JAYNE E. FLORES, CHAM

***** ******** ***.

Hemet, CA. 92544

Cell: 714/318-9532

BACKGROUND SUMMARY

Certified Healthcare Access Director with over 35 years of experience which includes all aspects of Patient Access, Pre-Registration, Insurance Verification/Authorization, Financial Counseling, Scheduling, Emergency Department, Skilled Nursing, Rehab and Sub Acute.

Assurance to all CMS compliance requirements providing education to department staff as well as Case Management.

Assurance to JCAHO requirements regarding Patient Rights and Responsibilities.

Reputation for positive relationships with staff and customers (i.e. patients, physicians, and ancillary departments) value team participation.

Competency in Quality Assurance of detailed charts and records through extensive knowledge of managed care, HMO, PPO and indemnity insurance procedures and requirements

Demonstrates accurate, reliable record tracking, through a thorough understanding of various department interrelations.

Offers solid support of customer service improvement and satisfaction.

Extensive experience in the following ADT Platforms- Paragon, MS4, Patient Access System (Tenet), Meditech, McKesson STAR.

KPC HEALTHCARE (Corp) Transfer Santa Ana, CA. 6/2019-2/2021

Regional Director of Patient Access

Accountable for collaborating with Patient Access Leaders of all seven KPC Healthcare Inc institutions to define strategy, policy, education methods and standards and compliance assurance in the areas of patient scheduling, pre-registration, registration, financial counselling, insurance verification, pre-certification and pre-authorization, and point of service collections and related patient access matters. Accountable for the successful, compassionate, financially responsible and compliant day to day operations of the Patient Access departments. Work closely with all Revenue Cycle Corporate Directors to assure timely reimbursement, compliance, and satisfaction of all customers served.

PHYSICIANS FOR HEALTHY HOSPITALS –PHH/KPC Hemet, CA. 1/2012- 6/2019

Director of Patient Access

Instrumental in the construction of modules, education of all department staff as well as other key departments on the new ADT system assuring a smooth implementation to the new EMR (Paragon).

Actively participates with the upgrades assisting ancillary areas with any needs or revisions needed to Registration, Paragon Compliance Advisor, or Horizon Patient Folder.

Educator to hospital staff on the new Service Excellence Program.

Excellent working relationship with ancillary departments, physicians and office staff.

Review, revise and create policies and procedures specific to the Patient Access Department.

CYMETRIX

Senior Consultant, Revenue Cycle Solutions Irvine, CA 4/2009-1/2012

Responsible for planning, implementing and directing the transformation of key revenue cycle business processes. In addition, oversee client relationship management, solution design and implementation of engagement results. Work with client project leaders and effectively guide the client through transformation efforts. Perform on-site Patient Access Department assessments.

IRVINE REGIONAL HOSPITAL AND MEDICAL CENTER Irvine, CA 8/2006-1/2009

Director of Admissions

Tenet Healthcare

Responsible for the daily operations of Admitting, Patient Financial Services, Scheduling and ED Registration

Excellent working relationship with Health Information Systems, Case Management, Business Development, multiple group IPAs and staff physician offices to assure appropriate guidelines are followed regarding admission and registration and financial clearance standards.

Interview, hire and perform annual reviews.

Identify and communicate opportunities to improve service or care.

Provide opportunities for staff training and growth.

Establishes expectations, sets priorities and manages processes to measure, systemically assess, implement improvement and maintain progress within the department.

Assure processes are designed to properly train and support new employees, assure competence of new and experienced staff.

Participates in hospital committees to improve service and streamline organizational processes.

Ensure departmental budget, salary/non salary are in conformance with stated operational objectives

Member of the ED and OR C2Q and Revenue Cycle Teams

LAKEWOOD REGIONAL MEDICAL CENTER Lakewood, CA 1/2004-4/2006

Director of Admissions

(Inter-facility transfer within Tenet Healthcare)

Responsible for the daily operations of Admitting Patient Financial Services, ED Registration, and PBX areas of an Acute Care and Acute Rehab facility.

Excellent working relationship with Health Information Systems, Case Management, Business Development, multiple group IPAs and staff physician offices to assure appropriate guidelines are followed in regards to admission and registration and financial clearance standards.

Interview, hire and perform annual reviews.

Identify and communicate opportunities to improve service or care.

Provide opportunities for staff training and growth

Establish expectations, set priorities and manage processes to measure, systemically assess, implement improvement and maintain progress within the department.

Assure processes are designed to properly train and support new employees, assure competence of new and experienced staff.

Participates in hospital committees to improve service and streamline organizational processes.

Ensure departmental budget, salary/non salary are in conformance with stated operational objectives.

COASTAL COMMUNITIES HOSPITAL Santa Ana, CA 7/02-1/2004

Director of Admissions

Tenet Healthcare

Direct and coordinate the daily operation of the Admitting, Emergency Room Registration, and Communications Departments of an Acute and Sub-Acute facility. This includes Insurance Verification, Financial Counseling, and Cashiers.

