Program Manager Revenue Cycle

Grace M Gumz, MBA, PMP, BSP, ITILf, CMUP

Independent – Program Manager/Director, a Business Professional and Consultant

229380 County Road E, Athens, WI 54411 (C) 715-***-**** **********@*****.***

Skill Profile

I have an MBA in Business Administration with 4.0 GPA, Certified in PMP, ITILf, BSP

Over 10 year’s healthcare experience in various Healthcare organizations and roles; clinically driven revenue cycle and standardization of various functions (registration/scheduling) are only a few examples of the work I’ve been engaged in.

Implementing both Cerner and Epic EHRs. Prepared and submitted RFI and RFP Surgical system

Understanding healthcare organizations, the roles physicians play in completing their documentation, orders, etc., in a timely and accurate manner is only part of helping an organization meet their financial/revenue goals and improving their financial margins. This clinical part of revenue cycle is only one part of the puzzle, as you need to look holistically at other aspects of revenue (coding, reimbursement, claims processing, clean claims software, and departmental changes, profee (professional fees) charges, etc.

I constantly utilize and demonstrate my maturity and ability to manage and motivate teams, both client and vendor engagement teams, with diverse skills and backgrounds. Teams have included staff members, senior and managerial levels as well as consulting professionals. Working collaboratively in this environment is critical, as failure to do so, can lead to failure of the engagement.

I foster an innovative and inclusive approach to work environments, effectively mentoring team members to ensure success for all.

I engage with key resources, to ensure our deliverables meet or exceed the quality expectations of our work product within our established timeline and budgetary constraints.

Monitoring the pulse of the engagement, the progress made or not made and taking corrective action (issue and risk management) when needed ensures our key stakeholders are well informed regarding our progress and outcomes. I repeatedly create and report out engagement status to Management teams to and including C-Suite.

I possess excellent oral and written communication skills which are critical and necessary to engage with all team member, especially essential for communication with C-Suite and above.

Cultivating and managing business development opportunities is demonstrated with an eye to the future needs of an organization as well as how to enhance the current engagement and outcome. I most recently completed a transformation engagement.

Most, if not all engagements I’ve been involved in start with a current state assessment, moving onto a future state, laying the foundation for what is to come. Identifying the deltas, as well as identifying what will stay the same, what will change, and what will stop, can give the team a sense of rightness and understanding of the necessity of the engagement with the intended goals of the organization. The start, stop, continue documentation is critical to gaining buy in. Process mapping is critical as well (a picture is worth a thousand words). I am six sigma trained.

I am analytical by nature and possess strong problem solving skills. The engagements I’ve taken have necessitated that I develop technical skills in addition to my business skill set.

Highlights of Work Experience

Program Manager – Healthcare Consultant 10+ years

Self-starter, progressive thinker, strategic and tactical planner, results oriented leader, problem solver, excels in leadership and execution skills

Portfolio, Transformation (SDLC) Consultant, Program Management, Sr. Project Manager, Sr. Consultant and Advisor, Revenue Cycle

All skills and experience gained over course of career are building blocks for next engagement and are transferable, industry and software agnostic

20 years Project Management experience; 15+ years’ experience working at or working with enterprise health systems; 10+ years’ experience in client facing, consulting or operational role, 6+ year’s PgM Management

Manage the implementation of new products into programs and manage progress, timelines, status, schedules, risks, issues, and resolutions to stakeholders.

Experience working at or working with enterprise systems.

Mergers and acquisitions (E.H.R. systems)

Proven track record of successfully delivering large complex projects and attaining high client satisfaction.

Direct large-scale, complex projects that may involve multiple internal and external partners

Develop the charter, integrated project plan, test, train and communication plans, resource plan, governance committees, change management plan, contingency plan, and related project management artifacts

Partner with business sponsors to define success metrics and criteria

Validate financial forecasts and provide ongoing reconciliation of resources and other related project expenditures

Facilitate all operational checkpoint activities throughout the lifecycle of projects

Collaborate between multiple departments and teams to reconcile competing priorities to maximize overall client satisfaction and project success.

Form strong relationships with clients by serving as the client champion, understanding, and communicating client feedback internally and holding individuals accountable to deadlines and needs.

