Summary
Overview
Work History
Education
Skills
Certification
Interests
Timeline
Generic

Ayshea Burroughs

Yuba City,CA

Summary

Dedicated and seasoned healthcare compliance professional with over 25 years of extensive experience in leadership, revenue cycle management, and physician billing. Proven record of driving process improvements, ensuring regulatory compliance, and fostering collaborative relationships within Sutter Health. Seeking a challenging role within Sutter Health to leverage expertise in revenue cycle, compliance, and operations.

Overview

25
25
years of professional experience
1
1
Certification

Work History

Deputy Chief Compliance Officer

Sutter Health
Sacramento, CA
03.2024 - Current
  • Assessed compliance risks and implemented appropriate measures to mitigate issues.
  • Conducted thorough investigations and created corrective action plans to prevent further risk including drug-diversion.
  • Evaluated staff performance regularly through constructive feedback sessions aimed at continuous improvement.
  • Provided oversight of risk adjustment to maintain compliance with requirements of government and private insurance plans as well as a Corporate Integrity Agreement.
  • Ensure compliance with all relevant laws, regulations, and payer requirements related to medical billing and collections.
  • Collaborated with clinical departments to address issues impacting documentation and coding getting $1.5M in claims resolved.
  • Analyzed financial data to identify trends and areas for improvement in revenue generation related medical necessity denials.
  • Streamlined internal workflows for improved efficiency across both clinical and administrative functions impacting revenue cycle for to Alzheimer's treatments.
  • Devised metrics for measuring staff, customer service and business outcomes and tracked performance for Documentation and Data Quality teams to enable tracking of issues across Sutter Health and insight for leaders of documentation and coding issues.

Ethics and Compliance Officer

Sutter Health
05.2015 - 03.2024
  • Provided training for compliance related issues such as Non-Monetary Compensation, Physician Arrangement Monitoring, Documentation and Coding, and Stark/AKS training as needed to executives, managers, clinicians, and employees.
  • Lead and conducted multiple investigations related to drug diversion, inappropriate behavior and coding and billing issues, which included partnerships with HR and SUI on high-risk investigative issues.
  • Collaborated with legal counsel on state and federal investigator on investigative requests.
  • Collaborated with teams within Ethics and Compliance Services department on coding and billing audits and developed corrective action plans.
  • Represented compliance at leadership meetings to provide compliance input and updates, and to receive and provide feedback on compliance challenges and opportunities.
  • Developed tools and educational programs to facilitate standardization of physician arrangement monitoring and work with OGC to create Sutter's policy on Non-Monetary Compensation, Stark and AKS as well as billing and coding policies.
  • Collaborated with senior leaders and human resources to mitigate risk and facilitate enforcement of appropriate discipline across affiliates.
  • Created and implemented effective compliance program for multiple entities across Sutter Health footprint, including Comprehensive Health Assessment Program, Sutter Medicare Direct, Sutter Surgery Center Division and Revenue Cycle.
  • Actively lead and participated in work groups associated with compliance, including annual risk assessment and investigations teams.
  • Actively managed components related to corporate integrity agreement around risk adjustment coding and establishing best practices.
  • Enhanced communication between team members by organizing regular meetings and fostering open dialogue.

Coding Analyst and Physician Educator

Sutter Medical Foundation
03.2013 - 05.2015
  • Responsible for administration of Sutter Medical Foundation's coding compliance program actively utilizing key elements of2effective compliance program.
  • Provided all clinician education and training related to revenue cycle, documentation and coding.
  • Collaborated with compliance on allegations of improper charge capture, coding, billing and government investigations including communication of corrective action plans.
  • Conducting coding and billing audits including monitoring protocols
  • Advocated for open-door policy for clinician communication and training around documentation, coding and revenue cycle.
  • Collaborated with Compliance Officer and billing partners to enhance communication within teams and clinicians.
  • Developed tools and educational programs to standardize coding compliance across all three medical foundations.
  • Applied expert knowledge of revenue cycle processes and appropriate, compliance documentation practices to complete revenue cycle process.
  • Achieved expertise in physician and ambulatory surgery center reimbursement guidelines across all payors.
  • Served as Recovery Auditor Contractor (RAC), Additional Documentation Request (ADR) and Target, Probe and Educate (TPE) SME for Sutter Medical Foundation including creating processes to re-bill and recover monies.
  • Collaborated with management regarding physician compensation issues.
  • Improved coding accuracy by conducting thorough research and staying up to date with industry standards.
  • Developed customized code sets for clients, resulting in streamlined billing processes.
  • Contributed to development of internal coding guidelines, ensuring consistency across teams.

