Qualifications for

Executive-Level IT Management / Revenue Cycle Management / Project Management

I offer over 30 years of Revenue Cycle Business success in the healthcare industry, with 20 years in a management role both as a consultant and employee. Background includes 18 years of experience in revenue cycle application consultations, project management, system implementations, revenue cycle management, systems assessments, and optimization projects. I have the unique ability to combine business needs/requirements with the IT technology skills and project management experience to lead RCM optimization projects and goals.

Areas of Expertise

Process Improvement

Project Management

Management of staff

Team Building/Management

Software Management

Patient Access Operations

Strategic Planning

Revenue Cycle Analysis

Denial Management

Performance Improvement Development

Cash Acceleration

Training/Development

Decision Support & Reporting

Professional Highlights

Revenue Cycle Lead Project Manager to Develop a ‘model’ system solution for the implementation of a new EHR in a 7 hospital system environment in the NY and NJ region. As the lead Project Manager I was responsible for the development of tracking issues/change management as well as for developing project scopes, timelines, and work plans for major application installations.

Improved cash collections for a major university health system in New York by 40+% through improving system processes and functionality as well as assisting in a management role of the Patient Financial Services Department over Billing and Collections departments increasing NY Medicaid reimbursement by $5M per month.

Served as an instrumental member of the Coding Cleanup Committee and reduced the number of accounts with bill holds as well as overall accounts receivables through the early identification of problem accounts, automated corrections, and claim denial management.

Served as the Consultant Project Manager and lead architect to consolidate multiple Siemens INVISION Hospital Systems utilizing Division Code Processing, which reduced application fees and on-going support costs through standardization.

Led a team in the system assessment, analysis and optimization of current processes and operations that reduced A/R days, reduced denials, and increased cash; Lead a team with project management, system design, and system setup for a seven-hospital healthcare system.

Senior consultant for Jackson Health in Miami for the implementation of Revenue Cycle Management Policies & Procedures and new Revenue Management System for Revenue Cycle Operations.

Career Synopsis

Healthcare Application Consulting Solutions LLC

Senior Consultant/ President 2004-Present

Provides consultation in the development and management of staff in an RCM healthcare environment as well as project management leadership for project implementations. Develops policies, procedures, and process standardization to improve overall RCM performance. Conducts Revenue Cycle process evaluations/assessments on both frontend and backend processes for potential improvements/optimizations, cash acceleration, and denial reductions.

Major Engagement: Providence Home Health and Hospice – July 2022 – March 2023

Interim Director of Revenue Cycle Department for Home Health and Hospice;

oCalifornia, Washington, Oregon, Texas, and Alaska

oPrimary responsibilities were the management of Billing & Follow up of Home Health & Hospice Receivables

Analysis of Denials and processes to reduce cost and denials and to improve cash flow.

Review of aging reports to establish strategies for increasing cash collections and reducing aged receivables

Identify key areas of manual processes and developed strategies and processes to reduce FTE requirements – Utilize Scripting Technologies

Identify and resolve key system issues for billing and follow up and developed processes/procedures to resolve and improve collections

Implemented Improved Documentation of Policies & Procedures and Training Documentation.

Develop KPI’s and benchmarks to assist in productivity and quality improvements

Major Engagement: Sight Growth Partners – March 2022 – July 2022

Interim Executive Director of Revenue Cycle Department for a multi-state system;

oPrimary responsibilities were the management of Coding, PFS, and Revenue Integrity within the Revenue Cycle group.

Analysis of Denials and processes to reduce cost and denials and to improve cash flow.

Review of aging reports to establish strategies for increasing cash collections and reducing aged receivables

Identify key areas of manual processes and developed strategies and processes to reduce FTE requirements

Identify and resolve key system issues for billing and follow up and developed processes/procedures to resolve and improve collections

Identify charging set up issues with inappropriate RVU’s causing bundling denial cash reductions.

