Dominique Miller
Houston
Summary
Healthcare leader with a proven track record specializing in Revenue Cycle Management, Value-Based Care Strategy and Physician Relations. Expert in transforming operations and enhancing profitability through strategic program development and stakeholder collaboration. Demonstrating exceptional team leadership and operational workflow optimization. Deep understanding of healthcare ecosystem and proven ability to generate meaningful results. Known for fostering team collaboration and adapting to changing project demands. Possesses strong skills in client relations and strategic planning, along with reliable and flexible approach to problem-solving.
Overview
10
10
years of professional experience
Work History
HEALTHCARE CONSULTANT (Part Time Business Owner)
Owner
01.2018 - Current
- Enhance value to the client through the design, development and strategic positioning of solutions, services, and offerings.
Led meetings within current client’s and future customer clients to drive new growth, improve operations, and enhance ROI results. - Preform needs assessments for customer and their clients and provided a strategic action map to better efficiency and profitability.
- Consult regarding Epic integration.
- Consult regarding Value Based Care Medicare programs
Value Based Care Manager
Medical Clinic of Houston
01.2023 - 10.2024
- Developed and created a new Value Based Care department and model within MCH for 10K Medicare lives, 8K awarded attribution.
- Developed and proposed policy and procedural changes regarding risk adjustment coding updates to maintain compliance with evolving healthcare laws and value-based care regulations.
- Co-Led with Executive Administrator and oversee contract negotiations between ACO REACH management company and MCH.
- Fostered relationships with vendors and with in-house executive leadership and multispecialty providers, 26 Internal Medicine providers and 14 specialists.
- Conducted market research to further clarify and implement REACH quality improvement activities and risk adjustment factors to create the best Strategies and articulate Medicare benchmarks and methodology.
- Developed provider education to define transitional care management/chronic care management, risk adjustment factor, medical loss ratio, surplus/deficit, defining Annual Wellness Visits and Hierarchical Conditioning Categories.
- Managed Devoted Medicare Advantage contracts and program requirements, HEDIS, STARs
Measure business performance by identifying and quantifying KPI drivers, review and manage risks and opportunities for performance, create solutions to mitigate risks for MCH providers. - Responsible for Value Based Care Program’s P&L and department budget.
- Analyzed and responded to inquiries regarding billing denials, edit work queues in Epic and medical coding issues.
- Hired 2 employees, risk adjustment coder and care coordinator, to aid in ACO REACH program.
- Worked closely with compliance nurse to make sure the teams and processes were compliant with Medicare rules and regulations.
DIRECTOR, NETWORK PERFORMANCE
Apricus Healthcare
05.2021 - 12.2022
- Co-Led with COO in managing Direct Contracting Medicare Program operations in the Houston, TX market.
- Proposed provider educational training regarding documentation which led to the facility achieving the quality measure within 6 months of training and consistently achieving quality goals.
- Oversaw clinic operations and project management to aid in the Transitional Care and Chronic Care Management
Under the Medicare contract agreement for Direct Contracting program, managed 31 provider clinics and 20,000 aligned beneficiaries. - Led internal cross‐functional workgroups focused on value‐based product & capability development, including the development of tools & resources for providers, reports/dashboard for program improvement, and training manuals.
NETWORK PERFORMANCE LEADER
Centene Healthcare (Wellcare)
01.2020 - 02.2021
- Exceeded YTD goal of $32 Million by securing contracts with individual provider groups along with large hospital groups such as Memorial Herman, HCA and Methodist, analyzing CAP and Fee for Service contracts and managing RCM and credentialing.
- Negotiating and implementing specialist (Oncology, Orthopedic, ENT) Medicare contracts for IPA/ACO.
- Oversaw and led 3 full time employees in physician Relations, contracting, credentialing and revenue cycle management.
- Co-developed with Executive Director, claims and contracting/credentialing department with Executive Director.
- Owned and managed the network performance and relationships of key provider groups, Committee Leaders and Board Leaders.
- Educated providers regarding documentation of appropriate capture of Hierarchical Condition Categories (HCCs) diagnosis to support accurate estimates of future health care costs and allocation of Medicare funds.
CLIENT PERFORMANCE MANAGER, RCM CONSULTANT
Revel
04.2019 - 01.2020
- Led revenue cycle management initiatives with Catholic Health Initiative (CHI) and independent practices nationwide.
