Associate Director Chief Financial
Resume:
Ernest D. Fusaro
Southborough, MA 01772
E-mail: ********@*******.***
Summary of Qualifications
Thirty-year career in healthcare, including twelve years in a leadership role focused on the oversight of revenue for the second-largest healthcare systems in both Massachusetts and Rhode Island. Excellent knowledge of hospital reimbursement issues, regulatory requirements, and managed care contracting. Expertise working in financially distressed organizations seeking merger options and new strategies.
Experience
Lawrence General Hospital, Lawrence, MA
Interim Chief Financial Officer (June 2024 – August 2024)
Assumed responsibility to present financial results to the Board and management team. During this period, the hospital finished with a positive bottom line and exceeded budget every month.
Integral role participating in the evaluation of the acquisition of the Steward Holy Family Hospital. Actively participated in all calls involving the decision-making process and evaluated all potential liabilities and opportunities as related to new non-exempt status, 340B and staffing models.
Participated in weekly position control meetings to manage FTE growth and nursing turnover.
Responsible for overseeing Revenue Cycle operations and evaluating opportunities related to outsourcing. Initiated complete chargemaster review identifying net revenue opportunities and eliminating false claim issues.
Lawrence General Hospital, Lawrence, MA
Executive Director of Financial Planning & Budget (April 2023 – May 2024)
Responsible for evaluating the hospital’s net revenue model and creating a new process for producing monthly entries to ensure transparency and accuracy. Updated prior methodologies and identified better data sources that improved monthly revenue recognition and streamlined the process to derive entries. The resulting audit of the 2023 financials was deemed much improved by the hospital’s outside audit firm.
Assumed a major role creating the FY 2024 budget. Worked closely with senior leaders to create assumptions and focused on several cost-cutting endeavors. Improved communication throughout the process and encouraged participation and created more accountability. At the same time, updates and greater efficiencies were identified with the budget software tool that will be permanently employed going forward. The new budget process resulted in a better, more accurate budget that promoted accountability and elevated knowledge throughout the organization.
Participated in a review of the hospital’s Revenue Cycle. Summarized proposals from several vendors to identify ways to improve collections. Created a standardized format of questions and responses to facilitate the review and enable senior leaders to make informed decisions. Opportunities associated with self-pay collections, improved ED coding, and chargemaster updates will generate several million dollars in new revenue for the hospital.
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Mount Auburn Hospital, Cambridge, MA
Director of Financial Planning (July 2021 – April 2023)
Responsible for creating the annual budget for both the hospital and physician group. Total expenses exceed $400M with a workforce of approximately 2,000 FTEs. Worked with senior leaders to identify both revenue and expense opportunities exceeding $36M to create a breakeven budget for FY 2023.
Responsible for overseeing monthly operating reviews (MORs) with department managers and directors. Also, responsible for presenting monthly financial results to leadership team. Assisted the contracted CFO with the monthly close and the annual budget process and briefly served as the Interim Chief Financial Officer.
Reviewed profitability of various service lines like Cardiac Surgery, Bariatrics and Orthopedics to assist with decision-making about growth plans, capital investment and marketing.
Assisted with the preparation of various regulatory filings including the direct oversight of the annual Medicare audit. Created supporting documentation and standardized workpapers and for future filings.
Care New England Health Care, Providence, RI
Vice President of Revenue Finance & Revenue Cycle (2017 – October 2020)
Responsible for the hospital revenue cycle functions of patient access, revenue integrity, health information management (HIM), coding, patient accounts, system applications and professional billing for four hospitals. Supervised seven directors with a staff of over 400 employees.
Integral role in working down receivable for a closed hospital along with overseeing various regulatory reporting needed for the closure of Memorial hospital.
Reorganized departmental responsibilities and eliminated over seventy positions.
Reviewed and reassessed provider-based billing procedures across the system to identify additional revenue opportunities. Identified over $15M in new permanent net revenue from additional billings to commercial insurers in fiscal year 2018.
Evaluated all outsourced receivable services and negotiated new arrangements related to both self-pay and low-dollar balances.
Maintained Revenue Finance responsibilities including oversight of all reimbursement functions and Managed Care Contracting.
Care New England Health Care, Providence, RI
Vice President of Revenue Finance (2014 – 2017)
Oversee the revenue and reimbursement functions of four hospitals with the responsibility for creating new standard revenue models for the financial statement and the annual budget. Created a new charge description master team to regularly review and update hospital charges and CPT coding. Responsible for all state and federal regulatory submissions and actively participated in all managed care contract negotiations.
Reorganized departmental responsibilities and conducted training sessions to elevate staff knowledge.
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Reviewed all monthly net revenue entries, eliminated incorrect and unnecessary adjustments, and created a standard reporting package.
Assisted with qualifying Kent Hospital for the 340B program. Annual drug savings exceed $300K.
Integral role in submitting applications to reclass Kent Hospital to the Worcester, Massachusetts wage area, thus preventing a $3M revenue reduction due to the loss of the Rhode Island imputed rural floor for fiscal year 2019.
Increased medical education payments from the Medicare program by over $1M by leading an initiative to close beds at the Memorial hospital campus.
Lahey Hospital & Medical Center, Burlington, MA
Payment Systems Consultant (2013 – 2014)
Provided guidance related to third party settlements, the net revenue budget, wage index revisions, and various state and federal regulatory submissions.