Major Engagement: UVA Health – Feb 2022 thru March 2022

Served as a Project Manager for the Revenue Cycle Epic Implementation

oTracked cost and budgets

oResource allocation for the project

oEstablished project goals, objectives, and timelines

oMaintained project status updates

oEstablished and monitored project risks

oAssisted in the Analysis and design phase of the implementation

Major Engagement: Prisma Health – Columbia, SC Sept. 2019 – Dec 2021

Interim Executive Director of Revenue Cycle Department for a multi-hospital system and Home Health & Hospice;

oPrimary responsibilities were the management of HIM, PFS, Customer Service, Revenue Integrity and Patient Access within the Revenue Cycle group.

Development of Denials Management team and processes to reduce cost and denials and to improve cash flow. This provided a $2M monthly cost reduction and reduced denials by 10%.

Assisted with the implementation of Epic

oDevelopment of Productivity Reports

oDevelopment of Dashboards

Revenue Integrity

Patient Access

PFS

Identify and engage in Process Improvements within Revenue Cycle

oConducted a Cash Acceleration Project.

Assisted in the development of Coding Optimization Processes utilizing CDI specialists and continuing education initiatives improving the collections by over $2M per month.

Mentor the staff as needed

Assisted in Improving and centralizing Patient Access operations with improvements in Authorization Management, Coverage Discovery, and formulation of a Financial Counseling team as part of a Patient Centric model of care delivery

Manage operations to meet and exceed KPI’s

Development of Vendor Management processes

Major Engagement: Children’s Mercy Health System – Kansas City, Mo. Feb 2018 – Mar 2019

Interim Senior Director / AVP of Revenue Cycle Department;

oPrimary responsibilities were the management of PFS, Customer Service, Revenue Integrity and Patient Access within the Revenue Cycle group.

Identify and engage in Process Improvements within Revenue Cycle

oConducted a Cash Acceleration Project.

oImplemented a Contract Management Software Solution

oSpearheaded project to bring IT Support within Children’s and away from the vendor due to delays in support functions

Mentor the staff as needed

Spear-headed a project to reduce credit balance volumes

oUtilized Optum as a resource to assist with commercial populations

oPerformed analysis on credits to isolate false credits and adjust as appropriate

oReduced credit balances from $10M to $3M

Assisted in Improving Patient Access operations with improvements in Authorization Management, Coverage Discovery, and formulation of a Financial Counseling team as part of a Patient Centric model of care delivery to improve point of service collections.

Contract with Accenture to assist with Revenue Cycle Transformation projects

oRev Cycle Admin – Define KPI’s

oRevenue Management Projects

Reports, High Dollar/High Risk mitigation, Denials with external departments, DNFB with external departments

oDenial Management & DNFB

oPoint of Service Collections & Self Pay

oCharge Capture

oPhysician Revenue Cycle

Development of Vendor Management processes

Patient Centered focus on outcomes tied to reimbursement

Major Engagement: Englewood Health System 2016 – 2018

Senior Consultant for providing Revenue Cycle application support for Siemens INVISION Patient Accounting. This includes support for OAS coding, OAS Profiles, Ad hoc Reporting, CWS, Room and Bed, Error Reconciliation, Case Mix, Doctor Master, RPM, PRM, OML/Billing, HPPI, and CDM.

Assisted in recommendations of INVISION system configuration for process improvement initiatives.

Provided integration support and resolution of HL7 error messages in Openlink

Identify additional areas of opportunities for system improvements, “best-practice” opportunities, and overall Revenue Cycle optimization.

Provide additional support for non Cerner Invision Applications; Integration, Gaffey billing

Major Engagement: Duke University Health System – Durham, NC Oct 2011 – Sept. 2015

Interim Senior Director of Revenue Cycle Department; Duke Raleigh, Duke Regional Medical Center, and Duke University Hospital. (Meditech, DSS, Openlink, and Siemens INVISION)

Primary responsibilities are planning, directing, organizing, and controlling the daily activities within the Revenue Cycle group.

Identify and engage in Process Improvements within the Revenue Cycle suite of applications; Improvements noted to date; IME Billing Automation, Late Charge Billing Cleanup; Secondary Billing Cleanup; Frontend data collection and process improvements;

Maintain reimbursement calculations utilizing Invision insurance master file maintenance and loading of OPPS Fee schedules, Case Mix Files, and contract management updates

Attend Epic training and certification program for Revenue Cycle Administration

Assistance with Epic Design and Project Management

Project Management and Implementation of 837 5010 format billing.

