Vice President of Revenue Cycle
TECHNICAL SKILLS & QUALIFICATIONS
? Professional Healthcare Executive with over 20 years Success in Revenue Cycle Management, Operations, and Healthcare Compliance.
? Expertise in A/R Reduction, Billing Analysis, Process Improvement and Human Resource Management. Experience includes, but is not limited to Medical Billing, Coding, Accounts Payable, Accounts Receivable, Reconciliation, Customer Service, and Collections � Private Insurance, HMO's, PPO's, Workers Compensation, Medi-Cal/Medicaid, and Medicare.
? Personable and Approachable Executive Leader with Excellent Human Relations Skills. RT/DME/HME, Home Infusion, TPN, Pharmacy, Radiology, Radiation Therapy, Hospital, Reconstructive Surgery, Family Practice, ENT, Urgent Care, Cardiology, Home Health, Labs, P/T, Anesthesiology, & Dermatology Billing and Receivables Management.
? General Management Experience including P/L, Data Processing, Human Resources, Accounting, Payroll, Accounts Receivable, Accounts Payable, and Corporate Budget/Operations.
? Major Accomplishments in A/R Reduction through Process Analysis/Re-Engineering, Training/Retraining, Policies & Procedures, and Personal Leadership. CMS-1500 and UB-04 filings (including electronic), CPT, RVS, ICD-9, ICD-10 CDT-3 Coding, Reconciliation, RVU pricing, Corporate Compliance, HIPAA, and JCAHO Standards Experience.
? Over 10 years Managed Care Contract Negotiating Experience.
? PC�s, Cal-Med, Mesta-Med, Microsoft Word, Excel, Windows 7 & XP, Lotus 1-2-3, Medical Manager, National Medical, Medfac, Novatime, ADP, Kronos, SAP, HTM, Dezine, Advantage, TIMS, Monarch, CentreVu, EPIC, HERAE, Medi-Soft, IDX, Pharmworks, NextGen, CPR+, Cybersource, Emdeon, Trizetto, Raintree, & others.
EXPERIENCE
Helios Revenue Cycle Management April 2016 � Present
Specialize in all aspects of healthcare billing and collections.
Owner/Managing Principal
� Offer outsource solutions to assist with increased cash collections, decreased claim rejections, and accelerated reimbursement for services provided.
� Provide strategic consultation and assistance to improve cash flow enhancement and decrease reimbursement losses.
� Provide optimal results, alignment of technology, improved operations and financial performance.
� Find new solutions to financial challenges, allowing clients to focus on their core business and achieve success.
Physical Rehabilitation Network, Carlsbad, CA April 2015 � May 2016
Physical/Occupational Therapy Provider
Vice President of Revenue Cycle Management
Reporting to the CEO, responsible for establishing, documenting, and implementing appropriate billing, collections, and cash posting policies and controls while maintaining up-to-date expertise of healthcare billing laws and regulations. Monitor billing and collections operations for compliance, apprise business office staff and executive team on issues of outstanding claims, and oversee daily activities related to delinquent accounts or special judgments. A/R: $90MM � Managed a staff of 60.
� Charged with merging Central Business Offices to create one office location in Southern California by writing new billing and collection policies and procedures, setting up new protocols, creating and rewriting job descriptions, and completely revamping the Revenue Cycle Department Organization Chart to align best practice outcomes.
ACCOMPLISHMENTS
? Reorganized and revamped the CBO, which increased cash collections and decreased the overall DSO from 74 to 48 days.
Biofusion LLC. Torrance, CA 2013 � 2015
Nationwide Specialized Provider of IVIG and Hemophilia Management
Senior Director of Reimbursement & Intake
Reports to the Senior Vice President of Reimbursement, Staff of 16: 1-Reimbursement Manager, 1-Intake Manger, 1-Admin Assistant, 3-Intake Coordinators, 5-Collectors, 2-Billers, 2-Reauth Reps , & 1-Eligibility Rep. A/R = $86MM.
? Responsibilities Include Oversight of the Entire Company Customer Service, Intake, Billing and Collections Team, which includes, Intake, Eligibility, Authorization, Reauthorization, Billing, Collections, & Appeals.