Identify, assess and resolve project risks

Ensure projects adhere to methodology and compliance standards set by the organization

Establish partnership with stakeholders continually influencing, communicating and aligning.

Define and track project achievements while developing, maintaining, and reporting on an overall and integrated delivery plan

Ensure end results are of the highest caliber with a clearly articulated scope and quantifiable business benefit

Support, share findings, and mentor others within the PMO regarding standards, organizational understanding, and relationship building to promote the successful delivery of projects

Strong planning, organizational, and leadership skills, including the ability to mobilize and motivate teams, set direction and approach, resolve conflict, deliver tough messages with grace, and execute with limited information and ambiguity

Excellent problem-solving and critical-thinking skills, including the ability to remove barriers and enable teams to complete their objectives

Strong verbal and written communication skills, including the ability to communicate at all levels with clarity and precision

Strong influencing and negotiation skills, including the ability to navigate in a highly matrixed organization effectively (agile and waterfall)

Strong interpersonal skills, including the ability to guide and influence others

Focused and versatile teammate who thrives in a dynamic situation, ambiguity, frequent change, or unpredictability

ServiceNow (SNOW) PPM, and Clarity PPM experience

Education, Certification and Training, Licensing

PMP Certified since 2006

ServiceNow (SNOW) PPM

BSP certified (Balanced Scorecard Professional) providing skills to assist organizations with their Strategic and Tactical Planning and execution

ITILf certified 2012

MBA – 4.0 GPA in Business with a Project Management focus – Walden University

Lean six sigma green belt trained

Attended JIRA training

MS Project, SmartSheet, V1 (Cerner), HP PPM

Microsoft suite of tools

Google drive forms

Epic Orion

Industry experience

Healthcare (16 + years), Insurance (20+ years), Finance (6 years)

Special projects: Epic RFP Response (Randstad Digital) September 2023

EMPLOYMENT AND CAREER HISTORY RECAP

Vertek Solutions – CHS – Program Manager

February 2023 – July 2023

Currently working on two Cerner programs. Proficient in google drive forms.

The first program (Merit) is a total of 5 hospitals and as part of the team, I am responsible for Base role assignment (over 1000 base roles), as well as over 3000 positions. This includes coordinating and managing both employed and contracted resources, physicians, office staff, and ancillary positions as well. Additionally, I’m I have oversight of BMDI deployment of Mindray related devices, monitors, vents, etc. and connectivity. I also have oversight of UniPOC and TeleTracking, eventually taking over TeleTracking planning and execution. I’m also managing the Command Center and Cutover Planning activities in concert with Cerner, Integration teams, TeleTracking and UniPOC, as well as local IT.

The second program which I am responsible for is the 2023 Conversion Program, consisting of 5 hospitals, 3 in wave one, 2 in wave two. Wave one is converting from Pulse to Cerner, and wave two is converting from Meditech to Cerner. Currently in the planning stage (pre-phase 0 planning), which consists of completion of the various site specific toolkits. This phase is slated to end in July, with Phase 0 planning slated to start after the upcoming go live of the Merit Program.

Managed roles and responsibilities for 5 organizations in prep for go-live. IDM/IAM tool set.

Tools used: SNOW, Google Worksheets and Documents, Adobe eSignatures, MS Office suites, Cerner Method M.

In SNOW (Service Now), we are tracking contracts, purchase orders, burn rates and expenses (financials), as well as issues and risks, resource planning. In Method M, we are managing Cerner Issues, Risks, Project documentation (DCWs), Status reporting.

Other status reporting is also occurring on a weekly and monthly basis, with a wide variety of executive leadership from a program perspective as well as site leadership.

Working with a variety of vendors, including but not limited to: Oracle/Cerner, 3D, TeleTracking, PwC, TelPro to name a few.

In addition, currently working with two vendors, one (Just Associates) on EMPI remediation and the other on (Ascendco) Preference Card analysis and build.

Pro Talent Advisors – Cottage One – Program Manager, Epic Integration

August 2022 – February 2023

This is an Epic shop with integrations to other software as listed below. I currently manage 12 projects. I have also been working with leadership on project methodology, resource planning (80/20) split, project prioritization and standards. Using ServiceNow (SNOW) as the PPM tool.

