Shovana D. Williams

**** ******** **** **, ***** #379. Raleigh, NC 27609

Email : ad1mc9@r.postjobfree.com Cell : 919-***-**** PROFESSIONAL

SUMMARY

WITH A DIVERSE SET OF KNOWLEDGE AND SKILLS IN HEALTHCARE REVENUE CYCLE, PHYSICIAN CREDENTIALING, AND PRACTICE MERGING, I HAVE GAINED EXTENSIVE BACKGROUND EXPERIENCE IN MY 29 YEARS IN THE FIELD. I EARNED MY B.A. FROM THE UNIVERSITY OF CONNECTICUT IN 1992 AND HAVE SINCE HONED MY BROAD-BASE COMPETENCIES TO BECOME A HIGHLY RESPECTED PROFESSIONAL IN THE HEALTHCARE INDUSTRY. THROUGHOUT MY CAREER, I HAVE DEMONSTRATED EXCEPTIONAL LEADERSHIP ABILITIES AND HAVE DEVELOPED A DEEP UNDERSTANDING OF THE HEALTHCARE REVENUE SYSTEM, MAKING ME AN ASSET TO ANY ORGANIZATION SEEKING TO STREAMLINE THEIR OPERATIONS AND OPTIMIZE THEIR REVENUE.

SKILLS

• Microsoft Word, Excel PowerPoint

Crystal Reporting, ADHOC

• Reporting,Medisoft, IDX-DBMS,

AVIO, Medical Manager, SMS,

CBSI,ePremis, Epic, MAIN MD,

QuickBooks

• Accounting, Versaform, Meditech,

MARSH, Core System and OnQ

system certified and Kareo

System. Cisco

• System Webex, All Google

Applications (i.e mail, calendar,

drive, hangout, etc...), Quickbooks

Pro Accounting

• Accounting, Functional, Strategy

• Accounts payable,

Gastroenterology, System

integration

• Accounts receivables, Insurance,

Tax

• Accounts receivable, Inventory,

Team management

• AR, Leadership, Workflow

• Balance, Managing

• BC, Marketing

• Billing, Materials

• Branding, Medical Manager

• Computer Knowledge, Microsoft

Word

• Contracts, Negotiating

• Preparing contracts, Negotiation

• Conversion, Optimization

• Counseling, Pathology

• CPT, Payroll

• Crystal, Policies

• Client, Processes

• Clients, Coding

• Customer services, Project

Management

• DBMS, Speaking

• Delivery, Quality

• Documentation, QuickBooks

• Drafting, Accounting

• Driving, Quickbooks Pro

• Economics, Radiology

• Electronic Data Interchange,

Recruiting

• EDI, Reporting

• EPIC Systems

• Financial, Seminars

• Floor Plan Schematics

• SMS Systems

• Budget preparation, Medisoft

• Budgets, Meditech

• Budget, Meetings

• Bi, Excel

• Call Center, Mail

• Cisco, Office

• CMS, PowerPoint

WORK HISTORY

INTERIM PROJECT MANAGER FOR KAISER PERMANENTE MID- ATLANTIC- PATIENT FINANCIALSERVICE DEPARTMENT (PFS) 02/2009-12/2010

•Provides high quality and cost-effective project management, analytic support services and technical expertise for broad array of issues

•Leads projects of complex scope in-depth analysis and evaluation of various factors

•Works on projects broad in scope and may involve multiple functional areas and/or span across service areas.

•Exercises judgment within generally defined practices/policies in selecting methods and techniques for obtaining results

•Develops project plans which identify key issues, problems, approaches, performance metrics and resources required

•Designs processes to address identified problems

•Establishes team membership and negotiates time commitments and resource allocation

•Provides staff leadership to multi-disciplinary teams

•Manages work of outside consultants

•Motivates team members and facilitates team meetings

•Acts as liaison, problem solver, and facilitator

•Cultivates and reinforces appropriate group values, norms, and behaviors

•Provides guidance to team on performance and productivity issues

•Designs research plans for data gathering and analysis

•Actively participates or may lead in analyzing data and developing recommendations and action plans

•Is accountable for development of project documentation for leadership and clients to facilitate sharing of project outcomes and best practices

•Plans and facilitates meetings

•Makes formal presentations to various audiences.

