Carlos Pedraja

Director of Operations - WMC Health Group

Miami, FL 33173

advkz8@r.postjobfree.com

305-***-****

Technically-sound and accomplished health care professional with twenty four plus years of progressive leadership experience in organizational structuring, business development, consultation and management, project analysis, monitoring, fiscal & operational services. Strong ability to understand and lead operational processes; administrative skills in planning, budgeting, contract negotiation, financial analysis, resource development and allocation, reimbursement mechanisms, personnel administration, and deliver in accordance with specified guidelines. Ability to analyze and make process improvements without disrupting business continuity, leading to cost savings and productivity. Work Experience

Director of Operations

WMC Health Group - Miami, FL

August 2014 to Present

Participated in the development and implementation of the mission, vision and values of the organization, including

high quality, patient focused health care.

• Supervised billing department, evaluate performance of department activities including ways to improve productivity and performance

• Implemented standards for productivity, quality, and customer-service standards; resolving problems; auditing; quality control; and identifying billing system improvements.

• Assisted CEO and management team in new clinical program development, ensuring participatory decision making

and appropriate design and implementation.

• Was Responsible for ensuring program and corporate compliance with primary health care policies and procedures,

as well as with those external regulatory bodies such as HCFA, FQHC, HIPPA, OSHA, CLIA and other professional

review and standards boards.

• Participated in the development of long-range strategic plans, governance structure and objectives for practice

management.

• Ensured staff compliance with the adopted health care plan as it relates to the stated objectives

(problems/needs)

the organization's clinical goals and the method of achieving the benchmarks listed.

• Responsible for the development of the plan of operations and coordinating corresponding budgets reflecting the volume, revenues, expenses, staffing and capital needs of the organization.

• Presented, facilitates and lead assigned process improvement events using methods of culture- appropriate team

building, team energizing, data gathering and analysis, problem solving, and project management.

• Assists the CEO with facility expansion and property acquisitions/transactions, as well as service mergers.

• Ensured responsible medical supply spending practices helps develop budgets and assures that tracking and inventory of supplies and equipment purchases are in compliance with operating budget.

• Analyzed, recommended and supported practice seeking to improve performance on quality measures to engage in work redesign, changes in organization systems, policies and procedures, and quality improvement process within

the organization.

• Presents, facilitates and leads assigned process improvement events using methods of culture appropriate team

building, team energizing, data gathering and analysis, problem solving, and project management.

• Evaluated process improvement information, materials, and methods to match specific organizational needs as outlined by management, and adapts them to use in the execution of process improvement even ts.

• Provided event follow-up to monitor the progress of planned improvement implementation to assure timely action,

appropriate management support, and achievement of expected benefits. Used appropriate measurement, analysis and evaluation methods to accurately identify and document process improvements.

• Coordinated with related departments and functions to assure appropriate information flow and understanding of

overall process improvement direction.

• Worked side by side with executives in developing transformational strategies in the adoption of process

improvement and guide staff in the implementation and execution of process improvement tools and methods.

• Assisted CEO in oversight of community outreach programs and may represent organization as a member on community outreach committees/groups within the community.

• Actively procured grant opportunities, assisting in preparation, application submission and ensuring program

compliance and administration occurs once the grant is received.

• Resolved problems related to utilization of facilities, equipment and supplies for the organization.

• Participated and ensured the development of organizational guidelines, policies and procedures in accordance with funding source requirements, as well as State and Federal law.

• Attend seminars, training sessions and in-services, to keep current with trends and practices in health care

administration, as needed.

• Participated in staff, management and provider meetings, as necessary.

• Performed other job related duties, as may be assigned.

• Increased revenues and income, minimize the bad debt rate, achieve the target profit margin percentage, and implement operating cost controls in the areas of staffing, supplies, purchased services, etc.

• Focused on census building efforts and strategic planning for all practices.

• Recruited physicians in targeted specialty areas, coordinate medical staff participation in new practice ventures and targets and develop new areas of medical care to offer at the practice.

• Supervised the development of more comprehensive outpatient care and ancillary programs.

• Developed positive relationships with local industry, local government, potential key health care providers, and the general public.

• Interacted and communicated with CEO and Board of Directors. Ensure the timely submission of month- end financial

and operational reviews, contribute to the development of and participation in corporate- wide strategic planning

efforts and maintains good communication with the corporate officers in areas where periodic reporting of results is

requested.

• Ensured that practice employees respond promptly to corporate requests for information. Communicate circumstances

and events of operations to Board and other appropriate people to keep all apprised.

• Developed, established & maintain accountable billing & collections processes/policies as coordinated with Physician

Partners

• Screened trained & managed all existing /new staff as required and hired by Physician Partners and/ or CEO

• Ensured all work contributing to productivity is received via scanning, mail, fax, etc. as pre -set by Physician Partners

• Monitored all daily, weekly & monthly productivity through spreadsheets and reports for all employees re: charges,

payments and AR management

• Planned & developed billing/operational processes & procedures to improve the operating quality and efficiency of each department

• Coordinated & implemented solutions from process analysis & general department projects

• Directed staff in the development, analysis & preparation of daily, weekly, & monthly reports

• Supervised staff in accordance with company policies & procedures set forth in Employee Handbook.