Introduced standardized Kickoff presentation, Test Planning, Training Plan, Stakeholder/Resource Register, Requirements documents, and others. Also explored ways to maximize strategic planning, both OpEx and CapEx, to identify resource needs, equipment costs and vendor engagement.

Projects engaged in and responsible for include: ZIO (cardio monitoring) and interface to Epic, CyberArk (security), WellSky upgrade and remote hosting, Capsule Middleware for Dialysis, Publishing data quality, Supply file remediation and integration to Epic, NetDocuments, NicView and Neonatal Transporter, Vitrea Upgrade, Breast MilkTracker Upgrade, Ambra and Structural Heart (Cupid, AMB, Prelude, Cadence, Revenue Cycle (PB & HP) others as assigned.

I have worked with SmartSheets, Kronos, ServiceNow and other software.

Pivot Point Consulting – UVA Community Health – Program Manager, Revenue Cycle - Epic Implementation and Acquisitions

March 2022 – July 2022

Epic implementation at two of three newly acquired (merger and acquisition) hospitals (acute) and ambulatory sites.

2 hospitals and associated ambulatory clinics to go live this year and the 3rd in April 2023

Responsible for the Revenue Cycle components PB & HB, reporting on current status, escalating issues/risks, conducting meetings for various sub-projects: Charging, Chart Correction, 3rd party apps, Interfaces, Devices, Cutover and Go Live Planning, Hospital based outpatient facilities, ARCR and ARCR (Revenue Cycle) Testing, and other areas as assigned.

Responsibilities include but not limited to identifying stakeholders and team rosters and creating Roles and Responsibilities matrix. Creating Epic Program level status reports containing both Clinical and Revenue cycle project updates. Creating dashboards for at a glance status of projects.

Working in Orion (Epic’s scheduling (project management) tool) creating extracts and evaluating schedule status (red, yellow, green). Providing extracts by project to project teams on weekly basis. Set expectations for project schedule updates and meeting cadence. Updating and monitoring RAID logs in Smartsheets.

Working in Team’s channels as our SharePoint, to managing documentation and transparency to all projects and project documentation. Brought consistency to project management documentation.

North Highland – (3 project assignments in last year) Transformation Consultant, Healthcare and Program Manager, CPAR project

State of Florida – CMS Interoperability November 2021 – February 2022

CPAR – CMS – Patient Access Rule Project

Assumed all responsibilities for project already in flight, with go live TBD

Managing MS Project Plan, issues, risks, conducting meetings, etc.

Scheduling and participation in JAD and Collaboration meetings for Data Ware house and Architecture Design sessions

Crafting new Charter and Project Plan for Implementation Phase of project

Review vendor deliverables (Accenture and Deloitte)

Review and provide input on Task Orders

Create a variety of status reports, weekly, monthly and others as requested.

Update MS Project as required to ensure project schedule is accurate and project stays the course.

Log and update issues, risks and decision logs.

Interact with leadership for the State of Florida CMS Interoperability project.

North Highland - Woman’s Health Organization August 2021- October 29, 2021

Transformation Consultant, SDLC, People, Process, Tools, Portfolio Management

Process improvement in Portfolio and Project Management in IT and Healthcare departments

Rounding on clinical departments. Creating 90 day sprints, based on 4 Pillars (Clinical, Revenue Cycle, Productivity, Other (tasks/process that doesn’t flow into (i.e., maintenance, upgrades).

Moved away from FIFO – First project/task in to First project/task out methodology

Modified internal process for help desk, input, reporting, prioritization – people, process, tools

Worked with Physician Practice leaders as well as Inpatient clinical departments (rounding), NICU, Surgery, PACU, AICU, HRU and developed process of gathering information and sharing updates on their urgent needs.

Conducted assessments of Inpatient Clinical departments

Developed PMO process and tools for managing projects and work; definitions of project, (t-shirt) sized projects as S, M, L with definitions

Created cheat sheet for PM vocabulary, as used at client site

Created process for input for new hire equipment, software and tools

Created a tool to be used for Portfolio Management and Strategic and Growth Play Book planning for upcoming fiscal year

Developed a set of tools to use for documenting and tracking projects and new work items in the IT Portfolio

Created new Portfolio dashboards

Worked with Clinical and Technical Leadership to develop 90 day sprints to move the needle from first in to first out, to planned work cycles

Work cycles within Portfolio are assigned by priority and urgency, while still maintaining the maintenance and break and fix work items

Developed process and plan to track actuals and estimated time for projects within the Portfolio.