•Establishes procedures regarding implementation of project outcome

•Assesses project impact on workforce

MANAGER OF NEW TECHNOLOGIES AND REIMBURSEMENT

*HIRE DATE: 07/2007-10/2008

Technologies and Reimbursement

• Responsible for managing the CPT/RUC activities and for supporting Practice Management and Economics Committee programs.

• Developed a Technology Assessment Subcommittee.

• Monitored health care environment and reported on areas that affect gastroenterology.

• Assisted companies with creating a CPT code and Relative Value for a potential device or procedure.

• Worked with the American Medical Association (AMA) staff in submitting code change applications to the Relative Value Update Committee (RUC).

• Responsible for attending the quarterly RUC and CPT meetings for new healthcare policy updates and application submissions to the GI society. CPT/RUC REPRESENTATIVE

Physician and Payor Credentialing Medicare 855A/B/I/R/O/S Enrollment Expert States of VA, MD, DC

REVENUE CYCLE PROJECT MANAGER CONSULTANT, PROJECT LEAD 01/2007 to 06/2007

Mergis Group, AGA Institute Bethesda, MD

• Leads & oversees major concurrent projects from conception through final implementation that are targeted toward specific revenue cycle improvements.

• Participates in development of the revenue cycle systems strategy & coordinates resources w/in revenue cycle business units, KP-IT & the KP Health Connect Competency Center, both nationally & locally.

• Represents the revenue cycle business perspective on local & national projects that require a detailed understanding of revenue cycle workflow & systems.

• Leads cross-functional work teams to address issues that impact revenue cycle effectiveness.

• Manages all aspects of the development & implementation of assigned complex projects.

• Develops & maintains detailed work plans, schedules, project estimates, resource plans & status reports.

• Conducts project meetings, project tracking, & analysis.

• Ensures adherence to quality standards & reviews project deliverables.

• Identifies project risks & takes appropriate actions to mitigate them.

• Encourages & motivates team members to achieve project & team goals Major, : Centers of Medicare and Medicaid Services (CMS), Medicare Advantage and Cost Encounter Data Submission, Workman Comp (WC) Electronic Data Interchange (EDI) deployment with P2P, Claim Optimization (835 Conversion) with Health Logic (subsidiary of Bank of America).

• Self-Pay Account Balance Vendor data merge and Kaiser Permanente of the Mid-Atlantic States, 855B Facility Enrollment Process. MD/DC MEDICAID AUDITOR CONSULTANT 02/2000 to 06/2007 EA MANAGEMENT GROUP Gainesville, VA

• Worked for various physicians and medical organizations providing various services including pre and post employment exams for our numerous clients (Homeland Security) Call Center.

• Customer services Call Center and Collection training.

• Responsible for entire Revenue Cycle Management and Project Management.

• AR Recovery over 120+ days.

• Financial counseling training.

• Physician Education on insurance contracting, and other various Practice Management duties.

PRACTICE MANAGER/MARKETING 01/1997 to 01/2000

Metropolitan Medical Center Annandale, VA

• Responsible for managing all aspects of physician/physical therapist medical practice.

• Responsibilities included but were not limited to managing accounts receivable and accounts payable.

• Preparing contracts for marketing to various companies and consumers in the metropolitan area for pre- employment and diagnostic testing.

• Created a billing and collections department including front and back-office procedures which were successful in keeping our A/R days down to 20 days turnaround.

• Responsible for all practice management.

• Responsible for system conversion and implementation.

• Instrumental in putting in place a self-pay cash at point-of-service fee schedule; effective in collecting 85 to 90% of all 60 and greater receivables.

• Handled all insurance credentialing and physician license renewal.

