Revenue Cycle Managed Care

Contact

954-***-**** (Home)

*************@*****.***

www.linkedin.com/in/heathernydick

(LinkedIn)

Top Skills

Managed Care

Revenue Cycle Management

Physician Relations

Honors-Awards

Board Member, of Board of Health

and Sanitary control for Broward

County

Commissioner

Commissioner

Publications

Effective AR Management boosts

the bottom line

Heather Nydick

Healthcare Services

Miami-Fort Lauderdale Area

Summary

Over 20 years of management experience in major healthcare organizations including both payor and provider (Hospital, Home Health and Physician) experience.

Specialties: Six Sigma Trained, LHRM, Revenue Cycle Management, Managed Care, Contract Negotiations, Healthcare Compliance and Compliance Auditing.

Experience

Centene Corporation

Utilization Management

February 2022 - Present (1 year 2 months)

Florida, United States

Innovative Healthcare Business Solutions

Director of Revenue Cycle Services

October 2020 - February 2022 (1 year 5 months)

Boca Raton, Florida, United States

Affiliated with Ortho Florida

Independent Consultant

Compliance, Revenue Cycle Consultant

May 2019 - October 2020 (1 year 6 months)

Miami/Fort Lauderdale Area

Jackson Health System

Change Healthcare/ Manager of Clinical Operations

July 2014 - May 2019 (4 years 11 months)

Miami/Fort Lauderdale Area

Pediatric Associates, South Florida

Director of Managed Care

September 2013 - July 2014 (11 months)

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Plantation, Florida

Jackson Health System

Revenue Integrity Specialist

February 2013 - August 2013 (7 months)

Project work with MedAssets

HRMC

Compliance Officer

September 2009 - February 2013 (3 years 6 months)

Hendry Regional Medical Center

Developed, initiated, maintained, and revised policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.

Collaborated with other departments (e.g., Risk Management, Internal Audit, Employee Services, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution.

Responded to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Developed a system for uniform handling of such violations.

Acted as an independent review and evaluation body to ensure that compliance Issues/concerns within the organization are being appropriately evaluated, investigated and resolved.

Identified potential areas of compliance vulnerability and risk; developed/ implemented corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.

Provided reports on a regular basis, and as directed or requested, to keep the Corporate Compliance Committee of the Board and senior management informed of the operation and progress of compliance efforts. Ensured proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required. Instituted and maintained an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures. HCA Physician Services

Program Director

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May 2008 - May 2009 (1 year 1 month)

Responsible for day-to-day operational management of the hospitalist program. Coordinated & developed systems that enhanced the quality and cost-effective delivery of patient care. Developed outreach for the Hospitalist program.

Facilitated the development of Collaborative Rounds with case management, and other ancillary departments of the hospital

Participated in the development and implementation of practice standards and clinical guidelines

Audited and evaluated compliance with clinical guidelines Planned and directed fiscal management to manage the program in an effective manner.

Developed processes to enhance the efficient utilization of resources frequently used by the Hospitalists such as testing, laboratory services, pharmacy, and specialty care.

Contributed to monthly administrative quality and financial reporting Collected, analyzed and interpreted complex data,as well as researching and preparing comprehensive reports.

Collaborated effectively with leadership and all healthcare providers to achieve desired outcomes for program.

Developed systems to facilitate communication of key information to patients/ families, PCP's, referring MDs, RNs, and other key stakeholders across the delivery system.

Functioned as a liaison for physicians, staff, and patients; responds to complaints/concerns in coordination with the Medical Director. Attended appropriate facility and departmental meetings regarding employment related matters, policies, procedures, and programs which may impact the program.