? The Scope of Responsibility includes Patient Care Coordination with Pharmacy and Nursing.
? Management of a Customer Service Patient Billing and Financial Assistance Team.
? Assist Patients with Drug Foundation Programs and Financial Assistance Application Reviews & Completion.
? Assistance with all Onsite and Offsite Branch Location Government Payer Audits.
? Payer contract negotiations and administration.
? Reimbursement & Intake Department Staff Compliance Education Updates & Reviews Administration.
? Reviewing all new Intakes for Profitability, Cost Analysis Reporting.
? Assist with CPR+ Month end Process and Monthly Report Distribution.
? Billed and Collected Multiple Payers, including Medi-Cal, Medicaid, Medicare, BC/BS, Champus/Tricare, PPO,
Self Pay, Private Payers.
ACCOMPLISHMENTS
? Reduced New Patient No Go Rate by 50%.
? Increased 90 Day & Over Cash Collections.
Crescent Healthcare Inc. Anaheim, CA 2006 - 2012
Nationwide Home Infusion/Pharmacy Provider (Acquired by Walgreens Infusion Services)
Director of Reimbursement
Reported to the CFO. Staff of 90: 7-Collection/Billing Supervisors, 1- Sr. Reimbursement Manager, 1-Reimbursement Manager and 70-Billers & Collectors, 4-Cash Posters, 1-Admin Assistant, & 6-Medical Records Clerks. A/R = $180MM.
? Responsibilities Included Oversight of the Entire Company Receivables Department, which Encompassed, Intake, Eligibility, Authorization, Reauthorization, Billing, Collections, Appeals, & Cash Positing.
? The Scope of Responsibility Included 11 Branch Locations throughout California, New Jersey, and Florida.
? Billed and Collected 330+ Payer Contracts, including Medi-Cal, Medicaid, Medicare, Champus/Tricare, PPO, HMO, Capitation, Self Pay, Private Payers and Multiple Hospital Partnership Agreements.
? The Scope Included Management of a Customer Service Patient Billing and Financial Assistance Team, who handled all Patient Inquiries.
? Payer Contract Review as it Pertained to our ability to Bill and Collect, along with time frame needed for Successful Reimbursement of Claims.
? Assistance with all Onsite and Offsite Branch Location Government Payer Audits.
? Reimbursement & Intake Department Staff Compliance Education Updates & Reviews Administration.
? Responsible for Proper Implementation of New System Conversions from Pharmworks to CPR+ and transition to EPIC EMR.
ACCOMPLISHMENTS
? Reorganized CBO, which decreased the overall DSO from 104 days to 40 days.
Advanced Respiratory Care, San Leandro, CA 2004 - 2006
Nationwide RT/DME distribution and sales, Oxygen Services, Durable Medical Equipment.
General Manager
Reported to the Western Regional Director. Staff of 35: 1-Customer Service Manager, 1-Clinical Manager, 1-Billing Manager, 1-Warehouse Manager/Dispatcher. A/R = $20MM.
? Responsible for the Entire Successful Branch Operations: Customer Service, Budget, Financials, HR, Accounting, Payroll, Accounts Payable, Accounts Receivable, Compliance, JCAHO Accreditation Standards, Monthly Operating Report, and Payer Contracting.
? Scope of Position handled Intake, Eligibility, Authorization, Reauthorization, Billing, Collections, Appeals, Cash Posting, Certificate of Medical Necessity, Medical Records, and Compliance Standards.
? Handled Multiple Payer Contracts, Including Capitation Agreements, as well as Medi-Cal, Champus/Tricare, Medicare, PPO�s HMO�s, Self Pay, and Private Payers.
ACCOMPLISHMENTS
? Reorganized the Central Billing Office, which decreased the Overall DSO from 212 days to under 90 days.
Maric College (Kaplan College), Carson, CA 2003 - 2004
Medical Billing Instructor
? Conducted classes in Medical Billing and Coding, including Concepts and Practical Applications; Policies and Procedures; Regulations and Compliance.
