February *, ****

Mrs. Caroline Kain

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

Harvey, LA 70058

Dear Sir or Madam,

I am interested in the Senior Project Manager position. I have over fifteen years of experience in hospital reimbursement. I worked for LCMC Touro Infirmary for eight years as the Manager of Financial Analytical Services. Per Troy Bond, AVP Touro Human Resources, I am eligible for rehire. I prepared the Medicare, Medicaid and CHAMPUS Cost Reports (a five month project.) I also completed cost report workpapers such as the GME (Graduate Medical Education) IRIS report (a three month project.) I completed DSH reports and analytical studies of DSH days to maximize reimbursement. I also filed the Medicaid NICU, PICU Outliers on a monthly basis with the State of Louisiana. I assisted with internal and external audits of revenue and revenue deductions. I completed net revenue schedules on a monthly basis that computed estimated reimbursement for government program payors, Managed Care and Commercial insurance carriers. Here are a few more reimbursement and leadership examples for your consideration.

During my tenure with Touro Infirmary, I performed an in-depth analysis and concluded the hospital was being reimbursed for inpatient rehab services related to the Medicaid beneficiary was far below operational cost. A business opportunity development process began. As a result, I gathered cost report data and information from the PM&R physician and prepared a profit/loss analysis for the organization. The Chief Executive Officer decided that I should present the loss analysis to the Department of Health and Hospitals of Louisiana with the Chief Financial Officer to request a Medicaid per diem to be doubled in amount. The State of Louisiana approved my request for the per diem that was paid at $850 per patient day to be increased to more than $1,500 per patient day. This resulted in an increased cash flow of approximately $5,000,000 annually.

Furthermore, I have more than fifteen years of diverse experience in the healthcare industry. I was also the team leader for the preparation of the Medicare and Medicaid (and CHAMPUS) cost reports. Most of my experience includes both a concentration in the improvement of cash flow and teaching several reimbursement classes on-site that related to the acute care arena as well as provider-based rehab units, skilled nursing units, psychiatric units and home health agencies. For example, I improved the understanding of what a post-acute care transfer adjustment was designed for in all settings from both the admit and discharge perspectives. I worked closely with the Billing Office and educated the staff on the differences among the discharge status codes and how it affects reimbursement. One nuance is to determine if an acute care patient returns to a skilled nursing facility as a resident or for a continuum of care. The two discharge status codes determine whether the Diagnosis Related Group (DRG) payment from Medicare is reduced or if the DRG is paid in full.

Another success story immediately followed Hurricane Katrina. There were nearly 1,000 displaced residents in the city of New Orleans. Charity Hospital closed and these residents were orphaned because the host hospital (Charity) that the resident rotated in no longer existed. I provided a business development plan that allowed the hospital to gain GME and IME reimbursement for these residents. Many began rotations at Touro Infirmary as well as at other healthcare facilities in the metropolitan area. In order to retain full reimbursement from CMS for the residency program, the documentation for the resident rotations had to improve. I worked closely with Louisiana State University Health Science Center (LSUHSC) and explained how the CMS audit process worked.

These are just a few examples of the most rewarding projects I was requested to direct. I would like to apply my wealth of experience to the Senior Reimbursement Analyst position. Included with this letter is my resume for your review. Please know it cannot demonstrate my interpersonal skills. Should you want to contact me for an interview, I can be reached at 504-***-****. I look forward to hearing from you soon.

Sincerely,

Caroline Kain

CAROLINE K. KAIN

3904 Lake Arrowhead Drive • Harvey, Louisiana 70058 • 504-***-**** • ad4qjz@r.postjobfree.com

WORK EXPERIENCE

Hancock Whitney Bank, Senior Accountant (06/2023-current)

Reconcile various investment accounts on daily basis.

Prepare balance sheet reconciliations.

Tulane University Hospital and Clinics, Assistant Controller (03/2018-06/30/2020)

Prepared and reviewed Medicare and Medicaid cost report schedules. Trained staff on Medicare and Medicaid reimbursement and cost reporting for organ transplant programs, DSH and Medical Education. Filed Medicaid NICU, PICU Outlier cases on a monthly basis with DHH.

Prepared IRIS report.

Led Medicare and Medicaid audits.

Computed contractual allowances and prepared accrual for Medicare and Medicaid insurance plans. Prepared budget for various payors. Maintained rapport with State of LA for cost reporting process and program monitoring.

Developed schedule to compute Medicaid contractual allowances for 30,000 patient days that include acute, neonatal intensive care, pediatric intensive care and well-baby days and prepared accruals for the financial statements.

Prepared balance sheet reconciliations, assisted in audits, tax returns and regulatory reporting.

Prepared Schedule H for TUHC and Tulane School of Medicine.

Approved and prepared balance sheet reconciliations for Government Program related accounts.