Preferred Care Partners

Consultant for Hospital Contract Management

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February 2007 - April 2008 (1 year 3 months)

Negotiated Hospital contracts for expansion counties in central Florida Catholic Health East

Executive Director

January 2000 - May 2006 (6 years 5 months)

Responsible for Holy Cross Hospital, Holy Cross Physician Group, Home Health in Fort Lauderdale, Florida and Mercy Hospital, Mercy OutPatient Diagnostics in Miami, Florida

Holy Cross Health Ministries

Executive Director of Managed Care

January 2000 - January 2006 (6 years 1 month)

The primary job responsibilities were the same as below for Mercy Hospital. Mercy Hospital

Executive Director of Managed Care

January 2001 - January 2004 (3 years 1 month)

Primary responsibilities include contract negotiations of major hospital, rehab, physicians, and ancillary contracts

Attained $1,000,000 administrative cost savings through the successful re- negotiation of major Health Plan contracts

Responsible for all insurers contracting including plan relationships for Florida hospitals, Physician groups, acute Rehab Hospitals and a surgery center in Florida's most highly penetrated managed care market Built Managed Care portfolio to over $300 Million, a 5%+ of HCHM total net revenue

Provided guidance to Division CFO on market positioning and leverage strategies relative to hospitals relationships with insurers Developed with CFO division case management function, revenue integrity policies and audit protocols charge master maintenance tools, and insurer audit reserve analysis

Negotiated $6,000,000 in accounts receivable settlements with many major payers to settle short pays, contract, and interpretation Built and maintain current managed care relationships with key plan executives during a period of price concession avoidance and rate increase strategies

Implemented business development processes whereby major plan PCP's and physician networks became an area of focus by hospital executives, supporting volume growth during a period of open access sales by major plans Page 4 of 6

Implemented systems and pricing templates to maximize price hospital and surgery center service offerings, establishing key category reimbursement rates based upon cost coverage and margin goals

FLORIDA ACUTE CARE SPECIALISTS, INC

Director of Provider Operations/Administrator

January 1997 - January 2000 (3 years 1 month)

Primary responsibilities included negotiation of physician and ancillary contracts and implementation

of Hospitalists programs throughout the Tri-county areas Implemented innovative Hospitalist program for four major health plans Increased membership from 200,000 covered lives to 500,000 Oversight and developed educational presentations regarding program/product Interacted with 48 Hospitals and over 700 physicians across six Health plans Organized physician panels by hospital for coverage of 75,000 commercial/ Medicare lives

Recruited physicians for hospitals without coverage and liaison between health plan, primary care providers, and employed physicians Created financial and utilization reports for skilled Nursing ORAL HEALTH SERVICES

Vice President of Managed Care/Business Development/Marketing January 1996 - January 1997 (1 year 1 month)

Primary responsibilities included acquisition of Vision Care Plan, Marketing, and Implementation of new products

Developed pricing for all dental and vision services for Health Plans, Third Party Administrators, and municipalities

Provided oversight and maintained budget for statewide locations

(Jacksonville, Tampa, and Gainesville) Maintained and managed a strong provider and specialty statewide network

Developed broker strategic plan to increase covered lives of 50,000 members Standardized all marketing, enrollment and media communication documents related to dental and vision services

Instrumental in obtaining the exclusive agreement for Dental and Vision services for one of the largest school board entities in the nation Increased earnings by 8 million dollars

Created electronic open enrollment forms on site to employers to facilitate the speed of enrollment process

PCA

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Network Operations and Development

January 1994 - January 1996 (2 years 1 month)

Responsibilities included negotiation of major hospital and ancillary contracts Avert hospital contract terminations, re-evaluating and re-contracting the Southern Region's ancillary network to remove non-system administrable provisions and improve cost effectiveness

Maintained and managed a strong provider and specialty statewide networks Standardized all provider agreements and established the overall philosophy of contracting with HMOs, IPAs and hospitals

Evaluated, negotiated, and implemented cost-effective provider agreements Developed and maintained Network Development fiscal year budget of $700M Special Projects State of Florida Operations & Development PCA Healthplan

Director of Network Development,State of Florida

1993 - 1996 (3 years)

Education

Broward Community College - Florida

Diploma, Nursing

Macon Area School of Nursing

University of South Florida

Risk Managemnt, LHRM

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