Financial Analyst and Physician Educator

Sutter North Medical Foundation
12.2003 - 03.2013
  • Served as leader of coding compliance for Sutter North Medical Foundation.
  • Implemented first thorough coding compliance program for Sutter North Medical Foundation.
  • Standing member of Physician Compliance Committee
  • Member of System Foundation Coding Leadership under Ethics and Compliance.
  • Led and facilitated Recovery Audit Contractor (RAC) and Additional Documentation Requests (ADR).
  • Performing coding and billing audits on physicians to ensure coding compliance.
  • Developed coding tools for clinicians.
  • Partners with compliance to conduct investigation of alleged revenue cycle compliance issues.
  • Conducted training, in-services, and other education regarding diagnosis, procedure code assignment and regulatory requirements.
  • Actively worked coding and claim denials while looking for trends to reduce denials and increase charge capture.
  • Increased stakeholder satisfaction by delivering timely, accurate financial information tailored to their specific needs.
  • Implemented effective internal controls to mitigate risks associated with financial misstatements or fraud incidents.
  • Evaluated proposed projects'' ROI using NPV, IRR, and other financial metrics, helping prioritize initiatives with maximum value potential.

Customer Service Lead

Sutter Health
07.1999 - 12.2003
  • Documented, researched and resolved customer service issues.
  • Trained and oriented new customer service representatives.
  • Adjudicated claims in line with departmental policies and procedures.
  • Determined payment or denial for each claim based on established rules and processes.
  • Entered new and updated claims data into computerized claims adjudication system.
  • Analyzed medical records, bills, and other supporting documents to assess and process claims.
  • Enhanced customer satisfaction by resolving complex issues and providing timely solutions.
  • Managed high call volumes while maintaining professional demeanor, resulting in increased customer loyalty.
  • Established strong relationships with clients, leading to repeat business and positive feedback.
  • Mentored junior staff members to improve their knowledge of company policies, products, and services.

Education

Master of Science - Health Administration

University of Phoenix
Phoenix, AZ
07.2022

Bachelor of Science - Health Administration

University of Phoenix
Phoenix, AZ
03.2021

Skills

  • Process Improvement
  • Dynamic and Diligent
  • Self-Directed
  • Cross-functional Collaboration
  • Project Management
  • Public Speaking
  • Stakeholder Engagement

Certification

  • Health Care Compliance Certification (CHC)
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)

Interests

EXTRACURRICULAR ACTIVITIES , Kiwanis – Yuba Sutter Supper Club (Lt Governor and Past President) Kiwanis - Early Risers Club (Member Kiwanis - Regional Advisor for Division 14 Key Clubs Playzeum (Vice President of Board) LANGUAGE Englishaspose_nerdinfographic_0_45 Fluent

Timeline

Deputy Chief Compliance Officer

Sutter Health
03.2024 - Current

Ethics and Compliance Officer

Sutter Health
05.2015 - 03.2024

Coding Analyst and Physician Educator

Sutter Medical Foundation
03.2013 - 05.2015

Financial Analyst and Physician Educator

Sutter North Medical Foundation
12.2003 - 03.2013

Customer Service Lead

Sutter Health
07.1999 - 12.2003

Master of Science - Health Administration

University of Phoenix

Bachelor of Science - Health Administration

University of Phoenix

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Ayshea Burroughs