Revenue Integrity
Resume:
Norwell, MA *****
310-***-**** (Cell Phone)
PROFESSIONAL EXPERIENCE
VALLEY PRESBYTERIAN HOSPITAL, Van Nuys, CA 2011 – 2021
Manager, CDM/Revenue Integrity
Lead a team of consultants which reviewed and revised the Charge Description Master. Created policies/procedures governing charge capture and revenue integrity. Hired and trained charge and coding auditors. Developed formal audit program. Formed and manage teams of financial and clinical personnel that conduct ongoing process review and implement and monitor improvement plans. Obtained two professional coding credentials and provide ongoing training for outpatient coding auditors.
CORNERSTONE HEALTHCARE GROUP, Houston TX 2010 – 2012
Consultant, CDM/Revenue Integrity
Consulted remotely with Corporate Chief Financial Officer to lead a team to review and revise the Charge Description Master for 9 Long Term Acute Care Facilities. Lead a team of clinical managers to implement policies and procedures governing charge capture.
BROTMAN MEDICAL CENTER, Culver City, CA 2008 – 2010
Director, Audit and Revenue Integrity
Reviewed/revised Charge Description Master with pricing guidelines for all revenue producing departments. Created and lead a team of clinical and financial managers which developed a charge audit program including policies and procedures which guided all charge processes. Hired and trained Revenue Integrity Auditors to maintain the program.
CENTURY CITY DOCTORS HOSPITAL, Los Angeles, CA 2005 – 2008
Revenue Cycle Manager
Responsible for evaluation and management of all aspects of the revenue cycle, from admitting functions, to assisting with collection issues, especially as related to clinical documents and charging practices. This was a new entity that opened its doors to patients in October of 2005, licensed for 170 beds, an outpatient clinic and an outpatient radiology center. Hired, trained and managed a team of charge capture specialists which created policies, procedures and processes to direct charge capture, monitor the results, and implement improvement plans.
DANIEL FREEMAN MEMORIAL AND MARINA HOSPITALS, Inglewood, CA 2002 - 2005
Manager CDM/Revenue Integrity
Reviewed/revised Charge Description Master, developed, implemented and monitored formal charge audit program. Developed and lead a Charge Capture Team comprised of Clinical and Financial Managers to conduct ongoing assessment of charge capture processes and implement corrective action.
CENTURY CITY HOSPITAL, Los Angeles, CA
Medical Auditor/Revenue Integrity/APC Coordinator 1998 - 2002
Created and implemented a formal charge audit program; formed charge capture team of clinical and financial supervisors to monitor the program and implement corrective action. Obtained professional credential as a Medical Audit Specialist.
Family Nurse Practitioner/Registered Nurse 1991 - 1998
Staff Nurse (CQI/Education/Employee Health)
Relief House Nursing Supervisor
Direct patient care/CQI activities for geriatric clinic and Emergency Department. When functioning as house nursing supervisor, on site supervisor for facility staff and facility operations. Covered for Emergency Department Director in her absence.
CENTINELA HOSPITAL MEDICAL CENTER, Inglewood, CA 1989 - 1991
Emergency Department Manager
Clinical Manager for busy inner city Emergency Department (120 patient visits per day). Supervised clinical staff, maintained charge description master; handled department budget; implemented and monitored CQI activities; monitored paramedic base hospital radio operations; prepared for JCAHO surveys; participated in multiple facility wide committees.
HARBOR-UCLA MEDICAL CENTER, Torrance, CA 1985 - 1988
Pre-Hospital Care Coordinator - Emergency Department
Coordinated and provided education programs for nurse, physician and paramedic personnel; monitored and supervised prehospital care performance of all levels of clinical staff and provided feedback for annual evaluation process; coordinated Mobile Intensive Care Nurse Courses; Triage Nursing Courses; Prehospital Physician Courses; ACLS Provider and Instructor Courses. Directed prehospital care in collaboration with Prehospital Care Physician Director.
LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES, Los Angeles, CA 1980 - 1985
Acting EMS Program Head- Medical Monitoring Unit 1983 - 1985
Paramedic Base Hospital Coordinator, Pre-Hospital Care Programs 1980 - 1983
Monitored prehospital care performance of 34 paramedic base hospital facilities and 33 prehospital care provider agencies, including Los Angeles City and County Fire Department prehospital operations. In collaboration with EMS staff, developed and implemented policies and procedures for Los Angeles County EMS Programs. Supervised clinical staff in prehospital care settings. Assisted with certification and recertification process for prehospital personnel; worked with base hospital facilities to develop and implement facility level prehospital related policies. Assisted District Attorney as needed with prehospital care investigations.
HARBOR-UCLA MEDICAL CENTER, Torrance, CA 1977 - 1980
Mobile Intensive Care Nurse, Emergency Department 1978 - 1980
Critical Care Registered Nurse, Intensive Care Unit 1977 - 1978
Directed patient care in busy urban trauma center. Directed prehospital care via base hospital radio operations. Assigned as charge nurse in large emergency department (300 patient visits per day) and 12-bed surgical intensive care unit.
SPARTANBURG REGIONAL MEDICAL CENTER, Spartanburg, SC 1975 - 1977
Staff Nurse, Medical/Surgical Unit 1976 - 1977
Staff Nurse, Emergency Department 1975 - 1976
Directed patient care in large urban trauma center.
EDUCATION
General
Associate Degree, Nursing, 1973 - 1975
Massachusetts Bay Community College, Wellesley Hills, MA
Bachelor Degree, Nursing, 1983 - 1984
University of Phoenix, Irvine, CA
Teaching Credential, Health Sciences, 1984 - 984
California State University, Long Beach, Long Beach, CA
Master of Science, Nursing, 1984 - 1992
California State University, Los Angeles, Los Angeles, CA
Post-Master’s Certification, Family Nurse Practitioner, 1995 - 1996
Family Nurse Practitioner Program
University of Southern California, Los Angeles, CA
Specialty Courses/Certifications/Affiliations
Registered Nurse, 1975 (active license maintained)
Mobile Intensive Care Nurse Development Course, 1977
Comprehensive Critical Care Nursing, 1979
Advance Cardiac Life Support Provider, 1979
Advanced Cardiac Life Support Instructor, 1981
Basic Trauma Life Support Provider, 1987
Certified Family Nurse Practitioner, 1996
Pediatric Advanced Life Support Provider, 2001
Former Member American Association of Medical Audit Specialists
Certified Medical Audit Specialist, 2004
Medicare Boot Camp, 2004
Certified Outpatient Coder, Hospital 2012 (COC)
Former Member American Association Professional Coders (AAPC)
Certified Interventional Radiology and Cardiovascular 2013 (CIRCC)
Current Member ZHealth Publishing
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