Mentor the staff as needed and develop an ongoing training program

ICD-10 Project Management, analysis, review and testing

Decision Support Solutions (DSS) data warehouse support and management

Vendor Management, which includes, extract design, balancing procedures, and automation

Data extractions and database design/development for clinical information

Develop automated processes to support the Epic Resolute Hospital Billing system

oWork Queues

oAutomated Denial Adjustments

Major Engagement: University of Mississippi Medical Center – Jackson, MS 2010 – 2011

Interim Regional Director of Revenue Cycle Application Support within IT.

Primary responsibilities are planning, directing, organizing, and controlling the daily activities within the Revenue Cycle Application Support group.

Identify and engage in Process Improvements within the Revenue Cycle suite of applications

Lead a team for COBOL and mainframe support

Support and optimization of the Siemens INVISION applications for Patient Registration areas, Health Information Management, and Patient Accounting. As well as other add-on applications such as SSI billing and Contract Management calculation resolutions

Mentor the staff as needed and develop an ongoing training program

Assist the staff with standard project management methodologies.

Major Engagement: St. Vincent – Indianapolis, IN 02/01/2010 – July 2010

Project Lead for RCM Optimization and Reconfiguration.

Initial responsibility was to perform a system assessment of the Invision application configuration and Revenue Cycle business process and to then provide recommendations for overall collection improvements. This included all facets of the revenue cycle process.

Identify key areas for cash acceleration and increased cash reimbursements

Determine resource and budgeting requirements to implement approved recommendations

Primary responsibilities are to review Siemens INVISION set up and design, identify production improvements through use of new technologies, improve and optimize system design, automation, and performance, and identify revenue and cash improvement opportunities.

Identify and engage in Process Improvements within the Revenue Cycle suite of applications including mitigation of late charges, denials, and rework.

Work toward establishing a ‘Model’ solution across all of St. Vincent Healthcare INVISION systems.

Major Engagement: St. Mary’s – Evansville, IN 07/15/2009 – 12/31/09 (Migrated to parent company at St Vincent Health System in Indianapolis).

Project Manager for Siemens INVISION System Optimization and Reconfiguration.

Initial responsibility was to perform a system assessment of the Invision application configuration and Revenue Cycle business process and to then provide recommendations for overall collection improvements.

Primary responsibilities are to review Siemens INVISION set up and design, identify production improvements through use of new technologies, improve and optimize system design, automation, and performance, and identify revenue and cash improvement opportunities.

Identify and engage in Process Improvements within the Revenue Cycle suite of applications including mitigation of late charges, denials, and rework.

Assisted in the design and implementation of ENAD Processing.

Mentor the staff as needed and develop an ongoing training program. Training provided to PA Staff for Status Transfers, billing functions.

Implementation of REF and REF Desktop Tool for correcting errors from other systems.

Identify key areas for cash acceleration and increased cash reimbursements – Increased Medicaid reimbursement by over 100K / annum.

Complete review of ePremis Bridge Routines and set up for optimal billing and to update Siemens where possible.

Improved Cash performance from $25 – $28M / Month to over $30M / Month through improved billing processes and denial management.

Major Engagement: Jackson Health System – Miami, Florida 07/14/2008 – 07/14/2009

Project Leader/Manager for Systems Implementation and Revenue Cycle Process redesign.

Primary responsibilities are to review Siemens INVISION set up and design, identify production improvements through use of new technologies, improve and optimize system design and performance, identify revenue and cash opportunities.

Identify and engage in Process Improvements within the Revenue Cycle department.

Support and optimization of the HIS applications for Patient Registration areas, Health Information Management, and Patient Accounting. As well as other add-on applications such as the SSI Billing Editor and Document Imaging.

Mentor the staff as needed and develop an ongoing training program

Assist the staff with standard project management methodologies.

Identify key areas for cash acceleration and increased cash reimbursements

Identify areas for improved revenue capture.

Major Engagement: Mercy Health System – North Region 05/05/2008 – 07/12/2008

Interim Regional Director of Revenue Cycle Application Support.