IT Works – Einstein Healthcare

Sr. Project Manager – June 2021 – August 2021

Worked with Senior Leadership on the strategic planning initiative for their portfolio.

Created PMO Tool Kit so that entire team can use and set process in place so that documentation is standardized within the portfolio.

Conducted training on tool to be used for Strategic Planning, CAP, OpEx

Used PPM – Portfolio Management tool, Service Now

Phreesia project assigned.

North Highland – Healthcare Consultant

Revenue Cycle Liaison and Transitional Support

Quorum Health January 2021- April 2021

Transformation Consultant, SDLC, People, Process, Tools

Attended Jira demos and training

Supporting Quorum Health’s implementation of MEDHOST Direct in multiple hospitals.

One hospital (referred to as Client 1) implemented Cerner’s Community Works and MEDHOST Direct

A second hospital implemented MEDHOST Direct – only – no Cerner integration.

Cerner Service Requests (eService), Service Now (SNOW) Incidents, AMS reporting, daily issue resolution calls.

Engaging Cerner, in weekly, sometimes daily meetings to work through implementation planning and go live activities.

Responsible for working through Command Center logistics and Cutover Planning

Revenue Cycle – charge recon, charge entry, CDM (Avelead) build process (Supply chain/Materials management), issue resolution for all Rev Cycle issues, as well as solution issues

Post go live – working with both Cerner and Client 1 to work down the Service Requests (SRs) that had not been resolved post go live. This activity was over 3 weeks in duration, working with Cerner, MEDHOST and Client’s resources to identify root cause of issue and work to resolution with Client 1 and Vendors.

Night of cutover, working with MEDHOST and Client 1 to print, and organize documents (Face sheets, detailed charges, and summary charges) and entry into new system.

Worked closely with MEDHOST and Client to ensure process followed and reconciliation occurred as planned.

Conducted Order set validation

Training and Sign-on fairs, while not part of my responsibility, it does have an impact on Client 1, for their ability to access the system in a timely manner and be able to work through issues (found several had not taken training and this impacted ability to resolve issues).

Status reporting to C-Suite, conducted weekly meetings, Go-live readiness assessment, and transition to support meetings.

Ensured resources available for Charge Recon, Backload of orders, Changing pre-reg to reg, Scheduling for future appointments on new MEDHOST Direct

Detailed planning for night and next day of cutover, ensuring all activities are planned and resources assigned.

Interfaces, new equipment deployments, infrastructure, AD, Testing are all part of projects.

Healthcare Consultant

MedSysGroup – Ambulatory Advisor

February 2019 to August 2020 (Large northeastern multiple hospital and clinical locations)

Working in concert with Cerner as a Clinical Ambulatory Advisor

Currently working with 26 locations and over 90 practices as well as Article 28

Utilizing the new Cerner framework for implementations (Agile Methodology (V1), Waterfall, workshops, current and future state assessments and planning)

Responsible for Ambulatory Practices, Article 28 Clinics

Responsible for creating test scripts, utilizing Cerner Test Builder; participant in Unit Testing, System Testing and Integrated testing (IT1 – IT4). Test scripts developed based on workflows for both Acute and Ambulatory systems.

Issue resolution and decision making in both V1 and MethodM. Tracked MethodM issues (related to testing scripts); application setup/configuration were tracked in V1. Stories, validation, etc. tracked in V1 as well.

CPM, Patient Access, Patient Accounting, Current state assessments, and future state recommendations for all areas (Lab, Radiology, Cardiology, Transplant, Immunizations, etc.), Interviews and planning with Providers for future state orders, quick orders, documentation, MPages, etc.

KPIs and MIPs integrated into solution

Monitoring, Integration effort, Data Migration, Patient access, EMPI remediation, standardized reg/sched – compatible to hospital process, Healthyintent and Patient Portal

Developing a plan/comparison for adding new practices to existing build (or not) depending on recommendations our team provides.