• Conducted preliminary interviews of new staff and facilitate employee orientation & training

• Established employee goals and conduct employee performance reviews based on guideline s from Physician

Partners

• Responsible for staff scheduling to include: work assignments/rotations, employee training, employee vacations,

employee breaks, overtime assignment, back-up for absent employees, cross training and shift rotations

• Assisted staff to resolve complex or out of policy operation problems and modify the processes, if necessary, to accommodate new regulations in industry.

• Scheduled and conducted regular department meetings.

• Managed credentialing activities for all companies and maintain current contracts in place for all respective

companies and providers via CAQH, PECOS, AHCA, etc.

• Communicated with CEO on Department operations on a monthly basis in the form of reports as defined by CEO at our Regular Monthly Meetings.

Operations Manager

Digestive Medicine Associates

January 2014 to June 2014

• Achieved budgeted financial objectives for all companies and departments.

• Increased revenues and income, minimize the bad debt rate, achieve the target profit margin percentage, and implement operating cost controls in the areas of staffing, supplies, purchased services, etc.

• Focused on census building efforts and strategic planning for all practices.

• Recruited physicians in targeted specialty areas, coordinate medical staff participation in new practice ventures and targets and develop new areas of medical care to offer at the practice.

• Supervised the development of more comprehensive outpatient care and ancillary programs.

• Developed positive relationships with local industry, local government, potential key health care providers, and the general public.

• Interacted and communicated with CEO and Board of Directors. Ensure the timely submission of month-end financial

and operational reviews, contribute to the development of and participation in corporate-wide strategic planning

efforts and maintains good communication with the corporate officers in areas where periodic reporting of results is

requested.

• Ensured that practice employees respond promptly to corporate requests for information. Communicate

circumstances and events of operations to Board and other appropriate people to keep all apprised.

• Developed, established & maintain accountable billing & collections processes/policies as coordinated with Physician Partners and/or CEO

• Screened trained & managed all existing /new staff as required and hired by Physician Partners and/ or CEO

• Ensured all work contributing to productivity is received via scanning, mail, fax, etc. as pre-set by Physician Partners

and/or CEO

• Monitored all daily, weekly & monthly productivity through spreadsheets and reports for all employees re: charges,

payments and AR management

• Planned & developed billing/operational processes & procedures to improve the operating quality and efficiency of each department

• Coordinated & implemented solutions from process analysis & general department projects

• Directed staff in the development, analysis & preparation of daily, weekly, & monthly reports

• Supervised staff in accordance with company policies & procedures set forth in Employee Handbook.

• Conducted preliminary interviews of new staff and facilitate employee orientation & training

• Established employee goals and conduct employee performance reviews based on guidelines from Physician

Partners and/or CEO

• Responsible for staff scheduling to include: work assignments/rotations, employee training, employee vacations,

employee breaks, overtime assignment, back-up for absent employees, cross training and shift rotations

• Assisted staff to resolve complex or out of policy operation problems and modify the processes, if necessary, to accommodate new regulations in industry.

• Scheduled and conducted regular department meetings.

• Managed credentialing activities for all companies and maintain current contracts in place for all respective

companies and providers via CAQH, PECOS, AHCA, etc.

• Communicated with Physician Partners and/or CEO on Department operations on a monthly basis in the form of reports as defined by Physician Partners and/or CEO at the Regular Monthly Meetings. Consultant

All Medical Personnel - Miami, FL

October 2013 to January 2014

October 2013 to January 2014 Consulting only)

• Responsible for daily operations of practice to ensure patient satisfaction

• In charge of supervising of all staff

• Ensured payment of all invoices and account reconciliation

• Over saw all practice operations, including consults with families of patients

• Established protocols for safety and hazardous material to ensure all facility requirements for OSHA were met.

• Developed guidelines for all employees to follow, implemented protocols to handle escalated issues, and assisted in establishing specifics guidelines to assist with daily practice operations

• Reviewed current practice policies and practices, outlined deficiencies and recommended changes. To included daily

operations, financials, contracts and staff.

• Recommendations achieved a 38% increase in revenue from patients and a 40% increase in collections from insurance payers.

• Degrease in total on hand inventory by 26 %

• Established effective par levels for all on hand pharmaceuticals products

• Stream lined all on line pharmaceutical sales

Director of Operations/ Business Development

Preferred Medical Group / Preferred Vascular Group 2012 to October 2013

Implemented all standards of vascular care for dialysis and non-dialysis patients to included consults, vein mapping,

creations, angiograms, angioplasty and follow ups.

• Created vascular surgeons surgery schedule at hospitals

• Hired all staff (administrative and medical personal including physicians, nurses and technicians)

• Organized the construction of all medical center

• Ensured sales and marketing efforts by conducting various events such as: on-sight tours of facility and training of center personnel to properly present the center services to all clients. Insuring sales and marketing staff meet or

excided sales goals.

