CATHY SIMON-MILLER

• Electronic Health Record Modernization (EHRM) program
• Rev Cycle Patient Accounting Project Manager responsible for facilitating day to day activities of the workgroups
• To ensure effective future state design and risk remediation of business operations focus areas
• Provide subject matter expertise across multiple domains and collaborates with other stakeholders to ensure cross-functional integration of revenue cycle processes
• Identify, remediate/escalate key program impacts, considerations, challenges, gaps, risks/issues, success factors
• Collaborate with Client SE, SA on risk and task issues
• Outstanding review of processes and concerns that are pending review (Veteran Eligibility, VA, Carveout, Encounters with Missing VHAP and Temporary /Confidential Addresses

Support the Department of Veterans Affairs (VA) Electronic Health Record Modernization (EHRM) program. Revenue Cycle Patient Accounting Project Manager responsible for facilitating day to day activities of the workgroups..To ensure effective future state design and risk remediation of business operations focus areas. Provide subject matter expertise across multiple domains and collaborates with other stakeholders to ensure cross-functional integration of revenue cycle processes. Identify, remediate/escalate key program impacts, considerations, challenges, gaps, risks/issues, success factors. Collaborate with Client SE, SA on risk and task issues. Outstanding review of processes and concerns that are pending review (Veteran Eligibility, VA, Carveout, Encounters with Missing VHAP and Temporary /Confidential Addresses.

• Works to exceed financial and productivity target maintain knowledge of new version updates and additional functionality
• Utilizes the agreed upon tools to minimize the variability of the install process while continuing to try to improve standards
• Delivers effective, measurable ATB support and training to our customers and internal staff on the applications they represent, identify, and communicate risks to the project and leadership am to ensure the success of the implementation
• Works with the Support team on issue resolution
• Scheduling module overview and training
• Registration module overview and training
• Conducts assessments of system use and process and makes recommendations for improvement
• Understands release changes and develops programs to assist customers with capitalizing on new functionality
• Referral Management Go Live and training
• Change request management process in EMR systems to maintain goals and support the process and traceability of changes to an interconnected set of factors
• Collaborations with team to assist in an agile environment
• Created Training Manuals, as well as ATE (At The Elbow Training)
• Review change management request for EMR system review, as well as team members review based on performance and training
• Prepare the organization for change, craft a vision of the legacy system, implement the change request, always work within the company’s culture to embed changes.

• Act as the main point of contact for Client prior to Pre-Go Live and Go Live and effectively communicate roles and responsibilities
• Define and track implementation metrics and KPIs while acting as an internal point of contact for other departments
• Working at the elbow doing Go-Live implementations
• Set clear and realistic expectations with clients
• Manage multiple implementation events, Pre-Go-Live, Favor Fair, and Learning Labs event, leading up to Go Live day
• ATE support for ambulatory and acute care
• Assist with defining enhancements to our products and provide customer feedback to the Evaluating, processing/resolving, and tracking of all Tier Trouble Tickets
• Monitoring Defense Health Agency (DHA) trouble ticketing system queues, entering and managing software problem incidents; Reviews trouble ticket to ensure that the documented information is complete, accurate, and sufficient to facilitate analysis of the issue;
• Coordinate with the Service Desk and/or ticket originator to confirm or obtain additional information as required
• Identifies business development opportunities and collaborates with the Account Manager and Client Executive
• Reviews Trouble Ticket to ensure that the documented information is complete, accurate, and sufficient to facilitate analysis of the issue.

• Member for many Cerner Go Live System Implementation, and Post Go Live Support
• Extract Revenue Cycle and Clinical documentation data from current legacy system into the Cerner Millennium and Community Works system
• Experience performing chart review ,Indexing via HBF
• Support for all on site and off-site Clinic’s and Hospital Specialties Doctors
• Acute and Ambulatory services
• Trainer for different Cerner modules, Registration, Patient Access, Scheduling, Oncology, and Radiology, Urology Behavior Health and Cerner Patient Accounting
• And Power Chart
• Legacy System abstractions
• IT Help desk, Service Now tickets and concern
• Utilize proven Cerner workflows and methodology to promote business continuity during Revenue Cycle client engagements
• Focused on collaboration and team results using the agile method as a tool to achieve the team’s goal
• Delegated task accordingly, to assist in system changes
• Assist client with change request prior to system go live
• Detailed risk and reviewed system resolutions for system and people change management.