? Scope of classes included billing on UB-04, CMS1500, Dental Claims, & Extensive Coding Training on HCPC, CPT, ICD-9, DRG, CDT, RBRVS, Inpatient Services, Outpatient Services, Medicare, Blue Card Program, Medical Terminology, Anatomy & Physiology.
Team Health Radiology, Tampa, FL 2003
Nationwide Radiology Management Services Organization, Imaging Services, TeleRadiology Services, and Radiology Consultation Services Provider.
Operations Management (CONSULTANT)
? Contract employment to help restore the Management Services Relationship between the Physicians and the organization.
? Oversaw Physician Credentialing, Scheduling, Physician Payroll, Imaging Site Operations, Provider Enrollment, Payer Contract Renegotiations, Provider Claims Batching, Pre-authorization, Insurance Verification, CME Tracking, Physician Coding Analysis, HIPAA Compliance training, and Accounts Receivable Analysis.
DJ Orthopedics, LLC, Vista, CA 2002
Nationwide Orthopedic Brace, Support, Distribution, and Sales.
Billing Operations Manager
Reported to the Vice President of Reimbursement. Staff of 66: 1-Cash Application Supervisor, 1-Forms Processing Supervisor, 1-Patient Services Lead, 1-Compliance Officer, 1-Collections Lead, 1-Refunds Specialist, 3-Reimbursement Analysts, 1-Cash Application Auditor/Trainer, 8-Cash Application Specialists, 11-Billers/Forms Processors, 9-Patient Services Representatives, 20-Collection Representatives, 6-Correspondence Representatives, and 2-Deposit/Mail Clerks. A/R = $100MM+.
? Responsible for the Company�s entire Billing, Compliance, and Collection Function for 600+ Orthopedic Offices Nationwide.
? Established Blue Card Training Manuals, Served on the Corporate Steering Committee, Developed a Customer Service Team and Implemented use of the CentreVu Call Management System.
? Billed and Collected Private Insurance, HMO/PPO's, Medicare/Medicaid, and Patient Pay Accounts.
ACCOMPLISHMENTS
? Established a Collections Department and Reorganized the Entire Billing Process, which increased weekly Cash Collections by over 60% and Decreased the DSO by over 100 days.
Med-Mart/Pacific Pulmonary Services, Antioch, CA 2001 - 2002
Nationwide RT/DME distribution and sales, Oxygen Services.
Regional Reimbursement Manager (CONSULTANT)
Reported to the VP of Reimbursement. Staff of 32: 1-Assistant Reimbursement Manager, 3-Reimbursement Supervisors, 3-Reimbursement Support Reps, 2-Cash Application Specialists, 2-Senior Reimbursement Reps, 2-Insurance Verification Reps, and 19-Reimbursement Reps. A/R = $60MM.
? Responsible for the entire Antioch Central Billing Office: Budget, Financials, HR, Accounting, Payroll, and the Complete Billing and Collection Function for 30 + outside Branch Offices. Billed and Collected Private Insurance, HMO/PPO's, Medicare/Medicaid, Champus/Tricare, & Others. A/R = $60MM.
ACCOMPLISHMENTS
? Reorganized The Central Billing Office in order to help with the Reduction of the Aging Receivable from over 100 DSO to 39 DSO.
Medical Tracking Services, Inc., Reno, NV 1998 - 2001
Factoring of A/R for DME Distributors, Radiology, Hospital, Home Health, Doctors, Medical
Start-Ups, Etc.
General Manager
Reported to the Regional Director. Staff of 20: 1-Supervisor of Cash Applications, 1-Supervisor of Data Entry, 7-Data Entry Clerks, 11-Cash Applicators. A/R = $40MM+.
? Responsible for the entire Reno Office Operations: Budget, Financials, HR, Accounting, Payroll, and the Complete Medical Receivables Factoring Function for 40 Providers. Extensive Oversight and Retraining of Clients Regarding Effective Due Diligence (Verification-Billing-A/R-Collection Processes) concerning Private Insurance, HMO/PPO's, Medicare/Medicaid, & Others. A/R = $40MM+.
ACCOMPLISHMENTS
? Managed Massive Growth (4 to 40 providers).
