Summary
Overview
Work History
Education
Skills
Accomplishments
Affiliations
Certification
Timeline
Jennifer Moore, MBA, AHCCA, CMA

Jennifer Moore, MBA, AHCCA, CMA

Healthcare Administration
Leesburg,FL

Summary

Results-driven Director of Revenue Cycle Management experienced in financial statement review, auditing and reporting. Well-versed in producing reports, evaluating multi-department operations and handling coding/ documentation improvement processes. Excellent reputation for resolving problems and obtaining company goals. Meticulous, conscientious and methodical in approach.

Overview

18
18
years of professional experience
3
3
Certification

Work History

Director of Revenue Cycle Management

Aegis Medical Group/ Primary Care Alliance DCE
01.2019 - Current
  • Developed team of Coding & Documentation Improvement Specialists to conduct HCC risk coding chart reviews
  • Created live attestations for the practicing providers
  • Developed Nationally recognized for CME HCC risk adjustment training presentation
  • Harbored strong relationships with health plans
  • Improved HCC coding/ HEDIS gap closure, while decreasing over coding
  • Developed billing department to assist MSO affiliate accounts as well as a claims
  • Built out claims processing department for payouts of the DCE.
  • Completed financial reporting and analysis for billing revenue cycle.
  • Negotiate and approve contacts and agreements
  • Assessed current revenue cycle procedures and implemented improvements to foster efficiency.
  • Deliver speeches, write articles, present information in meetings and conventions
  • Identified discrepancies between budgetary targets and actual revenue and expenses.
  • Monitored and guided revenue cycle operations.
  • Supported clinical team members with revenue cycle procedures and addressed issues.
  • Provided guidance and service on Risk adjustment processes
  • Complied with established internal controls and policies.
  • Performed routine closings, maintained clean, accurate and accessible records and kept close eye on transaction updates throughout each quarter.
  • Established and enforced internal controls, workflows and policies for tracking, reconciling and reporting on accounting activities.
  • Recruited, interviewed, hired and trained 100+ employees and implemented mentoring program to promote positive feedback and engagement.
  • Developed strategic plans for day-to-day financial operations.
  • Identified improvement changes regarding key processes for internal controls and accounting procedures.
  • Supported Operations with special projects and additional job duties.
  • Validated existing accounting management and reporting systems to assess quality and conformance, identify problems and implement corrective actions.
  • Established and checked coding/ HEDIS procedures, monitored reports and updated internal files.
  • Improved overall financial reporting by streamlining control processes and reporting structures.
  • Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
  • Oversaw high-volume accounting operations with 100-person team focused on efficient budget administration, AR, Coding and other financial management needs.
  • Developed metrics for Risk Adjustment objectives, supporting key positive results.
  • Accomplished multiple tasks within established timeframes.
  • Evaluated employees' strengths and assigned tasks based upon experience and training.
  • Adjusted job assignments and schedules to keep pace with dynamic business needs, factoring in processes, employee knowledge and customer demands.
  • Raised performance in areas of sales, management and operations by identifying and targeting areas in need of improvement.
  • Achieved or exceeded financial goals on regular basis by corrective coding and documentation practices
  • Directed staff and managed annual capital budget.
  • Prepared and recommended long-range plans for development of department personnel.
  • Propelled continuous improvements and strategically capitalized on current market trends.