• Execute advisory services to include current state assessments, future state recommendations, gap analysis, and remediation plans across the dimensions of people, process and technology
• Includes measurements and report outs to industry benchmarks
• Work with team to advise clients on how to effectively solve business issues leveraging their current products and services
• Provide consultative services, which leverage knowledge in industry relevant incentive programs
• Provide financial (or other benefits) to our customers and the patients they serve
• Support projects or contribute toward consulting service engagements in accordance with documented statement of work and delivery on time and on budget
• Actively participate in revenue cycle engagements for healthcare clients ranging from private physician groups to large healthcare systems to private equity backed corporations
• Team collaboration regarding changes with the organization EMR system.

• Provides subject matter expertise within the Cerner Revenue Cycle to include implementation and Post Go Live Support, and to ensure timely, accurate delivery of standard and custom-scoped objectives
• Revenue Cycle Management Front End and Back End process all aspects
• Execute project plans and objectives, identify and place required resources, review trends and possible project risk
• Managed a 3rd party Accounts Receivables Outsourced Vendor for Revenue Cycle (Mumbai India)
• Managed a team of 25 employees onsite from different departments AR, Claims Management, Billing and Cash
• Review and resolve accounts on hold or in DNFB/CFB status and work with appropriate leadership for Missing Documentation or Claim Edits
• Monitors performance KPIs and routine reports including, but not limited to any of the following : Registration Accuracy, POS Collections, Denial Rate, Estimate Utilization, Elective Self-Pay, Timely Recurring Discharges, DNFB/CFB, High-Dollar In-house, Medical Necessity Issues, Recoupments, Charge Reconciliation and Accuracy, and Late Charges
• Cash collections and variance to goal with detail explanation, A/R greater than 150 days with root causes, Denials trending by payor and root cause, Recoupments by payor and root cause, DNFB/CFB with any root causes
• Demonstrated ability to work independently to ensure Revenue Cycle operations are managed efficiently and effectively
• Reimbursement, Contract Management, Denial Management
• Accountable for the timely resolution of claim edits, submitting claims within third party insurance payer specified timeframes, and managing the unbilled inventory
• Task to focus on people change and development within the Rev Cycle department
• Which included business processes, system and technology processes and individual learning plans
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Works with internal departments and external organizations to resolve appeals
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Prepares, maintains, assists with, and submits reports as required
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently Defining issues; identifying root causes; interpreting data; understanding data dependencies; goal setting; establishing tracking and reporting metrics; updating project plans; leader of denial subcommittees; providing performance reports and deliverable preparation
• As needed, provide project management support, analysis, and/or technical expertise for a broad array of
• Revenue Cycyle initiatives
• Has responsibility for assisting teams in support of Regional or National Analysis and Research

• Provides subject matter expertise on the Revenue Cycle and ensure timely, accurate delivery of standard and custom-scoped objectives
• Partnered with engagement managers on project planning/phasing, scoping and timeline projection and with client leadership team for consistent communication across revenue cycle projects
• Developed understanding of client value metrics for each project and gathered critical client and departmental data while ensuring effective team negotiation and issues resolution in the implementation, plan design and timing of project deliverables
• Built and managed relationships with Client and Project team leaders, as well as support Solutions Consultant
• Scope included:
• Collaborating with management and teams to improve results and provide an in-depth analysis of customer requirements, prioritization, and characteristics
• Ensuring solutions design leverages Cerner recommendations and that change management processes are in place for successful implementation
• Consulting on departmental and service-line workflows, including associated Revenue Cycle and operational/process metrics
• Maintaining knowledge of solutions to remain current on IP development and utilize latest functionality and content on projects
• Analyze and interpret data to identify key performance indicators for maintaining business continuity and create mitigation plans to address risk areas
• Partners with consultants to assist in the collection and monitoring of the client’s key performance indicators to ensure business continuity are maintained
• Acts as a member of the engagement management team, providing Revenue Cycle expertise, Revenue Cycle implementation progress, and risk mitigation strategies
• Responsible for ensuring the testing strategy and execution supports the stated value objectives and goal of business continuity
• Responsible for analyzing impact of alignment and deviation from Model Experience
• Successfully using analytics to drive end-user adoption and post go-live stability.

