Chasmer Hernandez, CPHM
La Habra,CA
Summary
Executive management professional in clinical revenue cycle with 24 years leading case management, quality compliance management, and contract execution experience. Advanced knowledge of regulatory compliance and ability to identify vulnerabilities and create corrective action plans. Spearheads operational effectiveness and efficiencies to develop quality improvement activities and achieve regulatory compliance. Proficient in Clinical Documentation knowledgeable in evaluating medical records to determine accuracy and overall care quality.
Overview
10
10
years of professional experience
Work History
Director of Revenue Cycle Case Management
Eagle One Consulting Solutions
03.2017 - Current
- Establish, implements, and monitors annual goals, operating capital budgets, and policies/procedures for the quality management program.
- Designs, directs, conducts and coordinates quality management activities related to performance improvement, patient safety, corporate compliance and licensee/accreditation.
- Conducts root cause analysis, failure mode and effect analysis, and other risk analysis activities as necessary.
- Conducts investigations into possible violations of healthcare laws and regulations as required.
- Spearheaded professional growth and development through participation in educational programs, current literature, inservice meetings, and workshops
- Reorganized performance improvement processes to reduce fall rates, ventilated associated pneumonia, medication errors and pressure ulcers.
- Communicates necessary information to departments/services when problems or opportunities to improve patient care, patient safety practices, and/or corporate compliance arise.
- Developed reports to the governing body in a timely manner and coordinate with Joint Commission, CMS, CARF and other surveys as needed to develop responses in relation to deficiencies.
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Leveraged case management tools and conflict management techniques to help interdisciplinary teams achieve optimal outcomes.
- Coordinated with external agencies, such as insurance providers and regulatory bodies, to ensure smooth operations within the case management department.
- Collaborated with interdisciplinary teams to optimize patient outcomes and ensure seamless transitions between care settings.
- Enhanced patient care by implementing efficient case management systems and processes.
- Increased staff productivity by providing ongoing training, support, and mentorship for case managers and related professionals.
- Reviewed and developed intake and discharge planning strategies to encourage client engagement and retention.
- Served as corporate resource for compliance and audits to facilitate legal process and appeals.
- Maintained compliance with regulatory requirements through rigorous quality assurance processes and timely reporting mechanisms.
- Structured standardized case management processes to comply with regulatory agency statutes and standards.
- Managed and monitored program activities and evaluated quality for improvement recommendations.
- Integrated population health management principles into daily practice, promoting preventative care measures among patients as well as streamlined interventions when needed.
- Analyzed trends and data to inform decision-making and program development.
VP, Case Management
Thomson Alliance Consulting
10.2014 - 01.2017
- Directed planning, development implementation, coordination, monitoring and evaluation of contract performance as related to state and federally funded programs.
- Directed and assign staff in relation to performance improvement, interviewing, selection, training and mentoring.
- Oversaw collection of program data and its analysis in determining program design, delivery and effectiveness of all case management pilot programs.
- Streamlined the development of policy and procedures for Case Management Department.
- Participated in Medicaid and other healthcare reform initiatives and plans for implementation of relevant state and federal policies
- Review annual budget reports, strategic business/marketing plans.
- Reduce cost by effectively developing cost effective strategies to have favorable capitation contracts for health services.
- Collaborated with government officials to change policies and increase health outcomes on programs effort to improve health systems.
- Established performance goals for department and provided methods for reaching milestones.
- Implemented advanced data analytics tools to drive data-driven decision-making across all levels within organization, leading to better business outcomes.
- Delivered strong financial performance despite challenging economic conditions by executing prudent risk management strategies throughout all aspects of business operations.
- Spearheaded organizational restructuring initiatives, streamlining operations and reducing overhead costs.
- Monitored industry trends, keeping current on latest changes and competition in industry.
- Ensured regulatory compliance at all times by implementing robust internal controls systems coupled with proactive monitoring mechanisms.
- Managed financial planning and budgeting processes, ensuring fiscal responsibility and maximizing return on investments.
- Negotiated high-value contracts that maximized profitability while mitigating organization risks for.
- Monitored key business risks and established risk management procedures.
Education
MBA - Organizational Leadership
University of Far East
Manila, Philippines07.2025
No Degree - Nursing
Concorde School of Nursing
Garden Grove, United States09.1996
Skills
- Project management, PMP
- Policy Writer/ Implementation
- Interqual McKesson Criteria Care Guideline Certified
- MCG Criteria Care Guideline Certified
- Quality Management and Improvement
- Clinical Documentation - ACDIS
- Provider Contract Management
- Population Health Management, Certified
- Revenue Cycle Management, Certification
- Case Management
- Audit Coordination
- Regulatory Compliance
- Risk Assessment and Management
- Compliance Assessment
- Data Analysis
- Fraud prevention
- Process Implementation
Accomplishments
- Developed IMM process for hospital inpatient admission notification which led to regulatory compliance of CMS -10065
- Spearheaded program to reduce readmissions and length of stay for high risk patients initially. This program led to the expansion to all admission outside the outlier population
- Orchestrated the documentation compliance of over 2.0 years backlog review of all Medi-Cal admissions
- Chaired the UM Committee to identify cases of higher proportion at risk for over or under payment
- Handled all functions related to Case Management Performance Improvement, and to identify any target areas for improper payments
Timeline
Director of Revenue Cycle Case Management
Eagle One Consulting Solutions
03.2017 - Current
VP, Case Management
Thomson Alliance Consulting
10.2014 - 01.2017
MBA - Organizational Leadership
University of Far East
No Degree - Nursing
Concorde School of Nursing
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