• Established cost saving methods to improve efficiency of centers

• Developed all process of operations within PMG and PVS Vascular Centers

• Established centers to meet and exceed government guide lines for electronic medical records requirements for paperless, electronic medical records, RX prescriptions, Patient portal and employer portal

• Established cost saving methods to improve efficiency of centers

• Negotiated Insurance contracts for PMG obtaining higher reimbursement rates. Much higher than being currently

given in the area.

• Established free transportation for patients regardless of financial means, with an exceptional rating from patients

and providers.

• Negotiated the purchase of all equipment to be used in the medical center.

• Established guidelines to meet goals for each center, all centers preformed more than established goals and guidelines.

• New centers financial preforms were met within the first 6 months of operations, versus a performa of a year and a half.

VP of Operations

AmericanHealthClinics

2009 to 2012

• Member of the board of directors for both AHC and IMCS Network

• Directed operations for 45 medical centers including hiring, training and evaluations of center management staff

• Organized the construction of AHC first medical center. Negotiated the purchase of all equipment to be used in the medical center.

• Responsible for the hire, training and evaluation of all staff for medical centers

• Developed all process of operations within AHC medical center and IMCS Centers.

• Negotiated with several labs and medical suppliers obtaining the most cost effective solution based on our needs.

• Established centers to meet and exceed government guide lines for electronic medical records requirements for paperless, electronic medical records, RX prescriptions, Patient portal and employer portal with lab portal integration

of lab results.

• Payroll, reconciliation, and reporting

• Ensured sales and marketing efforts by conducting various events such as: on-sight tours of facility and training of center personnel to properly present the center services to all clients. Ensuring sales and marketing staff meet or

excided sales goals.

• Established cost saving methods to improve efficiency of centers

• Negotiated Insurance contracts for both AHC and IMCS obtaining higher reimbursement rates, much higher than

currently given to any centers.

• Negotiated the purchase of IMCS

• Restructured the operation of IMCS

• Improved the financial standing of IMCS

• Negotiated with centers to join the IMCS network

• Supervised daily operation of both AHC and IMCS

• Milestones, gold's, developments accomplishments too numerous to name for a startup business that meet and exceeded expectation.

• Supervised the billing & collection dept.

• Supervised all IT implementations, choose current operating system.

• Supervised sales & marketing teams, setting goals and targets planed marketing and sales tactics, helping us achieve

goals and targets.

Director of Operations

Concentra Medical Centers

1999 to 2009

• Directed and supervised employees in center.

• Hired, trained and evaluated center operations. Assisted Center Medical Director with disciplinary and terminating

of back office personnel.

• Developed and assisted in new policies, procedures and training programs for the center.

• Prepared and reviewed operational reports and schedules to assure accuracy and efficiency in center.

• Formulated annual budgets and reviewed financials with department heads. Established cost saving methods to improve efficiency of center.

• Conducted various events such as on-sight tours and training center personnel to present clinics services to clients to insure achievement or over achievement of established goals.

• Provided technical support and/or resources client and center personnel as needed (i.e., ADA, DOT regulations).

• Managed on-sight nursing services provided by center to client companies, including billing counseling, and supervision of on-sightpersonnel.

• Payroll, reconciliation, and reporting.

• Supervised physical therapy and dental department employees. Director of Operations

MedicalParkDiagnostic Centers

1989 to 1999

Supervision of day to day operations of 5(five) Diagnostic Centers

• Managed daily transactions of 5 diagnostic centers.

• Employees Evaluations and merit Reviews.

• Assisted in updating computer system. Overseeing all purchasing of equipment and supplies. Managing PACS System

• Overseeing X-Ray, Nuclear Medicine, CT, MRI, UltraSound and Mammography department.

• Overseeing Physician relations and marketing.

• Implementing Protocols for X-Ray, Ultra Sound, MRI, CT, Bone Density, and Mammography.

• Assisted with Cardiac Physicians in Thallium Stress Tests.

• Payroll, reconciliation, and reporting. Month End Closings.

• Achieved and expedited accreditation through AAAHC and obtained certification. Pharmaceutical Drug Study's investigator

• Diabetes study (Metformin) (Glucophage XR) Bristol-Myers Squibb.

• Bone Density study (Fosamax) Merck & Co., Inc.

• UTI study (AmNeal Pharmaceutical) Phenazopyridine Hydrochloride Education

High School Diploma

United States Military Academy Savanna

AS in Business Administration

Dade Community College Miami - Miami, FL

BS in Business Administration

University of Miami - Miami, FL

Skills

AHCA (10+ years), Avaya (10+ years), BILLING (10+ years), CPT (10+ years), Excel (10+ years), HIPAA

(10+ years), ICD (10+ years), ICD-9 (10+ years), IDX (Less than 1 year), Kronos (8 years), Medicaid

(10+ years), MEDICAL INVOICING (10+ years), Medicare (10+ years), Medisoft (7 years), Oracle (4 years), PowerPoint (10+ years), QuickBooks (10+ years), Risk Management (10+ years), Operation

(10+ years), Paychex (10+ years)

Certifications/Licenses

Radiologic Technologist

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