Issue and Risk management, Decision Documents and facilitation

Site visits, current state assessments and build out future state (Agile), Version 1 Methodology

Provider review of Orders, order sets, appointments (visit types), quick visits, provider documentation

Review of workflows and workflow approvals

Continue to work through workshops (currently on workshop7)

Prep for Testing phase; copy and built test scripts

Creating client test scripts from Cerner’s tool Test Builder and Workflow Designer

Working in concert with team to document and control decisions and deviations

Responsible for Decision Design process

Updating V1; familiar with V1 tool and Cerner’s new V1 scrum (iterative) methodology

Program Manager - Healthcare Consultant (Revenue Cycle)

Regional Medical Center, SC

November 2018 – January 2019

Managing a Healthcare Revenue Cycle project involving:

Trained on and experience with Cerner’s new V1 Iterative Methodology

Review of entire program (list below not all inclusive)

oDiscussed MU guidelines and project impact

oThe importance of CPOE, and standard reporting (Lights On)

oImportance of looking at total project, not just a small piece (Revenue Cycle)

oExplained the integration of a clinically driven revenue cycles

oReview of Denials; resource usage; new processes

Departments impacted (partial list)

oPatient Accounting, Patient Registration and Scheduling, HIM, Charge Services, Case Management, Behavioral Health, Ambulatory teams, IT, Lab (Quest and Cerner), Rad and others

Influenced and explained benefit to client to reconsider their decision to NOT conduct the following work efforts:

oEMPI remediation

oCentralized/Standardized scheduling and registration

Medical necessity

Pre Reg

Limit of quick reg

Scheduling and registration in ancillary departments

oThe importance of CPOE, and standard reporting (Lights On)

Claims Processing (nThrive an nThrive Bolt on)

oClean claim processing

oDenials

oCDM build

oReview of charges by department

Training

oDevelop training plan

oWork with vendor and client to determine scope of training

oWork with team to determine use of SMEs, as both trainers and at the elbow (ATE) support

Testing

oBegan testing plan, scripts

oDevelop timeline for script development and test case scenarios (use of new end user workflows)

oRefine testing timeline based on prior experience

went from two IT sessions to 4

allowed sufficient time for break/fix

Interfaces

oIntegration between existing systems and Cerner

oIncludes 3M 360

oStockcamp

oeMedic

oConducted an analysis of all integration points, interfaces, FTP

Reporting to C-Suite

oDeveloped a standard dashboard (red, yellow, green)

To report on program

Raise issues and concerns

Wins

Issues needing leadership attention

oDeveloped communication plan

Stressed importance of regular, scheduled meetings

Importance of attendance

Importance of review of weekly status reports (no surprises)

Several other aspects of Revenue Cycle programs

oReview of multiple assessments that were conducted by various organizations

oConsolidated findings

oPresented to leadership

oThose areas that have been decided to not move forward (i.e. Wireless, Infrastructure, and other recommendations), developed a decision document to be signed off by leadership.

Decision documents helped track critical decisions of leadership, and narrow down scope of program

Program tools developed

oCommunication plan

oDecision matrix (RACI)

oStakeholder Register

oProgram Dashboard

oDecision documents

oSuccess criteria (SMART objectives)

oRevised existing charter, to refine scope statements

oWeekly status reports prepared with Vendor to provide comprehensive report to leadership

Bemis Organization, Program/Project Consultant

Oshkosh, WI

August 2018 – November 2018

Assigned several manufacturing projects in logistics area of organization. Consulted on Program Management, Strategic Planning

Program Manager – Healthcare Consultant

Cerner Consultant Ambulatory – Atlanticare (Northeastern (NJ) location)

February 2018 – August 2018

Responsible for Cerner Implementation Program’s Ambulatory Activation planning and assessment. Program includes a June go live date, conversion from ECW to Cerner, multiple interfaces, integration between lab systems and Cerner, and extended build for Pharmacy, hardware and networking. Approximately 13 Urgent Care sites and over 90 Practices at over 60 locations. Responsible for 90, 60 and 30 day readiness assessment, Super User and Elbow 2 Elbow (E2E) go live planning, Cut-over plan, Command Center Strategy and reporting out to C-Suite on progress of project.

As part of activation planning, I’ve immersed myself in the program to understand and assess where the project is as it relates to making a June go live date, and identifying any issues or concerns regarding moving forward with the go live. Training, Testing, Build, practice engagement (clinicians, providers, front office) are all part of the assessment. I meet on a regular basis with leadership for reporting purposes and ensure awareness of current state of project.