Blue Cross Blue Shield of Louisiana, Medical Economics Analyst (09/2014-03/2018)

Prepared contract proposals and supported negotiations for: Acute, Rehabilitative and Behavioral Health facilities, Ambulatory Surgery Centers (ASC) and other ancillary providers including several free-standing facilities and several multi-campus Healthcare Systems.

Reviewed federal and state law payment policies for Medicare and Medicaid to determine if rates provided by BCBSLA are in alignment for the population served. Developed fee schedules for a variety of general provider types such as ASCs and outpatient services.

Reported on variances in the annual $2B budgetary forecast of the organization’s medical spend on a monthly basis to leadership. Most providers received a 3% increase in reimbursement for medical spending.

Responded to provider appeals, payment disputes and general inquiries. Modified policy and procedures related to the issues discovered. Identified medical configuration issues in system and formulated correction plan for accurate pay.

Prepared financial analysis on several lines of business: dialysis treatments, rehab, chemical dependency and skilled nursing visits to determine payment rate.

Touro Infirmary, Manager of Financial Analytical Services (01/2006 - 05/2014)

Significant revenue responsibilities such as net $1B in gross revenue by computing contractual allowances for all payers and analyzing payments received for each insurance carrier. Supported and coordinated negotiations for managed care contract offers with insurance companies such as Blue Cross and Blue Shield of Louisiana.

Project Manager for Bad Debt Revenue Integrity Committee to optimize reimbursement and protect revenue.

Prepared balance sheet reconciliations on a monthly basis.

Assisted in the preparation of the financial statements on a monthly basis.

Worked closely with LSU-HSC & Tulane School of Medicine for residency reporting to CMS.

Responsible for the preparation, audit and filing of the Medicare and Medicaid Cost Reports to federal agencies. Prepared grants worksheet for low income reimbursement from the State of Louisiana. Prepared CHAMPUS Cost Report. Maintained rapport with State of LA for grant/cost reporting process and program monitoring.

Assisted in the preparation of tax schedules such as the 990 and Uncompensated Care and reconciled it to cost report.

Performed detailed analysis of disproportionate share (DSH) on monthly basis and one final review prior to the filing of the Medicare and Medicaid Cost Reports.

Analyzed the status of major teaching hospital profitability, provided intern and resident reporting requirements and supported the Medicare audit of IRIS and other cost reporting duties related to interns and residents.

Prepared and presented financial analyses for various service lines such as Rehab Hospital expansion and increase in therapy FTEs.

Reconciled general ledger accounts on a monthly basis; completed general accounting duties as assigned.

Supervised and trained a professional staff of three accountants and worked closely with several internal consultants. Trained staff on budget preparation for contractual allowances for all payors.

Assisted in budget preparation for all payors: Medicare, Medicaid, Managed Care and self pay.

Maintained cost accounting system, reconciled to financial statements and provided reports to senior management. Provided facility level profit and loss reporting and analyses. Acted as a resource for other employees in the use of decision support tools and software applications.

Tenet Healthcare, Manager, Reimbursement (08/1992 - 01/2006)

Developed and implemented a Denials Management action plan for the Admissions Department that was used on a daily basis to reduce payment denials and protect revenue; successfully reduced payment denials by 30% or $200K annually.

Actively participated in due diligence for several transactions: merger of Mercy Hospital (MBH) and Southern Baptist Hospital, acquisition of the Eye, Ear, Nose and Throat hospital and several physician practices, sale of MBH to Tenet Healthcare (THC), sale of THC MBH to Ochsner Healthsystem and closure of THS MBH due to Hurricane Katrina.

Prepared Medicare and Medicaid cost reports for Centers for Medicare and Medicaid Services and the Department of Health and Human Services. Prepared CHAMPUS Cost Report.

Reconciled Balance Sheet accounts; prepared monthly journal entries for revenue and expense accounts and responsible for Uncompensated Care Cost (UCC) tax schedules. Prepared financial analyses on several business lines.

Maintained cost accounting system, reconciled to financial statements and provided reports to senior management.

Assisted in budget preparation for all payors: Medicare, Medicaid, Managed Care and self pay.

EDUCATION, SKILLS and CERTIFICATION

Bachelor of Science Degree, Accounting, University of New Orleans, 1986

Completed pre-Nursing curriculum and accepted to LSU-School of Nursing, 1990 GPA 4.0

Certified Procedure Coder (CPC-P-A), 2016

Grant Writer, Boy Scouts of America, 2007-2013

Technology Skills: Microsoft Office, Excel, Microsoft Word, CMS 2552 Cost Report program, Facets, Crystal Report Writer, Oracle TriZetto NetworX Modeler, Sharepoint, Lawson, and various in-house reporting systems.

Contact this candidate