Primary responsibilities are planning, directing, organizing, and controlling the daily activities within the Revenue Cycle Application Support group.

Identify and engage in Process Improvements within the Revenue Cycle suite of applications

Support and optimization of the Siemens INVISION applications for Patient Registration areas, Health Information Management, and Patient Accounting. As well as other add-on applications such as ePremis.

Mentor the staff as needed and develop an ongoing training program

Assist the staff with standard project management methodologies.

Identify key areas for cash acceleration and increased cash reimbursements – Identified billing errors in Medicaid and rebilled and collected $5M for the prior year claims.

Major Engagement: Eastern Maine Health System 11/05/2007 – 05/01/2008

Responsible for Revenue Cycle Process Improvements and the support and optimization of the Siemens INVISION applications for Patient Registration areas, Health Information Management, and Patient Accounting. As well as other add-on applications such as ePremis.

Primary Activities to date include: (1)Review their charge processes, identifying missing revenue and enabling a stop gap of missing charges; (2) Review and redesign of their insurance and self pay follow up activities and programming the necessary updates in RPM; (3) Review and update their Siemens INVISION Patient Accounting Master Files and Profiles; (4) Identify and reduce manual processes to improve efficiency and reduce errors; (5) Provide key statistical data for CFO and other finances officers; (6) Review and update their statement processing. (7) Review and improve where necessary their processes and work flows for the patient revenue life cycle to minimize inefficiencies, reduce errors, and improve employee and patient satisfaction, while increasing revenues and cash collections. (8) Support and maintain ePremis as necessary.

Major Engagement: North Shore Long Island Jewish Health System 07/30/2007 – 11/02/2007

Project Manager responsible for the Project Initiation and Implementation of Siemens INVISION OAS Gold applications for Patient Registration areas, Health Information Management, Patient Accounting, and Nursing.

Developed the Project Charter and Proposal, Project Work Plan, communication standards for issues, decisions, and Change Control, and budget for approval.

Major Engagement: Albany Medical Center (AMC) (Albany, NY) 04/01/2007 – 05/30/2007

Interim IT Manager assisting in personnel development, review/design of current processes and day-to-day operations of a staff of 10 IT Project Managers/Support personnel.

Served as Project Manager for a major implementation of Acusis physician dictation system. The project was not going well and I developed a project plan and various other documents to support the project team in tracking issues, decisions, and changes.

Developed a ‘Model’ for managing projects on their local intranet utilizing a database provided by AMC to assist those junior project managers in the process of running major projects. Included were documents and spreadsheet templates for contact list, issues management, change management, scope change document, Agendas, Meeting Minutes, decisions documentation, go-live punch list, and an outlined project plan.

Assisted and participated in the design of Soarian Financials with the project managers and users.

Major Engagement: Duke University Health (Durham, NC) 01/01/2007 – 03/31/2007

Provided application support for Siemens INVISION Patient Accounting. This includes support for OAS coding, OAS Profiles, Ad hoc Reporting, CWS, Room and Bed, Error Reconciliation, Case Mix, Doctor Master, RPM, PRM, OML/Billing, HPPI, and CDM.

Assisted the direction of INVISION system configuration for process improvement initiatives.

Identify additional areas of opportunities for system improvements, “best-practice” opportunities, and overall patient accounting system optimization.

Continue to provide remote support as needed and as time permits.

Major Engagement: Westchester Medical Center (Valhalla, NY) 10/31/2005 – 12/31/2006

Provide Revenue Cycle consultation within Patient Accounting Department. We have been able to improve the overall cash collections by over 40% while reducing the number of accounts by 33% and increasing the 0 to 60day aged revenue through improved charge capture initiatives by 30%.

Provide management and cash flow improvement initiatives within the government payers billing department. This included the overall reduction of the outstanding AR, denials, and account volumes while increasing cash collections.

Developed automated secondary billing processing to improve billing functionality and reduce timely filing denials for secondary payers.

Resolved Payer reimbursement Calculation issues and maintained payer contracts.

Developed specific database reporting for non-billed accounts which isolates billing issues and emails these reports to the proper management/support staff daily.

Worked in the development of a Denial Management Process which has seen a steady decline in our denials through focused reporting and system automation and improved processes to eliminate the issues identified.

