Revenue Cycle Integrity

LORI A. LAWTHER

MONACA, PA ***** • 412-***-**** • ******@*****.***

Director, Revenue Integrity

Self-motivated, innovative leader with experience defining and developing strategies to maximize gross and net revenue capture across an organization. Collaborate with cross-functional departments, including information technology (IT), revenue cycle operations, clinical informatics, and compliance to conduct holistic, system-wide evaluation of operational and economic feasibility and deliver structured recommendations to drive revenue growth. Demonstrate strong cross-functional communication, analytical skills, strategic thinking, creative problem-solving, and strong leadership. Thrive in dynamic, fast- paced environments with the ability to multi-task and prioritize multiple projects simultaneously and influence others. AREAS OF EMPHASIS

Budgeting Capital Planning Revenue and Profit Optimization Organizational and Excellent Communication Skills Attention to Detail Ability to Inspire and Motivate Team Members Patient Relations Cross-Functional Collaboration Regulatory Compliance Policy Development Education, Training & Auditing System Development Decision-Making Skills Medical Terminology Medical Billing and Coding Medicare & Medicaid Knowledge HIPAA Guidelines TECHNOLOGY SKILLS

Microsoft Office Suite Medical Billing Software Epic PROFESSIONAL EXPERIENCE

ALLEGHENY HEALTH NETWORK (AHN) Pittsburgh, PA 02/2015 – Present Director, Revenue Integrity 08/2020 – Present

Direct revenue integrity management, strategies, policies, procedures, budget processes, project implementations, program expansions, and committee representation. Supervise a team of 23 and develop and manage revenue cycle workplan for both facility and professional services, focusing on key areas. Collaborate closely with operational leadership to ensure projects are completed on time. Develop and track financial and performance metrics to ensure organizational goals are achieved, while upholding a rigorous approach to budgeting and capital planning. Work closely with operational management to ensure projected revenues, expenses, and profit targets are achieved. Prepare and deliver reports and recommendations to senior leadership regarding business operations to support decision-making.

• Successfully expanded revenue integrity program, encompassing both facilities and Revenue Cycle Center (RCC) of physician practices and organizations, by conducting audits of departments, hospitals, and physicians, providing educational resources, and engaging with cross-functional departments to identify $8.6M in revenue opportunities.

• Directed the development of a newly constructed hospital, overseeing the capital project, and creating a Charge Description Master (CDM) and corresponding fee schedule.

• Managed the development, implementation, and enforcement of organizational policies and procedures, while maintaining a robust internal control environment to secure assets, guarantee adherence to policies and procedures, and achieve compliance with applicable laws and regulations.

• Shifted the department from a reactive to a proactive approach, initiating meetings with departments heads to provide education and guidance on addressing areas of opportunity and missed revenue, resulting in substantial revenue recovery.

• Oversaw the development of a New Product Committee by collaborating with clinical department leaders, coding, and managed care to present an impact analysis to the Chief Financial Officer (CFO) and finance department for approval.

• Managed New Business Committee, ensuring all new business initiatives underwent a comprehensive review by revenue cycle, ensuring CDM charges were accurately created, priced, and mapped to cost center locations. Manager, Revenue Integrity 02/2017 – 08/2020

Managed a team of 20, providing leadership and guidance to staff to ensure high levels of performance. Consistently ensured the financial stability of the health system by maintaining a comprehensive and precise charge listing and charging process that aligned with federal regulations. Managed the health system’s CDM, ensuring all billable activities were accurately represented. LORI A. LAWTHER P A G E 2

Supervised revenue integrity of clinical departments by providing education, training, and resources to effectively capture clinical charges. Collaborated with cross-functional teams to enhance charge capture and identify opportunities for improvement.

• Led the integration of a hospital’s legacy system into Epic by establishing a consolidated CDM and working to rectify previous issues related to information updates.

• Guaranteed price transparency by monitoring, analyzing, and updating CDM pricing in response to reimbursement modifications and strategic plans.

• Fostered an inclusive and collaborative environment that focused on employee recognition, professional development opportunities, and in-service education, resulting in improved work practices and an enhanced culture. Revenue Integrity Analyst 07/2016 – 02/2017

Served as a trusted advisor to provide practice and regulatory guidance and recommendations for improvements to Revenue Cycle Center (RCC) for facilities and physician practices and departments.

• Developed and executed strategies to optimize end-to-end procedures, including root cause analysis, monitoring, auditing, reporting, and educating on topics such as revenue cycle and problem-solving across all leadership levels.

• Collaborated with clinical staff, practices, and leadership to optimize workflows and procedures by identifying training and development needs across all revenue cycle processes and ensuring appropriate hand-offs for designated topics.

• Communicated with departments to highlight areas where charge capture was being missed to resolve issues.

• Established and implemented internal controls to ensure complete and accurate documentation and billing procedures.

• Assisted in optimizing clinical documentation through thorough analysis.

• Worked closely with insurance follow-up and billing departments to resolve issues with accounts and coach cross-functional team members on resolving problems independently.

Charge Capture Analyst – Revenue Integrity 12/2015 – 07/2016 Analyzed charges denied by insurance companies and followed up with IT and clinical departments to provide education. Corrected workflow to provide charge capture opportunities, leading to improved patient satisfaction. Account Collections Specialist II SBO 02/2015 – 12/2015 Trained self-pay and customer service groups on Epic billing system, properly processing insurance filings, subsequent insurance payments, and contractual adjustments. Accurately processed applications for financial assistance, collected payments, and provided guidance and support to other staff members. Earlier Experience:

UPMC Physician Services, Pittsburgh, PA – Billing Specialist II 03/2012 – 02/2015 UPMC Magee Women’s Hospital Breast Imaging, Pittsburgh, PA – Clinical Support Specialist III 03/2011 – 03/2012 Medical Service Associates, Pittsburgh, PA – Billing Specialist 10/2009 – 03/2011 EDUCATION AND CREDENTIALS

STRAYER UNIVERSITY Bachelor of Science in Healthcare Management Certifications and Professional Training

• Certified Revenue Integrity Professional (CRIP)

• Certification in Healthcare Revenue Integrity (CHRI)

• Pittsburgh Technical Institute, Medical Coding Certificate

• ICD-9 Coding – Anatomy, Physiology, Biology, Medical Terminology, Medical Billing, Insurance

• ICD-10 Medical Coding

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