EDUCATION
Bristol University � Bristol, TN
Bachelor of Business Administration
TECHNICAL SKILLS & QUALIFICATIONS
? Professional Healthcare Executive with over 20 years Success in Revenue Cycle Management, Operations, and Healthcare Compliance.
? Expertise in A/R Reduction, Billing Analysis, Process Improvement and Human Resource Management. Experience includes, but is not limited to Medical Billing, Coding, Accounts Payable, Accounts Receivable, Reconciliation, Customer Service, and Collections � Private Insurance, HMO's, PPO's, Workers Compensation, Medi-Cal/Medicaid, and Medicare.
? Personable and Approachable Executive Leader with Excellent Human Relations Skills. RT/DME/HME, Home Infusion, TPN, Pharmacy, Radiology, Radiation Therapy, Hospital, Reconstructive Surgery, Family Practice, ENT, Urgent Care, Cardiology, Home Health, Labs, P/T, Anesthesiology, & Dermatology Billing and Receivables Management.
? General Management Experience including P/L, Data Processing, Human Resources, Accounting, Payroll, Accounts Receivable, Accounts Payable, and Corporate Budget/Operations.
? Major Accomplishments in A/R Reduction through Process Analysis/Re-Engineering, Training/Retraining, Policies & Procedures, and Personal Leadership. CMS-1500 and UB-04 filings (including electronic), CPT, RVS, ICD-9, ICD-10 CDT-3 Coding, Reconciliation, RVU pricing, Corporate Compliance, HIPAA, and JCAHO Standards Experience.
? Over 10 years Managed Care Contract Negotiating Experience.
? PC�s, Cal-Med, Mesta-Med, Microsoft Word, Excel, Windows 7 & XP, Lotus 1-2-3, Medical Manager, National Medical, Medfac, Novatime, ADP, Kronos, SAP, HTM, Dezine, Advantage, TIMS, Monarch, CentreVu, EPIC, HERAE, Medi-Soft, IDX, Pharmworks, NextGen, CPR+, Cybersource, Emdeon, Trizetto, Raintree, & others.
EXPERIENCE
Helios Revenue Cycle Management April 2016 � Present
Specialize in all aspects of healthcare billing and collections.
Owner/Managing Principal
� Offer outsource solutions to assist with increased cash collections, decreased claim rejections, and accelerated reimbursement for services provided.
� Provide strategic consultation and assistance to improve cash flow enhancement and decrease reimbursement losses.
� Provide optimal results, alignment of technology, improved operations and financial performance.
� Find new solutions to financial challenges, allowing clients to focus on their core business and achieve success.
Physical Rehabilitation Network, Carlsbad, CA April 2015 � May 2016
Physical/Occupational Therapy Provider
Vice President of Revenue Cycle Management
Reporting to the CEO, responsible for establishing, documenting, and implementing appropriate billing, collections, and cash posting policies and controls while maintaining up-to-date expertise of healthcare billing laws and regulations. Monitor billing and collections operations for compliance, apprise business office staff and executive team on issues of outstanding claims, and oversee daily activities related to delinquent accounts or special judgments. A/R: $90MM � Managed a staff of 60.
� Charged with merging Central Business Offices to create one office location in Southern California by writing new billing and collection policies and procedures, setting up new protocols, creating and rewriting job descriptions, and completely revamping the Revenue Cycle Department Organization Chart to align best practice outcomes.
ACCOMPLISHMENTS
? Reorganized and revamped the CBO, which increased cash collections and decreased the overall DSO from 74 to 48 days.
Biofusion LLC. Torrance, CA 2013 � 2015
Nationwide Specialized Provider of IVIG and Hemophilia Management
Senior Director of Reimbursement & Intake
Reports to the Senior Vice President of Reimbursement, Staff of 16: 1-Reimbursement Manager, 1-Intake Manger, 1-Admin Assistant, 3-Intake Coordinators, 5-Collectors, 2-Billers, 2-Reauth Reps , & 1-Eligibility Rep. A/R = $86MM.
? Responsibilities Include Oversight of the Entire Company Customer Service, Intake, Billing and Collections Team, which includes, Intake, Eligibility, Authorization, Reauthorization, Billing, Collections, & Appeals.