- Fostered business relationships with hospital medical groups and independent practices.
- Improved year to date cash collections by $9M in 8 months and exceeded goals by implementing denial decision tree work groups, improving A/R, improving client and department workflows and processes.
- Developed training materials and educated on client front-end processes to align key performance indicators.
Analyze and respond to inquiries regarding billing denials.
DIRECTOR, BUSINESS DEVELOPMENT
South Texas Surgical Hospital
02.2018 - 10.2018
- Co-Lead with hospital CEO, CFO and CNO to implement hospital initiatives related to operations, contracting, Center of Excellence program, business development, budget planning for program development, and patient outreach programs.
- Budget planning with CEO for new Bariatric and Wellness service lines, analysis of internal P&L’s and identify revenue cycle trends, contracts, and insurance analysis.
- Identified and implemented both a Wellness and Bariatric Program for hospital with a forecasted return of investment (ROI) of $3.5M
- Oversaw onboarding implementation of new providers and working with insurance payer contracts to verify credentialing for all commercial and federally funded payers.
- Attended governing board meeting to discuss managed care contracts, physician credentialing and strategic growth initiatives.
CLIENT MANAGEMENT LEADER
Optum 360
05.2015 - 10.2017
- Nominated for company “Superhero Award” for relationship building, project management, and client satisfaction; featured in company’s newsletter for achievements leading to distinction.
- Fostered business relationships with Catholic Health Initiative C-Suites, regional directors, practice managers, and physicians for over 80 clinical practices by displaying an executive presence and effectively influencing clients to follow and accept recommendations.
- Increased over-the-counter collections by 46% and collections/RVU by 34%.
- Cultivate relationships with Deloitte Epic IT staff to influence change and identify issues and solutions.
- Developed training materials and educated on market front-end processes to align key performance indicators, best practices, and client goals, resulting in 100% client satisfaction among users who participated in training.
- Implemented clinical process improvement projects for terming insurances, authorizations, verification of benefits, patient balance estimator tool to improve over-the-counter collections per clinical event, EHR workflows, patient de-escalation/conflict management, and insurance 101.
- Led coding team meetings to identify claim edits to reduce denials, to ensure proper claim coding and to identify trends for further education to physicians.
- Analyzed and responded to inquiries regarding billing denials, edit work queues in Epic and medical coding issues.
Selected to perform needs assessments for existing clients and potential new business. - Designed employee mentorship program, achieving immediate buy-in from leadership.
Education
Bachelor of Science - Healthcare Business Management
University of Houston, Clear Lake, TX, US
Clear Lake, TX05-2008
Associate of Science - Business
San Jacinto College, Houston, TX, US
Houston, TX05-2005
Skills
- Physician Relations
- Contract Management
- Value based Care Strategy
- Policy Development
- Program Development
- Staff Development
- Leading Teams
- Physician Education
- Stakeholder Collaboration
- Operational Workflows
- EPIC/Nextgen/EMR Systems
- Regulatory / Compliance
Accomplishments
Honors-Awards
- Superhero Award Nominee
- Top Business Development Award: Trailblazer Award - 113% of ROI and Century Award - 297% of ROI
- National Society of Leadership and success (NSLS), Sigma Alpha PI
Languages
English
Timeline
Value Based Care Manager
Medical Clinic of Houston
01.2023 - 10.2024
DIRECTOR, NETWORK PERFORMANCE
Apricus Healthcare
05.2021 - 12.2022
NETWORK PERFORMANCE LEADER
Centene Healthcare (Wellcare)
01.2020 - 02.2021
CLIENT PERFORMANCE MANAGER, RCM CONSULTANT
Revel
04.2019 - 01.2020
DIRECTOR, BUSINESS DEVELOPMENT
South Texas Surgical Hospital
02.2018 - 10.2018
HEALTHCARE CONSULTANT (Part Time Business Owner)
Owner
01.2018 - Current
CLIENT MANAGEMENT LEADER
Optum 360
05.2015 - 10.2017
Bachelor of Science - Healthcare Business Management
University of Houston, Clear Lake, TX, US
Associate of Science - Business
San Jacinto College, Houston, TX, US
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