Jamie Gertsch

• Analyzed accounts receivable data to identify trends and discrepancies.
• Developed strategies to enhance revenue recovery processes and streamline workflows.
• Utilized advanced ERP systems for tracking collections and reporting financial metrics.
• Collaborated with clients to resolve billing disputes and improve payment timelines.
• Developed customized reports for management to track key performance indicators in accounts receivable operations.
• Prepared detailed aging reports for management review on a regular basis, highlighting potential risks in the AR portfolio.
• Self-motivated, with a strong sense of personal responsibility.

Financial Engineering & Revenue Optimization Governance, Risk & Compliance (GRC) Operational Intelligence & Scalability

• Architected a greenfield dual-payer revenue ecosystem, projecting a 117% increase in gross revenue (from $28.1M to $61.3M) over a 3-year horizon by successfully integrating commercial payers alongside state funding.
• Eliminated compliance-driven revenue leakage through end-to-end systems integration, driving a projected 110% expansion in Total Net Revenue and an NPV of $15.3M by year three.
• Neutralized systemic financial erosion within Regional Center operations via a data-driven intake strategy, recovering previously unbilled services and increasing average annual growth from 5% to a projected 45%.
• Operationalized complex regulatory frameworks (Title 17, Lanterman Act, SB 946), converting mandated compliance into a $15M+ value-add by bridging the gap between clinical delivery and commercial reimbursement eligibility.
• Fortified organizational defensibility by establishing audit-ready protocols that secured enterprise-wide revenue integrity across multi-site operations in Anderson and Chico.
• Spearheaded the development of a proprietary real-time BI application, providing the C-Suite with instantaneous visibility into a 36.5% to 45.0% CAGR, optimizing workflow status and financial throughput metrics.
• Engineered a high-impact payer-relations strategy, leading negotiations that expanded market share and secured favorable rate structures to support a $43M OPEX scaling plan without compromising net margins.

• Architected enterprise-wide operational controls ensuring 100% recovery eligibility across all U.S. government contracts (FAR/DFARS).
• Eliminated compliance vulnerabilities by designing rigorous internal audit and risk-mitigation programs.
• Led the integration of revenue-protecting documentation standards throughout the full contract lifecycle.
• Streamlined reporting processes, improving accuracy and efficiency of deliverables.
• Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.

Financial Engineering & Yield Optimization Governance, Risk & Compliance (GRC)

• Orchestrated a comprehensive RCM transformation that realized a 15% increase in Net Collection Rate within nine months, significantly accelerating cash velocity through a total redesign of recovery workflows.
• Optimized revenue integrity by elevating clean-claim rates from 82% to 96% and securing a 12% reduction in denials, achieved through aggressive process remediation and front-end architectural improvements.
• Engineered a $250K annual revenue expansion within the drug therapy program by performing a high-level cost-benefit analysis and implementing a recovery-focused operational redesign.
• Mitigated critical institutional risk by identifying $500K+ in Medicare coding exposure; led the strategic self-disclosure process and rebuilt the compliance framework to prevent future loss.
• Fortified organizational defensibility by transforming coding and billing workflows from high-risk vulnerabilities into audit-resilient, standardized processes.

Strategic Leadership & Revenue Integrity

• Orchestrated a rapid departmental transformation from reactive collections to proactive revenue integrity, leading a national team to stabilize and scale laboratory billing operations.
• Neutralized systemic "Medical Review" bottlenecks by identifying specific coding triggers responsible for hundreds of national denials; re-engineered the architecture to align with carrier thresholds and bypass manual review stops.
• Safeguarded organizational assets by identifying and remediating $200K in Medicare overpayments, executing a clean self-correction that fortified compliance standing and prevented potential audit penalties.
• Secured immediate portfolio-wide cash acceleration by eliminating high-volume claim friction, ensuring clinical panels met automated adjudication criteria.

Scalability & Operational Efficiency

• Optimized nationwide genetic laboratory revenue operations, achieving a 25% reduction in contacts-per-resolution by re-engineering communication protocols and streamlining the inquiry-to-adjudication pipeline.
• Engineered enterprise-grade A/R performance dashboards that institutionalized real-time visibility and drove a 20% reduction in portfolio-wide aging across national accounts.
• Architected standardized revenue recovery panels for immediate national deployment, creating a plug-and-play framework for rapid revenue capture and consistent financial throughput across decentralized labs.

Operational Transformation & Velocity

• Leveraged "Payer-Side" logic to spearhead a comprehensive redesign of appeals and claims adjustment workflows, reducing cycle time by 8 days and significantly accelerating resolution velocity.
• Engineered "denial-proof" reimbursement systems by translating complex payer policy into foundational process improvements, mitigating downstream friction for provider networks.
• Spearheaded data-driven program enhancements by identifying emerging denial trends, influencing executive-level strategic decisions regarding claims processing and policy adjudication.

Strategic Advocacy & Policy Reform

• Catalyzed federal policy modernization by identifying systemic medical necessity denials rooted in outdated clinical standards; successfully advocated for policy updates that reduced scrutiny and improved member access to critical treatments.
• Negotiated complex single-case agreements and bulk appeals, optimizing recovery rates and strengthening provider-payer relationships through sophisticated adjudication strategies.
• Secured high-yield appeal outcomes through meticulous clinical and technical analysis of claim denials, closing operational gaps via targeted provider education and error remediation.

Revenue Strategy & Front-End Transformation

• Architected the facility’s inaugural Private Pay Flat-Rate Fee Schedule, transforming front-end revenue strategy and driving upfront cash collections from $20K to $87K per month (a 335% increase).
• Engineered high-impact scripting techniques for patient access teams, optimizing financial counseling outcomes and improving organizational liquidity.
• Designed a performance-based incentive program in collaboration with Administration, establishing a $250 monthly bonus structure tied to a $10K upfront collection milestone, which institutionalized a culture of fiscal accountability.
• Served as the primary liaison between clinical staff and patients, ensuring clinical workflows remained patient-centric while maintaining rigorous financial clearance standards.

Labor Relations & Strategic Negotiation

• Appointed to the Executive Negotiation Table for the facility’s inaugural SEIU contract negotiations, representing organizational interests while balancing complex labor and operational requirements.
• Served as Shop Steward for five distinct departments, acting as the lead mediator for labor-management conflicts and preventing grievance escalations through proactive intervention.
• Mitigated institutional risk by bringing clarity to high-tension labor situations, stabilizing department morale, and ensuring operational continuity during sensitive contract transitions.