? The Scope of Responsibility includes Patient Care Coordination with Pharmacy and Nursing.
? Management of a Customer Service Patient Billing and Financial Assistance Team.
? Assist Patients with Drug Foundation Programs and Financial Assistance Application Reviews & Completion.
? Assistance with all Onsite and Offsite Branch Location Government Payer Audits.
? Payer contract negotiations and administration.
? Reimbursement & Intake Department Staff Compliance Education Updates & Reviews Administration.
? Reviewing all new Intakes for Profitability, Cost Analysis Reporting.
? Assist with CPR+ Month end Process and Monthly Report Distribution.
? Billed and Collected Multiple Payers, including Medi-Cal, Medicaid, Medicare, BC/BS, Champus/Tricare, PPO,
Self Pay, Private Payers.
ACCOMPLISHMENTS
? Reduced New Patient No Go Rate by 50%.
? Increased 90 Day & Over Cash Collections.
Crescent Healthcare Inc. Anaheim, CA 2006 - 2012
Nationwide Home Infusion/Pharmacy Provider (Acquired by Walgreens Infusion Services)
Director of Reimbursement
Reported to the CFO. Staff of 90: 7-Collection/Billing Supervisors, 1- Sr. Reimbursement Manager, 1-Reimbursement Manager and 70-Billers & Collectors, 4-Cash Posters, 1-Admin Assistant, & 6-Medical Records Clerks. A/R = $180MM.
? Responsibilities Included Oversight of the Entire Company Receivables Department, which Encompassed, Intake, Eligibility, Authorization, Reauthorization, Billing, Collections, Appeals, & Cash Positing.
? The Scope of Responsibility Included 11 Branch Locations throughout California, New Jersey, and Florida.
? Billed and Collected 330+ Payer Contracts, including Medi-Cal, Medicaid, Medicare, Champus/Tricare, PPO, HMO, Capitation, Self Pay, Private Payers and Multiple Hospital Partnership Agreements.
? The Scope Included Management of a Customer Service Patient Billing and Financial Assistance Team, who handled all Patient Inquiries.
? Payer Contract Review as it Pertained to our ability to Bill and Collect, along with time frame needed for Successful Reimbursement of Claims.
? Assistance with all Onsite and Offsite Branch Location Government Payer Audits.
? Reimbursement & Intake Department Staff Compliance Education Updates & Reviews Administration.
? Responsible for Proper Implementation of New System Conversions from Pharmworks to CPR+ and transition to EPIC EMR.
ACCOMPLISHMENTS
? Reorganized CBO, which decreased the overall DSO from 104 days to 40 days.
Advanced Respiratory Care, San Leandro, CA 2004 - 2006
Nationwide RT/DME distribution and sales, Oxygen Services, Durable Medical Equipment.
General Manager
Reported to the Western Regional Director. Staff of 35: 1-Customer Service Manager, 1-Clinical Manager, 1-Billing Manager, 1-Warehouse Manager/Dispatcher. A/R = $20MM.
? Responsible for the Entire Successful Branch Operations: Customer Service, Budget, Financials, HR, Accounting, Payroll, Accounts Payable, Accounts Receivable, Compliance, JCAHO Accreditation Standards, Monthly Operating Report, and Payer Contracting.
? Scope of Position handled Intake, Eligibility, Authorization, Reauthorization, Billing, Collections, Appeals, Cash Posting, Certificate of Medical Necessity, Medical Records, and Compliance Standards.
? Handled Multiple Payer Contracts, Including Capitation Agreements, as well as Medi-Cal, Champus/Tricare, Medicare, PPO�s HMO�s, Self Pay, and Private Payers.
ACCOMPLISHMENTS
? Reorganized the Central Billing Office, which decreased the Overall DSO from 212 days to under 90 days.
Maric College (Kaplan College), Carson, CA 2003 - 2004
Medical Billing Instructor
? Conducted classes in Medical Billing and Coding, including Concepts and Practical Applications; Policies and Procedures; Regulations and Compliance.