• Prepare timely forecasts and account status report to provide management team with critical information needed to manage.

• Resources necessary to support patient account activities; performed in- depth analysis to capture understanding of prospects infrastructure, identifying revenue opportunities from insurance and third-party payers. DIRECTOR OF REIMBURSEMENT 04/1995 to 12/1996

Integral Health Associates, PC Chevy Chase, MD.

• Provided financial oversight to all satellite centers.

• Responsibilities included but were not limited to handling all Managed Care, Medicare, BC/BS and third-party insurance contracting in collaboration with the local management of all company operating entities.

• Conducted site reviews for our 7 satellite offices assuring that they were complying of our overall healthcare systems mission.

• Responsible for compliance with all Medicare/Medicaid policies and regulations.

• Responsible for reporting on monthly revenue projections and rejection trends that impacted our revenue to the Board, CFO and Comptroller.

• Responsible for all productivity reporting established standards and targets for all reimbursement procedure activities by site; served as primary liaison between the CBO, managers, physician's comptroller,

• CFO and VP of operations; supported system integration activities including data conversions; assisted in recruiting of team members; monitored and optimized reimbursement from third party payers on collection activity by payer and by CPT codes recommending fee adjustments or coding enhancements.

DIRECTOR OF REIMBURSEMENT 06/1993 to 04/1995

United Health Inc Oxon Hill, MD.

• Responsible for overseeing MSO operation for our parent institution, Greater Southeast Hospital.

• Managing seventeen physicians' private practices that are also employees of the hospital.

• Responsible for creating innovative ways to generate revenue for a healthcare institute that was highly populated with 70% Medicaid and 30% Medicare patients.

• Provided physicians with CPT training to maximize our reimbursement scale.

• Provided training for front-end and back-end employees.

• Managed marketing for the MSO model for other non-physicians at Greater Southeast Hospital and Fort Washington Hospital Recruit and hired all non- clinical staff.

• Responsible for billing/collections of 11 specialty departments and team management over 40 employees at all locations including staff at our Fort Washington Hospital location.

EXECUTIVE LIAISON 08/1991 to 06/1993

George Washington Medical Faculty Associates Washington, DC

• Responsible for four (4) departments which my daily responsibilities were to work closely with each department Chairman within the following departments: Neurological, Radiology and Pathology departments.

• Responsible for evaluating and managing all financial and budgetary analyses.

• Provide reporting and analysis to the chairmen on all financial matters.

• Responsible for ongoing training of Physicians and staff on changes in policies and procedures that would impact revenue monitored monthly department budgets.

• Resolved all department financial issues that improved fiscal operations for corporate office; generated all ADHOC/Hayes reports to use as tools to determine and forecast new directions in improving the bottom line.

• Analyzed trends and recommendations that impacted the physician's accounts receivables; performed special studies covering a broad spectrum of functions or activities as directed by the comptroller.

• Managed and negotiated all insurance contracts for the providers; negotiated 80th to 90th percentile contracts based on tracking and productivity data personally captured, this assisted in negotiating a higher payment scale; provided operations support to department supervisors. EDUCATION

BSBA Bachelor of Science Business Administration 2003 University of Connecticut, Storrs, CT

GPA: 3.8

AFFILIATIONS

• The Small, Women-owned, and Minority-owned Business (SWaM) certified Association of Healthcare Coding Specialist (PAHCS)

• Certified Coding Specialists (CCS)

• National Association of Healthcare Executives (NAME)

• Management Group Managers Association (MGM),

• Medicare Metropolitan Area Task Force

CERTIFICATIONS

Certified Coding Specialist- Physician-based (CCS-P) AHIMA

CERTIFIED

PROFESSIONAL

CODER (CPC)

Became a Certified Coding Specialist- Physician-based (CCS-P) while working for American Gastroenterological Association (AGA), as the Manager of Innovations Technology with Dr. Jay Pasricha, MD, and Dr. Joe Brill.

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