Currently engaged with vendors to understand project status, and provide feedback to leadership on areas of concern, such as training, final testing, issue resolution, equipment deployment, etc. Program in final stages of testing, and preparing for Train the Trainer (TTT) sessions, Instructor Led Training (ILT) and preparing support plans and logistics.

Quick study ability to immerse myself into this project in its final stages and provide insight and feedback on areas of concern and complete required planning documentation and preparations for go live.

Program Manager – on contract to Boca Raton Regional Hospital, FL

August 2017 – January 2018

Responsible for Cerner Implementation Program for client. Program includes conversion of McKesson to Cerner, Hardware, BMDI, Revenue Cycle, Patient Access and Billing, Training, Data Migration, Testing, Command Center and Cut-over planning, Super User coverage matrix, Communication Planning, Integration and Change Management. Program in implementation phase. Familiar with Consulting Framework and Method M. Go live date was 10-21-17 and was very successful. Gearing up for second phase.

Understanding correlation between DCWs, DTAs, ESH and application configuration ensuring clinically driven revenue is optimized.

Various consulting agencies with variety of resources (matrix organization). Developed a drive to live plan and dashboard to track progress of program.

Completed the following course work and actively completing other Cerner uLearn courses as well as pursuing Revenue Cycle certifications.

Program Manager/Director – on contract to St. Dominic’s Hospital, Jackson, MS

November 2015 – July 2017

Responsible for Cerner Implementation Program for client. Program includes conversion of McKesson to Cerner, Revenue Cycle, Hardware, Training, EMPI Remediation, Integration, Communication and Change Management, Lawson Upgrade, Materials Management, Supply Chain, Patient access and other sub projects. Program in implementation phase. Familiar with Consulting Framework and Method M.

Review of vendor TCO, identified areas not accounted for in both solution (FSI) and resource timelines; recommended correction. Review of Cerner SOW and Contract; identified areas of concern that I addressed with Client and Cerner EL. Areas included but not limited to client resource allocation, definition and responsibility of testing, overall timeframe for project with key deliverables in question (aggressive timeline). Reviewed Cerner’s implementation plan and sighted issues/problems with the plan, and accuracy of reporting where key deliverables were concerned (DCW as an example, build, etc.). Worked with the client to develop an implementation and resource plan, identified resource allocation roadblocks. Suggested work arounds and solutions which included bringing on additional resources to help with the heavy lifting (Testing, test case scenarios, system validation).

Experience with Lawson, Material Management, Supply Chain and Finance builds and DCW correlation to CDM. Experienced in conducting Revenue Cycle and finance/supply chain steering committee meetings; bringing the correct resources together to make decisions and move project forward.

Managing all aspects of implementation program. This includes but not limited to the following areas reporting to myself:

Cerner Millennium (Model and Revenue Cycle) – Engagement Leader

Lawson ERP Project Manager

Communication/Change Manager

Transformational Learning and testing leader(s)

Integration / Data conversion

C-Suite reporting and other leadership reporting responsibilities

Management of matrix organizational resources

Took on additional responsibilities for projects in prep for go live. These projects include, but not limited to, Interfaces (FSI (Foreign Systems Integration)), Supply Chain Management, Lawson Implementation go-live issue management, LAB (Outreach, MDI, Mayo).

Program Manager – Healthcare Consultant

Dignity Health, Phoenix, AZ – Program Manager – April 2015 – November 2015

Accelerated project delivery – brought the ICD10 Provider Acute Program live by the 10-1 deadline within 6 months of engagement. Program Manager of Provider Clinical Acute, supporting 40 hospitals utilizing Meditech and Cerner Millennium as core E.H.R.s. Responsible for 5 project managers and 15 provider applications, ranging from oncology, to physician tools to Cerner Millennium.

This remediation effort was a late start for the facilities, in that the projects were started, stopped (2013), started again and stopped again (2014). The final start date was April of 2015 for Cerner and June for the remaining 15 application. All applications were remediated, tested and ready for production prior to 10-1-15.

Responsibilities included hiring team members, on-boarding (both Dignity Health and ICD10 specific onboarding), making assignments, providing guidance, follow-up and execution of the projects.

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