? Scope of classes included billing on UB-04, CMS1500, Dental Claims, & Extensive Coding Training on HCPC, CPT, ICD-9, DRG, CDT, RBRVS, Inpatient Services, Outpatient Services, Medicare, Blue Card Program, Medical Terminology, Anatomy & Physiology.
Team Health Radiology, Tampa, FL 2003
Nationwide Radiology Management Services Organization, Imaging Services, TeleRadiology Services, and Radiology Consultation Services Provider.
Operations Management (CONSULTANT)
? Contract employment to help restore the Management Services Relationship between the Physicians and the organization.
? Oversaw Physician Credentialing, Scheduling, Physician Payroll, Imaging Site Operations, Provider Enrollment, Payer Contract Renegotiations, Provider Claims Batching, Pre-authorization, Insurance Verification, CME Tracking, Physician Coding Analysis, HIPAA Compliance training, and Accounts Receivable Analysis.
DJ Orthopedics, LLC, Vista, CA 2002
Nationwide Orthopedic Brace, Support, Distribution, and Sales.
Billing Operations Manager
Reported to the Vice President of Reimbursement. Staff of 66: 1-Cash Application Supervisor, 1-Forms Processing Supervisor, 1-Patient Services Lead, 1-Compliance Officer, 1-Collections Lead, 1-Refunds Specialist, 3-Reimbursement Analysts, 1-Cash Application Auditor/Trainer, 8-Cash Application Specialists, 11-Billers/Forms Processors, 9-Patient Services Representatives, 20-Collection Representatives, 6-Correspondence Representatives, and 2-Deposit/Mail Clerks. A/R = $100MM+.
? Responsible for the Company�s entire Billing, Compliance, and Collection Function for 600+ Orthopedic Offices Nationwide.
? Established Blue Card Training Manuals, Served on the Corporate Steering Committee, Developed a Customer Service Team and Implemented use of the CentreVu Call Management System.
? Billed and Collected Private Insurance, HMO/PPO's, Medicare/Medicaid, and Patient Pay Accounts.
ACCOMPLISHMENTS
? Established a Collections Department and Reorganized the Entire Billing Process, which increased weekly Cash Collections by over 60% and Decreased the DSO by over 100 days.
Med-Mart/Pacific Pulmonary Services, Antioch, CA 2001 - 2002
Nationwide RT/DME distribution and sales, Oxygen Services.
Regional Reimbursement Manager (CONSULTANT)
Reported to the VP of Reimbursement. Staff of 32: 1-Assistant Reimbursement Manager, 3-Reimbursement Supervisors, 3-Reimbursement Support Reps, 2-Cash Application Specialists, 2-Senior Reimbursement Reps, 2-Insurance Verification Reps, and 19-Reimbursement Reps. A/R = $60MM.
? Responsible for the entire Antioch Central Billing Office: Budget, Financials, HR, Accounting, Payroll, and the Complete Billing and Collection Function for 30 + outside Branch Offices. Billed and Collected Private Insurance, HMO/PPO's, Medicare/Medicaid, Champus/Tricare, & Others. A/R = $60MM.
ACCOMPLISHMENTS
? Reorganized The Central Billing Office in order to help with the Reduction of the Aging Receivable from over 100 DSO to 39 DSO.
Medical Tracking Services, Inc., Reno, NV 1998 - 2001
Factoring of A/R for DME Distributors, Radiology, Hospital, Home Health, Doctors, Medical
Start-Ups, Etc.
General Manager
Reported to the Regional Director. Staff of 20: 1-Supervisor of Cash Applications, 1-Supervisor of Data Entry, 7-Data Entry Clerks, 11-Cash Applicators. A/R = $40MM+.
? Responsible for the entire Reno Office Operations: Budget, Financials, HR, Accounting, Payroll, and the Complete Medical Receivables Factoring Function for 40 Providers. Extensive Oversight and Retraining of Clients Regarding Effective Due Diligence (Verification-Billing-A/R-Collection Processes) concerning Private Insurance, HMO/PPO's, Medicare/Medicaid, & Others. A/R = $40MM+.
ACCOMPLISHMENTS
? Managed Massive Growth (4 to 40 providers).
EDUCATION
Bristol University � Bristol, TN
Bachelor of Business Administration