Intimate working relationship with Health Information Systems, Case Management, Business Development, multiple medical group IPAs and staff physician offices to assure appropriate guidelines are followed in regard to admission and registration criteria resulting in optimum financial reimbursement.

Interview, hire and perform annual reviews.

Identify and communicate opportunities to improve service or care.

Establish expectations, set priorities and manage processes to measure, systemically assess, implement improvement and maintain progress within the department.

Assure processes are designed to properly train and support new employees, assure competence of new and experienced staff.

Participates in hospital committees to improve service and streamline organizational processes.

Ensure departmental budget, salary/non salary are in conformance with stated operational objectives.

BREA COMMUNITY HOSPITAL Brea, CA 11/99-7/2002

Admitting and Communications Manager

Direct and coordinate the daily operation of the Admitting, Outpatient, and Emergency Room registration areas, Insurance Verification/Financial Consulting, Cashiers and Communications for an Acute and Neuro-Sub Acute facility.

Intimate working relationship with Case Management, Business Development, multiple Medical Group IPAs and staff physician offices to assure appropriate guidelines are followed in regard to admission and registration criteria resulting in appropriate financial reimbursement.

Maintain department Policy and Procedure manuals.

Interview, hire and perform annual reviews on departmental staff.

Streamlined admission and outpatient registration process resulting in decreased patient waiting time increase of preregistrations, collections and accuracy of registration information.

Streamlined the Emergency Room registration processes, which included 1st Reports online with the Meditech computer system, working with IPAs to allow ER Physicians to act on behalf of the patient’s PCP in the auth process for ER treatment.

TUSTIN REHABILITATION HOSPITAL Tustin, CA 4/99-11/99

Admitting Manager Tenet Healthcare

Directed and coordinated the daily operation of the Admitting and Communications Departments for an Acute Rehabilitation and Skilled Nursing Facility.

Intimate working relationship with Clinical Liaisons, Case Managers, multiple insurance payors and Medical Group IPAs to assure admissions are accurately screened for appropriateness and financial reimbursement.

Member of the Quality Improvement Committee to continuously identify and improve departmental and interdepartmental systems to ensure efficiency and optimum patient and customer satisfaction.

Maintain department Policy and Procedure manuals.

MISSION HOSPITAL REGIONAL MEDICAL CENTER Mission Viejo, CA 1996-1999

Admitting Manager

Directed and coordinated the daily operation of the Admitting, Emergency Room and Sports and Wellness Registration areas in a multi-specialty tertiary care, trauma facility.

Streamlined admittance process, decreasing wait times, by implementation of Point of Service registration for all scheduled, pre-registered patients. Increased pre admissions by 30%.

Member of Quality Improvement Committee to continuously identify and improve systems to ensure accuracy and optimum customer service.

Maintained extensive multi-faceted policy and procedure manuals

Increased Press Ganey scores throughout the department from the 34th percentile to the 90th percentile through extensive staff development and training.

CHILDREN’S HOSPITAL OF ORANGE COUNTY Orange, CA 1985-1995

Admitting Manager

Directed and coordinated the daily operation of the Admitting and Ambulatory Care Registration Areas in a pediatric/multi-specialty tertiary care hospital.

Competent liaison between the hospital and physician offices to ensure optimum customer service.

Successfully provided periodic in-service training to physician offices and registration staff regarding complex procedures and insurance requirements resulting in more adequate financial reimbursement.

Identified and resolved any issues affecting the smooth and accurate flow of patient access.

Streamlined admittance procedure decreasing wait time to 3 minutes or less by consolidating multiple forms into one resulting in less signatures required by patients at the time of registration and overall lower cost for the department.

Increased customer satisfaction by 75% due to upgrading and revising of procedures resulting in higher accuracy rate.

Successfully aided in the conversion from Compucare computer system to Shared Medical System on the hospital side, and later to Signature product on the Ambulatory Care registration side.

Maintained extensive, multi-faceted policy and procedure manuals.

Recognized by upper management for effective management and training of all admitting staff in the change-over from manual admission procedures to an on-line computer system for registration resulting in significant decrease in wait time.

EDUCATION

Coastline Community College, Fountain Valley, CA

Mercer County College, Trenton, NJ

PROFESSIONAL DEVELOPMENT

CHAM Certification 3.2009

Attend annual CAHAM & NAHAM conferences

Participated in an eight month “New American Hospital “Program

Numerous Management, Consent Law, and

Customer Service workshops

Paralegal courses

PROFESSIONAL AFFILIATIONS

National Association of Hospital Access Management

Recipient of the 2001 Carl Satterfield Award, which recognizes an Admitting Professional for their outstanding contributions in the Admitting Field.

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