Identify key areas for cash acceleration and increased cash reimbursements – Identified multiple system issues resulting in increase of cash collections from $32 Million/month to over $50 Million / month.

Major Engagement: Eastern Maine Healthcare System (Maine) 01/07/2005 – 10/28/2005

Provided application support for Siemens INVISION Patient Accounting. This includes support for OAS coding, OAS Profiles, Ad hoc Reporting, CWS, Rom and Bed, Error Reconciliation, ePremis Billing, Case Mix, Doctor Master, RPM, PRM, OML/Billing, HPPI, and CDM.

Assisted the direction of INVISION system configuration for process improvement initiatives.

Identify additional areas of opportunities for system improvements, “best-practice” opportunities, and overall patient accounting system optimization.

Provide additional support for non Siemens Applications; Database Report and design, NDC/ePremis, PC architecture

Major Engagement: St. Luke’s Regional Medical Center (Idaho) 03/01/2004 – 01/13/2005

Provided project management support at including risk management, analysis, mitigation, and change management processes for the Division Processing Project.

Assisted the direction of INVISION system configuration for the implementation of Division Code Processing thereby allowing all healthcare facilities to run within one Hospital/Region Code. This reduced the overall system maintenance required by creating a “Standard” practice solution for both the Clinical and Financial areas of the organization.

Computer Task Group Healthcare (CTG)

Senior Consultant 1999-2004

Served as project manager for installing hospital-based applications and team leader for system implementations. Monitored staff augmentation. Led the patient accounting team through numerous implementations. Assisted in the development of HIPAA-compliant billing. Conducted research of and developed Siemens division processing for account facility identification and case mix assignments. Ensured compliance to HCPCS and revenue coding. Attended weekly meetings with project directors to discuss project scopes, issues, and status.

Major Engagements: Clarian Health System (Indiana); Kaiser Permanente (California); Duke University Health System (North Carolina); Catholic Health East (Pennsylvania / New Jersey)

Provided business and systems expertise in registration and collections processes to assist in system analysis and optimizations, reducing A/R days from 90+ to approximately 60

in 6 months.

Served as project team leader for the SMS INVSION installation for an eight-hospital system.

Assisted in the analysis and development of the Invision Master Files, including analysis and coding. Includes frontend profiles and backend master files, Medical Necessity checking, Room and Bed master design and implementation, service master development, billing and collections, work queue design and implementation, etc…

Columbus Regional Healthcare

Manager of Financial Applications 1995-1999

Maintained daily operations of all financial applications and project managed various financial system implementations. Conducted financial analysis of ROEs (Return on Equity) for major ventures by determining NPV (Net Present Value) of potential projects. Led and directed the IS department at an affiliate hospital through the conversion of Siemens INVISION. Managed a hospital’s conversion from IBAX to Siemens INVISION. Composed various ad-hoc reports to generate files in specific formats for external file transfers for various organizations and government affiliates.

Managed and supported the patient financial software for the healthcare system, including the SMS Patient Financials and the Premis Billing System (now NDC).

Florence General Hospital – Now Carolina Hospital System

Information Services Director 1990-1995

Prepared annual budgets, performed staff evaluations, and researched alternative IT improvement methods for cost reductions, improved patient care, and organizational profitability. Collaborated with senior management to develop long-term strategies. Served as program manager for updates of financial systems.

Managed projects for upgrading the hospital’s information system from and antiquated process to a modern platform and newer application technologies for General Financials, Patient Accounting, Patient Management, Medical Records, and Nursing Order Communications on an IBM AS/400 platform running across a counter-rotating SONET backbone network.

Education & Affiliation

M.B.A., Troy University Graduated - 1999

B.S., Computer Science & Mathematics, Francis Marion University Graduated - 1986

Epic application training for Resolute Hospital Billing and System Administration

CHIME & HFMA, Member since 1986.

HFMA CRCR Certified

References:

Gary Kunkel, Business associate, ad1a5k@r.postjobfree.com, 817-***-****

Greg Klotz, Interim VP of Revenue Cycle, ad1a5k@r.postjobfree.com, 248-***-****

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