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Manager Physician

Location:
Fort Lauderdale, Florida, United States
Posted:
September 21, 2019

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Resume:

Heather Nydick adaesb@r.postjobfree.com

**** ** **** ***** *****, FL 33324 954-***-****

Summary Of Qualifications

Senior-Level Healthcare Professional with 15+ years of management experience demonstrating a comprehensive background in managed care and contract pricing – negotiations, revenue cycle audit, and management. Strong negotiating skills with an orientation for results. Self-motivated team player with the ability to work well with a diverse groups of individuals – maintaining a balanced objective and fact-based perspective as part of any problem solving process. Excellent communication skills as well as management leadership and multi-tasking abilities.

●Medical Review Process

●Appeal and Denial process

●Process Development

●Governmental Enrollment

●Revenue Cycle

●Compliance Audits

●Claims Resolution

●Risk Management

●Six Sigma Trained

●Coding Audits

Professional Experience

ChangeHealthCare/ Jackson Health Systems Miami, FL

Manager of Clinical Operations 2014 – Present

●Manage daily operations onsite for Changehealthcare for the Denial Management program. Perform 50+ audits daily – utilizing Interqual and Milliman Criteria and write appeal letters identifying appropriate criteria.

●Facilitate monthly denial management meetings for 5 Hospitals using the Jackson Health Systems.

●Provide Monthly Case Management meetings for over 120 Case Managers regarding Denials Process.

●Prepare details denial and appeal information on a monthly basis for all 5 Facilities and their CFO’s.

●Lead and participate in the restructuring of Centralized Clearance Center to reduce denials by 5% or more.

●Take full responsibility for all operational communications for concurrent review denials and appeals.

Pediatric Associates Plantation, FL

Director of Managed Care Contracting 2013 – 2014

●Oversaw the day-to-day management functions of Contracting and Managed Care through the appropriate assignment of responsibilities, delegation of authority, and overall direction of workflow process.

●Negotiated risk-based agreements for 28 offices throughout Florida. Established risk-based modeling to reconcile $15 million in revenue under the new Managed Medicaid Assistance lives assigned to group.

●Implemented and established software program to automate internal HEDIS and Quality measures.

●Contracted with a group of 3 large Hospital IPA groups, which resulted in a floor bonus of $200 thousand.

●Developed contracts detailing Quality initiatives performances with financial impact of over $3 million.

●Provided training to staff, new hires, and employed physicians on Obamacare and the trends noted in PA’s current revenue stream. Developed MMA material and implemented the roll out to all offices.

Med Assets/Jackson Health Systems / Miami, FL

Revenue Integrity Specialist 2013 – 2013

●Managed to customers’ CDMs based on current regulatory guidance. Provided onsite, charge master, and other outpatient revenue cycle consulting to customers in accordance with scope of the contract.

●Experienced in performing line item CDM review by determining the application and appropriateness of coding, compliance, and other regulatory requirements while minimizing all potential risks.

●Performed review of hospital claims and bills to ensure the reported services and charges were supported by clinical documentation. Organized, developed, and documented CDM, billing, and clinical integrity findings. Led in recommendations for designated hospital outpatient and physician departments.

●Led systematic review of order entry system files in comparison to CDM files to assist in minimizing risk.

●Demonstrated ability in conducting client meetings, including: review of data, general CDM or coding/revenue cycle education, and/or conferences with executive leadership using finding summary.

●Reviewed system files in comparison to CDM files to assist in minimizing risk and optimizing revenue.

Hendry Regional Medical Center Clewiston, FL

Chief Compliance Officer-2009-2010/Compliance Analyst / Contract Management and Compliance 2009 – 2012

●Re-established the compliance plan and implemented a contract management system as well as the annual internal audit process. Led implementation of contract management system for hospital and physician’s contracts, provided audit and claims compliance with governmental and insurance entity’s, provided education to staff physicians and employees on credentialing and compliance changes/programs.

●Centralized all contracts and created routing process throughout the system, assisted managers in concentrating on department tasks, improved review process, and provided timeframe for renewals.

●Managed all Medicare requests for Additional Data Reviews, basically eliminating ADR’s for one year.

●Identified potential areas of contract compliance vulnerability and risk; developed/implemented corrective action plans for resolution of problematic issues, and provided guidance to avoid similar situations.

HCA Physician Services East Florida Division Fort Lauderdale, FL

Director for Hospitalist Program 2008 – 2009

●Reported to Hospitalist Market Director. Assisted in establishing Hospitalist program in Broward County.

●Took responsibility for physician’s contracts, physician credentialing with hospitals and health plans, and physician claims processing and documentation. Coordinated and developed systems that enhance quality and cost-effective delivery of patient care. Developed outreach for the Hospitalist program.

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

Preferred Care Partners Miami, FL

Hospital Contractor 2007 – 2008

●Managed hospital contracting and renegotiation of all facilities. Assisted claims review and resolution team for all facilities. Responsibilities included negotiation of all major hospital and ancillary contracts.

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

Holy Cross Health Ministries Fort Lauderdale, FL

Executive Director of Managed Care 1999 – 2006

●Attained $1M admin cost savings through the successful re-negotiation of major Health Plan contracts.

●Built Managed Care portfolio to over $300 Million, a 5%+ of HCHM total net revenue. Provided guidance to Division CFO on market positioning, and leveraged 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.

Education / Training / Licensure

Broward College – Bachelors in Applied Science – completed 120 hours towards RN degree- in progress with dual major RHIA Presently Attending

University of South Florida – Licensed Health Care Risk Manager

Holy Cross Learning Institute – Six Sigma Trained Green Belt

Central Georgia College – Licensed Practical Nurse (LPN)

Affiliations

Board Member – Department of Health and Sanitary Control Board-(Broward County)/Commisoner for Health Facilitates Authority Board(Broward County)Board Member-Special Olympics Sallarulo Race for Champions. Political consultant.

AHIMA, FHIMA, HFMA, HCCA, MGMA, and FNA

Computer Skills

Siemens (Invisions, EDM), (Powerchart, PMOffice), Cerner, Esson Canopy, Interqual and MCG Milliman Criteria Guidelines, MedAssets (Knowledgesource, CDM, CCA

MediRegs (Contract Management), IDX (Physician Contract Management), Meditech (EMR) PMMC (Contract Management System), EthicPoint (Compliance reporting system), ComplyTrac (Compliance tracking and assessment system), Microsoft Office: (Word, Excel, PowerPoint, Outlook), MS Viso, MS SharePoint,



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