• Turning Point RCS
• Payment Variance Recovery Unit, Complex Claim Unit, Vendor Liaison
• This unit was responsible for all closed accounts that have balances, commercial, workers comp and Medicare, Medicaid that were not paid according to the contract agreed rates
• Successfully managed claims that are appealed and re-billed at the contracted negotiated rate
• Continued…, Managed units that are responsible for scrubbing accounts that were missed by the Shared Service Center on the open AR
• Oversaw claims that are reviewed by the contract rate and re-billed or appealed based upon their findings
• Responsibilities included but are not limited to: managing 20 employees and re-organizing two revenue cycle departments, to include realigning the responsibilities back to the RHM (Regional Health Ministers)
• Conducted financial analysis, reported findings, developed organizational-wide financial goals, and assisted in developing strategic plans
• Effectively managed employee’s time cards, employee appraisal, offsite implementation within the Regional Ministers (sister hospitals)
• Provided comprehensive analyses of financial and statistical data used in determining funding to be selected to overseas protective security programs in the assigned regions; conducting internal audits, coordinated external audits, and prepared audit reports
• Oversaw month end reporting and day-to-day operations
• Vendor Liaison, working with contractors working in AR backlog of accounts, workers comp and commercial accounts
• Responsible for vendor access, invoices and onsite reviews
• Participates and with Product Management to feedback on issues with current products and provide input around new products
• Identified instances where resource use is inconsistent with approved financial plans and priorities and reconciles inconsistencies in cooperation with upper management
• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner
• Tracks the status and progress of denials and appeals
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Works with internal departments and external organizations to resolve appeals
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Prepares, maintains, assists with, and submits reports as required
• Works with management to identify, trend, and address root cause of denials, helps pinpoint strategies for reducing A/R
• Effectively handles all communications, including telephone, electronic, and paper correspondence from payers and departments within the business office
• Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliances issues and payer discrepancies

• Managed a growing B/AR of $82 million dollars, while also maintaining responsibility for 30 on-site employees and 5 contract employees
• Applied polices and changes to help reduce the growing AR while implementing new system changes to enchant a better workflow process for the staff
• Reduced the AR days and the outstanding cash by Dec 31, from 57 days to 48 and $83 million to $52 million by Dec 31, 2013
• Motivated the staff and increase the Hospital MOT Survey by 30% from a 61% department rating to an 84% department rating overall
• Rebuild the Revenue Cycle Team, defined job descriptions, policies, and procedures
• Managed all day-to-day processes for patient accounting – timecards via Kronos payroll system, employee scheduling, account auditing, productivity, and system issues
• Contribute to overall revenue by bringing projects/products live per plans
• Prepares and communicates work schedules for colleagues and schedule client meetings
• Tracks and communicates key metrics including point of service cash collections, registration productivity, quality, accurate and timely insurance verification and securing authorizations as necessary
• Works with management to identify, trend, and address root cause of denials, helps pinpoint strategies for reducing A/R
• Request and schedule testing and training activities with client
• Customer Service policies and procedures, patient advocates
• Attends, prepares materials and actively participates in the facilitation of mandatory monthly staff meetings, new hire training, team building, in services and continuing education sessions
• Implements processes and tools to consistently achieve established key performance metrics
• Identifies and addresses team member training needs to outperform expectations
• As a subject-matter expert, assists team with escalated customer and client issues, coaches and trains other colleagues as needed
• Effectively handles all communications, including telephone, electronic, and paper correspondence from payers and departments within the business office
• Makes suggestions for process improvements and develops project plans with target milestone dates
• Cash collections and variance to goal with detail explanation, A/R greater than 120 days with root causes, Denials trending by payor and root cause, Recoupments by payor and root cause, DNFB/CFB with any root causes
• Participates and with Product Management to feedback on issues with current products and provide input around new products

• Managing 20 people within the department of revenue cycle recovery
• Assessed business trends, costs, revenues, balance sheets, income statements, and other financial data to evaluate asset utilization and recommend changes in operations and financial activities
• As part of Receiver Acquisition Team for PFS to merge with Lawrence & Memorial Hospital, responsible for day a to day operations within the work closely with the CFO to determine FTE’s sustainable
• Detailing the AR to the maximum ability to transition to the new owners
• Successfully implemented process for reduction of A/R days of 68 and outstanding A/R of $40M upon arrival at Westerly
• Reduced A/R days to 49, outstanding receivables to $28M, a 20% decrease in the outstanding A/R
• Created smooth transition of management from Westerly Hospital to Lawrence & Memorial Hospital
• Provides colleague performance data in preparation of annual reviews
• Operational activities, including implementation updates, reporting, escalations and presenting at client meetings
• Supports leadership with analyzing Patient Access performance to drive client satisfaction and related revenue cycle results
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Identify and track open issues, along with solution plans (JIRA tickets, cases, etc.) during Implementation to successfully go live with clients
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Works with internal departments and external organizations to resolve appeals
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Prepares, maintains, assists with, and submits reports as required
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently