Financial Services and Revenue Cycle Integrity 2008 -2010

Oversee all aspects of Revenue Cycle Integrity, Billing, Accounts Receivable Management, and Self-Pay Collections for the Corporate Business Office.

Responsible for monthly corporate-wide A/R reporting and financial analysis, development of annual budget and fiscal year goals & objectives.

Direct a team consisting of five Managers, 6 Supervisors, 67 on-line personnel, report to Vice President, Revenue Cycle.

Accomplishments:

Maintained days in AR at 36 - 42

Established in-house process for Ambulance billing and receivable management.

Lead management advisor and stakeholder for the implementation of new Claim Scrubber system

(XClaims).

Restructured department for cost effectiveness; decrease of seven FTEs.

Maintain an expertise in governmental regulations and third-party payer requirements.

Assist with Corporate Compliance Department investigation and resolution of compliance issues.

Oversee various initiatives and work with the IS department to ensure state-of-the-art billing processes

are in place and functioning properly.

Automated and developed plan of action for working claim rejections associated to OCE for Medicare

In addition, Keystone Mercy receivables; reduction of $5 million in gross charges.

Director, Revenue Cycle Integrity 2005-2008

Corporate, Patient Financial Services

Operationally responsible for the development, implementation and standardization of processes for a five hospital Health Care System to insure that optimal reimbursement was received. Identified and implemented corrective action plans associated with compliance related issues and executed procedures to insure the reduction of the Accounts Receivable is a cost-effective approach. Responsibilities included facilitating Revenue Cycle meetings with all levels of management including Executive management.

Automation of OCE process for Medicare and Keystone Mercy Health Plan accounts. The implementation of this process resulted in a seven to fourteen-day turnaround of accounts and decreased receivables by five million in gross dollars, with a net reimbursement of 10 percent on a monthly basis, based on our reserve.

Identified procedures, services and devices for services being rendered in the Cardiology department; however, the clinical departments did not capture the charges at the time of service. Interviewed the department’s staff and management team and working collaboratively we identified 746 accounts that were reprocessed for additional gross charges totaling $1.6 million gross dollars with an additional net reimbursement of $428,000.00.

Facilitator of various Revenue Cycle Teams; developed and implemented system wide Best Practices corrective action plans for various department.

Instituted a System-wide Best Practices Manual for clinical departments to use as a reference tool to ensure charge capture and reconciliation was completed efficiently and accurately.

Consultant for Crozer Keystone Health 2004- 2005

Corporate, Patient Financial Services

Responsibilities were to establish a process and tracking mechanism for identifying accounts held from processing due to OCE related coding issues for a five hospital Health Care System. Created department specific manuals and conducted educational seminars for educating the physicians, ancillary department directors, and staff on the proper charging and coding criteria to ensure that the five facilities were in compliance with governmental and non-governmental Third Party payer guidelines.

Reduced the Medicare Gross Receivable by 18.4 million dollars within six months; by educating the departments, holding them accountable for the accounts that remained on the receivable at

gross charges and by working in collaboration with physicians and all levels of management in the Finance, Patient Financial Services, Patient Access and Compliance Departments.

Reviewed the Health System’s Charge Description Master for the Pharmacy Department, Operating Room, SPU, and Cancer Center to insure that all CPT/HCPCS codes were current and that charges were created and captured by the departments.

Attended and participated on a monthly basis in the Business Office Review meeting for both Chester Crozer Medical Center and Delaware County Memorial Hospital.

ARC GROUP ASSOCIATES, Jenkintown, PA 2003 – 2004

Director, Governmental Operations

Consultant

Operationally responsible to develop and streamline the Governmental Department to ensure that the proper billing protocol was completed and in compliance, follow up was proficient and optimal reimbursement was generated for all clients. Responsibilities included training and educating the middle management and a staff of fifteen employees on the various types of Governmental billing, follow-up, and reimbursement methodologies. This included developing procedures, creating Knowledge Transfer reports to the clients to notify them of billing and reimbursement deficiencies and attending meetings with the clients.

Developed/implemented policies and procedures to ensure that the processing and resolution of accounts were in compliance with Governmental and other Third Party payer guideline.

Increased productivity and set productivity standards.

Revised the implementation process to secure client information on an early out timeframe so that current guidelines were established for the scope of the project.

Met with clients to review standard productivity reports on a monthly basis, also responsible to research and resolve any client issues efficiently to ensure we were a solution to their needs.

Crozer Keystone Health System, Upland, PA 2002 – 2003

Delaware County Memorial Hospital

Director – Patient Access

Directed a team of thirty-nine employees who were responsible for ensuring accurate, timely, and efficient registration and financial data were obtained from both the patients and insurance companies. Oversaw five departments, which included Admissions, Financial Services, Outpatient Central Registration, Emergency Room, and Pre-Registration Patient Access Departments.

Reorganized the Outpatient Central Registration Department, which resulted in a decrease of patient wait times, increased patient satisfaction, and a more efficient process. The reorganization enabled the department to reduce expenses by reallocating staff and reducing PRN hours.

Provided budget and financial reporting support to Corporate Administration and business partners.

Developed departmental guidelines, which resulted in excellent Customer Service skill sets for the employees and recognized by the hospital.

Provided training programs and developed employees to enhance their growth potential.

Attended and participated in all essential hospital and corporate held meetings.

Mercy Health System, Conshohocken, PA 1999 – 2002

Corporate Office

Director – Patient Accounts

Directed, developed, and implemented the corporate wide APC program in compliance with Medicare regulations to optimize reimbursement for the five hospitals Health Care System. Direct report to the Corporate Vice President of Patient Financial Services.

Restructured the System’s Charge Description Masters to comply with Medicare’s APC regulations and maximize reimbursement. Increased revenue for the system’s four Emergency Room Departments by 50%, this was accomplished by creating charges for the surgical procedures performed in the ERD.

Completed a comprehensive assessment of the system’s coding practices, which resulted in developing and implementing policies and procedures to correct the deficiencies.

Revised and instituted corporate procedures to meet Federal-billing compliance and mandated regulations.

Collaboration with Health System to perform System wide functions to provide continuous compliance education and to conduct assessments on existing programs to optimize revenue.

Mercy Suburban Hospital, Norristown PA

Director – Patient Financial Services/Patient Access Departments Direct Patient Financial Service/Patient Access Departments and reported to Vice President of Patient Accounting. Oversaw Admissions, Emergency Room Registration, Outpatient Central Registration Department, Inpatient and Outpatient Billing, Follow Up and Self-Pay Collections.

Developed and implemented all policies and procedures that ensured compliance with Federal and State programs.

Successfully converted both Patient Registration and Financial Systems from HBOC Saint to SMS Unity and SMSNET on time and within the projected budget.

ARC GROUP ASSOCIATES, Jenkintown, PA 1998 - 1999

Director – Recovery Department

Managed ARC’s Recovery operations operationally developed new programs as conceived by Marketing and Upper Management. Various programs included the Billing and Reimbursement of Implantable Devices, Recovery of Zero Balance Accounts, Collection of Active A/R accounts, and Charge Description Master review for twenty clients.

Directed thirty-five employees to successfully obtain corporate goals completing the above programs, which involved forty contracts for twenty clients nationwide.

Initiated productivity standards and quality monitors that increased departmental efficiency.

Teamed with IS group to automate all client downloads for electronic billing. Eliminated manual intervention resulting in decrease in days in AR by 15 days and enhancing client’s cash flow.

Worked with the clients to ensure satisfaction with corporate services.

Collaborated with and frequently participated in the corporate marketing efforts, including client visits and conducting operational on-site reviews with the facilities Patient Accounting offices to ensure compliance and to direct special projects.

Pennsylvania Hospital, Philadelphia, PA 1990 – 1998

Manager, Accounts Receivable

Managed the Accounts Receivable Department Inpatient/Outpatient Billing, Follow-up, Collections, Cash Application/Reconciliation, Nurse auditing and Customer Service Units for a multi-specialty facility (450-acute beds, 30-bed SNF, and 200-bed psychiatric facility). Developed and implemented policies and procedures for a staff of 46. Updated and monitored coding of CPT/HCPCS for Charge Description Master.

Established Quality Focus Committee that resolved patient accounting/operations issues.

Turned around billing deficiencies in a psychiatric geriatric program that was under 100% review by ensuring staff met Federal billing criteria. Program was under "no review" for the last six months that I was the manager.

Prominently involved in conversion team that created electronic billing (Claim Agent). Researched, reviewed, selected, and installed software approved by Hospital Administration. This install resulted in the reduction of the AR Days from 57 days to 42 within the first 120 days of implementation.

EDUCATION

Saint Joseph’s University, Philadelphia, PA

Completed courses towards B.S. Degree, did not complete

Full Circle, Exton, PA

Certified in Project Management

Intermediate Certification

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