Steward Health Care System, Boston, MA
Vice President of Reimbursement & Financial Analysis (2008-2013)
Oversee the revenue and reimbursement functions of eleven hospitals with responsibility of ensuring accurate revenue recognition, reimbursement maximization and regulatory adherence. Directly supervise eight employees.
Qualified St. Elizabeth’s Medical Center for the 340B drug discount program by
attaining the 11.75% Disproportionate Share (DSH) threshold, resulting in annual drug cost savings exceeding $2M.
Responsible for obtaining over $19M in Electronic Health Record revenue from both
the Medicare and Medicaid programs.
Responsible for coordinating the transition to a new balance sheet methodology for all system hospitals.
Assisted with the transition to the Kaufman Hall budget software to be used during the annual revenue budget process.
Responsible for evaluating government insurer issues for all new acquisitions including third party reserves and future rate forecasts.
Assisted with identifying a $1M AR valuation error at the Good Samaritan campus caused by a procedural problem with how payments were applied to patient accounts.
Provided oversight to qualify Holy Family Medical Center as a State DSH hospital, which ultimately reduced their Health Safety Net assessment by over $1M.
Coordinated a reduction to the NICU bed license at St. Elizabeth’s Medical Center, which increased indirect medical education reimbursement from the Medicare program by $1M per year.
Implemented strategy to de-exempt Psychiatry units at the Holy Family campus, which enabled the hospital to qualify for the 340B drug discount program, resulting in drug cost savings exceeding $1M per year.
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Responsible for the submission of the Uniform Medicaid and Low Income Uncompensated Care Cost & Charge Report to the Massachusetts Medicaid Office, which secured the receipt of $6.3M from the Medical Assistance Trust Fund.
Secured Morton Hospital’s participation in the Medicare rural floor settlement after
they joined Steward, thus making the hospital eligible to receive $1M.
Responsible for providing detailed explanations about third party liabilities to
JP Morgan as part of the annual field audit; meetings resulted in an increase to Steward’s line of credit by $6M.
Trained new community benefits staff on how to prepare financial analysis for annual submission.
Caritas Christi Health Care, Boston, MA
Corporate Director of Reimbursement (2007-2008)
Responsible for reimbursement functions of the entire Caritas six-hospital system. This included all hospital reimbursement analysis, HMO payment negotiations, payer relations, public sector payer cost reporting, the annual net revenue budget, and the monthly and year-end contractual allowance analysis, and ad hoc corporate projects. Directly supervised eight employees.
Created a cost report compliance manual for usage throughout the system.
Negotiated a new Neighborhood Health Plan contract for Good Samaritan Medical Center, which increased revenue by $240K annually.
Responsible for permanently obtaining $100K in Medicare reimbursement for the
Pharmacy allied health training program at St. Elizabeth’s Medical Center.
Reopened 2005 Medicare cost report for St. Elizabeth’s Medical Center to add days to the disproportionate share calculation; revision resulted in an additional $360K in
revenue.
Caritas Christi Health Care, Boston, MA
Regional Director of Reimbursement & Managed Care (2004-2007)
Responsible for reimbursement functions of a multi-hospital region. This included hospital reimbursement analysis, HMO payment negotiations, payer relations, public sector payer cost reporting, the annual net revenue budget, and the monthly and year-end contractual allowance analysis, and ad hoc projects. Directly supervised four employees.
Identified $600K in improperly paid cardiac cases from Harvard Pilgrim.
Evaluated MassHealth case mix data used to derive the annual inpatient case rate,
Identified numerous errors, which resulted in corrections that generated an additional $3.5M in revenue.
Renegotiated new contract for the preparation of the annual Disproportionate Share
calculation, which generated over $250K in savings annually.
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Caritas St. Elizabeth’s Medical Center, Boston, MA
Director of Reimbursement & Managed Care (2003-2004)
Responsible for conducting all risk/reward financial analyses to be used by senior management in decision making. Provided overall direction of reimbursement department with focus on revenue maximization. Directly supervised four employees.
Created a net revenue model with new source files from the hospital’s Meditech system.
Increased medical education payments from the Medicare program $400K annually by leading an initiative to close medical/surgical beds.
Reopened 2002-2003 Medicare cost reports to correct resident-to-bed ratio used in the indirect medical education calculation; revision resulted in an additional $150K in
revenue.
Caritas St. Elizabeth’s Medical Center, Boston, MA
Reimbursement Manager (2000-2003)
Responsible for the monthly and year-end contractual allowance analysis, the development of the annual net revenue budget and the preparation of all third party settlement reports.
Responsible for implementing a medical education affiliation agreement between St.
Elizabeth’s Medical Center and Carney Hospital, which utilized unused training slots
and resulted in an additional $1M in Medicare revenue per year for St. Elizabeth’s
Medical Center.
Responsible for permanently obtaining $200K in Medicare reimbursement for the
pastoral care training program.
Responsible for providing net revenue assumptions and guidance related to the annual budget process for all hospitals in the organization.
Caritas St. Elizabeth’s Medical Center, Boston, MA
Reimbursement Supervisor (1998-2000)
Fresenius Medical Care, Waltham, MA
Senior Financial Analyst (1995-1998)
Memorial Hospital (Worcester, MA)
Senior Financial Analyst (1992-1995)
UMASS Medical Center (Worcester, MA)
Financial Analyst (1987-1992)
UMASS Group Practice Plan (Worcester, MA)
Collections Supervisor (1985-1987)
Education
Master of Business Administration 1986
Anna Maria College, Paxton, MA
Bachelor of Administration 1984
Holy Cross College, Worcester, MA
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