Heather Nydick
Healthcare professional
Davie,FL
Summary
Senior-Level Healthcare Professional with 15+ years of management experience demonstrating a comprehensive background in managed care and contract pricing – negotiations, revenue cycle audit, and management. Strong negotiating skills with an orientation for results. Self-motivated team player with the ability to work well with a diverse group of individuals while maintaining a balanced objective and fact-based perspective as part of any problem- solving process. Excellent communication skills as well as management leadership and multi-tasking abilities. Medical Review Process, Contract negotiations and management, Contract compliance Governmental Enrollment, Revenue Cycle Compliance Audits, Claims Resolution, Risk Management Process oriented Six Sigma certified
Overview
9
9
years of professional experience
2
2
years of post-secondary education
Work History
Director of Revenue Cycle
Ortho Florida/ IHBS
Boca Raton, FL
01.2020 - 01.2022
- Responsible for identifying patient reimbursement issues and facilitate resolution with Payers
- Collaborated with team to ensure that claims, denials, and appeals are efficiently processed
- Worked to resolving billing-related issues
- Monitored and analyze CPT codes, diagnoses, and procedures to ensure appropriate documentation for payments
- Produced and evaluate monthly and quarterly revenue reports for physicians and team
- Participated in program/service evaluation activities; facilitate changes in provision of service based on Continuous Quality Improvement results
- Compiled and prepared various status reports for management to analyze trends and make recommendations
Manager of Clinical Operations
ChangeHealthCare/ Jackson Health Systems
Miami, FL
01.2014 - 01.2019
- Managed daily operations onsite for Changehealthcare for the Denial Management program
- Perform 50+ audits daily – utilizing InterQual and Milliman Criteria and training case management to identify appropriate criteria for admission and concurrent reviews
- Facilitated monthly denial management meetings for 5 Hospitals using the Jackson Health Systems and management of healthcare plans compliance with contract requirements
- Provided Monthly Case Management meetings for over 120 Case Managers regarding Denials Process
- Prepared detail reporting of denial and appeal information monthly for all 5 Facilities and their CFO’s
- Lead and participate in the restructuring of Centralized Clearance Center to reduce denials by 5% or more
- Responsible for all operational communications for concurrent review denials and appeals
Director of Managed Care Contracting
Pediatric Associates
Plantation, FL
01.2013 - 01.2014
- Oversite of the day-to-day management functions of Contracting and Managed Care through the appropriate assignment of responsibilities, delegation of authority, and overall direction of workflow process
- Negotiated risk-based agreements for 28 offices throughout Florida
- Established risk-based modeling to reconcile $15 million in revenue under the new Managed Medicaid Assistance lives assigned to group
- Implemented and established software program to automate internal HEDIS and Quality measures
- Contracted with a group of 3 large Hospital IPA groups, which resulted in a floor bonus of $200 thousand
- Developed contracts detailing Quality initiatives performances with financial impact of over $3 million
- Provided training to staff, new hires, and employed physicians on Obamacare and the trends noted in PA’s current revenue stream
- Developed MMA material and implemented the roll out to all offices.
Revenue Integrity Specialist
Jackson Health Systems / Med Assets
Miami, FL
01.2013 - 01.2013
- Managed to customers’ CDMs based on current regulatory guidance
- Provided onsite, charge master, and other outpatient revenue cycle consulting to customers in accordance with scope of the contract
- Experienced in performing line item CDM review by determining the application and appropriateness of coding, compliance, and other regulatory requirements while minimizing all potential risks
- Performed review of hospital claims and bills to ensure the reported services and charges were supported by clinical documentation
- Organized, developed, and documented CDM, billing, and clinical integrity findings
- Led in recommendations for designated hospital outpatient and physician departments
- Demonstrated ability in conducting client meetings, including review of data, general CDM or coding/revenue cycle education, and/or conferences with executive leadership using finding summary
- Reviewed system files in comparison to CDM files to assist in minimizing risk and optimizing revenue.
Education
bachelor’s - applied science
Broward College
Davie, FL 09.2021 - Current
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University of South Florida, Cross Learning Institute
Licensed Practical Nurse - undefined
Central Georgia College
Skills
- AHIMA, FHIMA, HCCA, MGMA, and FNA
- COMPUTER SKILLS
- InterQual Auto review with multiple interfacing applications, MediRegs (Contract Management), IDX (Physician Contract Management), Meditech (EMR) PMMC (Contract Management System), EthicPoint (Compliance reporting system), ComplyTrac (Compliance tracking and assessment system), Microsoft Office: (Word, Excel, PowerPoint, Outlook), MS Visio, MS SharePoint, Siemens (Invasions, EDM), Cerner (Powerchart, PMOffice), MedAssets (Knowledge source, CDM, CCA), MCG Milliman Criteria- Esson Canopy Allscripts, Greenway Intergy and Practice Analytics
- Revenue Cycle Management
- Billing Cycle Performance
- Correspondence Writing
- Electronic Document Management System
Timeline
bachelor’s - applied science
Broward College
09.2021 - Current
Director of Revenue Cycle
Ortho Florida/ IHBS
01.2020 - 01.2022
Manager of Clinical Operations
ChangeHealthCare/ Jackson Health Systems
01.2014 - 01.2019
Director of Managed Care Contracting
Pediatric Associates
01.2013 - 01.2014
Revenue Integrity Specialist
Jackson Health Systems / Med Assets
01.2013 - 01.2013
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University of South Florida, Cross Learning Institute
Licensed Practical Nurse - undefined
Central Georgia College