Chief of Clinical Operations/ Center Administrator

Premier Medical Associates
10.2005 - 01.2019
  • Assisted in the growth of the the practice from one doctor and one location to 36 doctors and 14 locations
  • Developed an overseas team to conduct HCC/ MRA coding compliance
  • Developed MIPPS/ HEDIS team
  • Examined/ treated patients
  • Preformed routine laboratory tests
  • Collected blood, tissue, and other specimens
  • Answered phones
  • Scheduled patients for provider encounters
  • Instituted ancillary services
  • Implemented hospital rounding, rehab rounding, home visits to less fortunate patients in the ACN counties
  • Established physician owned pharmacy
  • Implemented HRA/ Annual wellness screeners with corresponding formats within EMR to enhance patient experience
  • Direct or coordinate an organization's financial or budget activities to fund operations, maximize investments, or increase efficiency
  • Confer with board members, organization officials, or staff members to discuss issues, coordinate activities, or resolve problems
  • Analyze operations to evaluate performance of a company or its staff in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy change
  • Direct, plan, or implement policies, objectives, or activities of organizations or businesses to ensure continuing operations, to maximize returns on investments, or to increase productivity
  • Prepare budgets for approval, including those for funding or implementation of programs
  • Direct or coordinate activities of businesses or departments concerned with production, pricing, sales, or distribution of products
  • Negotiate or approve contracts or agreements with suppliers, distributors, federal or state agencies, or other organizational entities
  • Review reports submitted by staff members to recommend approval or to suggest changes
  • Appoint department heads or managers and assign or delegate responsibilities to them
  • Direct human resources activities, including the approval of human resource plans or activities, the selection of directors or other high-level staff, or establishment or organization of major departments
  • Prepare or present reports concerning activities, expenses, budgets, government statutes or rulings, or other items affecting businesses or program services
  • Establish departmental responsibilities and coordinate functions among departments and sites
  • Implement corrective action plans to solve organizational or departmental problems
  • Coordinate the development or implementation of budgetary control systems, recordkeeping systems, or other administrative control processes
  • Direct non-merchandising departments, such as advertising, purchasing, credit, or accounting
  • Deliver speeches, write articles, or present information at meetings or conventions to promote services, exchange ideas, or accomplish objectives
  • Serve as liaisons between organizations, shareholders, and outside organizations
  • Review and analyze legislation, laws, and public policy, and recommend changes to promote and support interests of both the general population and special groups
  • Interpret and explain policies, rules, regulations, or laws to organizations, government or corporate officials, or individuals
  • Refer major policy matters to elected representatives for final decisions
  • Administer programs for selection of sites, construction of buildings, or provision of equipment or supplies
  • Direct or coordinate activities of businesses involved with buying or selling investment products or financial services
  • Direct or conduct studies or research on issues affecting areas of responsibility
  • Organize or approve promotional campaigns
  • Formulate, direct and coordinate marketing activities and policies to promote products and services, working with advertising and promotion managers
  • Identify, develop, or evaluate marketing strategy, based on knowledge of establishment objectives, market characteristics, and cost and markup factors
  • Direct the hiring, training, or performance evaluations of marketing or sales staff and oversee their daily activities
  • Evaluate the financial aspects of product development, such as budgets, expenditures, research and development appropriations, or return-on-investment and profit-loss projections
  • Develop pricing strategies, balancing firm objectives and customer satisfaction
  • Compile lists describing product or service offerings
  • Initiate market research studies or analyze their findings
  • Use sales forecasting or strategic planning to ensure the sale and profitability of products, lines, or services, analyzing business developments and monitoring market trends
  • Coordinate or participate in promotional activities or trade shows, working with developers, advertisers, or production managers, to market products or services
  • Consult with buying personnel to gain advice regarding the types of products or services expected to be in demand
  • Negotiate contracts with vendors or distributors to manage product distribution, establishing distribution networks or developing distribution strategies
  • Develop business cases for environmental marketing strategies
  • Conduct and administer fiscal operations, including accounting, planning budgets, authorizing expenditures, establishing rates for services, and coordinating financial reporting
  • Direct, supervise and evaluate work activities of medical, nursing, technical, clerical, service, maintenance, and other personnel
  • Maintain communication between governing boards, medical staff, and department heads by attending board meetings and coordinating interdepartmental functioning
  • Review and analyze facility activities and data to aid planning and cash and risk management and to improve service utilization
  • Plan, implement and administer programs and services in a health care or medical facility, including personnel administration, training, and coordination of medical, nursing and physical plant staff
  • Direct or conduct recruitment, hiring and training of personnel
  • Establish work schedules and assignments for staff, according to workload, space and equipment availability
  • Maintain awareness of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes, and financing options
  • Monitor the use of diagnostic services, inpatient beds, facilities, and staff to ensure effective use of resources and assess the need for additional staff, equipment, and services
  • Develop and maintain computerized record management systems to store and process data such as personnel activities and information, and to produce reports
  • Establish objectives and evaluative or operational criteria for units they manage
  • Prepare activity reports to inform management of the status and implementation plans of programs, services, and quality initiatives
  • Inspect facilities and recommend building or equipment modifications to ensure emergency readiness and compliance to access, safety, and sanitation regulations
  • Develop and implement organizational policies and procedures for the facility or medical unit
  • Manage change in integrated health care delivery systems, such as work restructuring, technological innovations, and shifts in the focus of care
  • Consult with medical, business, and community groups to discuss service problems, respond to community needs, enhance public relations, coordinate activities and plans, and promote health programs
  • Develop instructional materials and conduct in-service and community-based educational programs
  • Develop or expand and implement medical programs or health services that promote research, rehabilitation, and community health
  • Record patients' medical history, vital statistics, or information such as test results in medical records
  • Prepare treatment rooms for patient examinations, keeping the rooms neat and clean
  • Interview patients to obtain medical information and measure their vital signs, weight, and height
  • Authorize drug refills and provide prescription information to pharmacies
  • Clean and sterilize instruments and dispose of contaminated supplies
  • Prepare and administer medications as directed by a physician
  • Show patients to examination rooms and prepare them for the physician
  • Explain treatment procedures, medications, diets, or physicians' instructions to patients
  • Help physicians examine and treat patients, handing them instruments or materials or performing such tasks as giving injections or removing sutures
  • Collect blood, tissue, or other laboratory specimens, log the specimens, and prepare them for testing
  • Perform routine laboratory tests and sample analyses
  • Contact medical facilities or departments to schedule patients for tests or admission
  • Operate x-ray, electrocardiogram (EKG), or other equipment to administer routine diagnostic tests
  • Change dressings on wounds
  • Set up medical laboratory equipment
  • Perform general office duties, such as answering telephones, taking dictation, or completing insurance forms
  • Greet and log in patients arriving at office or clinic
  • Schedule appointments for patients
  • Inventory and order medical, lab, or office supplies or equipment
  • Keep financial records or perform other bookkeeping duties, such as handling credit or collections or mailing monthly statements to patients
  • Review physician notes for proper coding and documentation
  • Ensure HEDIS measures are being met throughout practice
  • Oversee medication adherence team for Medicare STAR metrics
  • Oversee clinical research teams in Costa Rica and India
  • Review medical charts for proper HCC scoring to ensure patient's correct RAF scores are reported
  • Perform quality audits for compliance
  • Monitor charts for correct reporting regarding Gpro, PQRs and Mips
  • Computerized office activities, maintained customer communications and tracked records through delivery.
  • Collected, validated and distributed information to employees.
  • Aided colleagues, managers and customers through regular communication and assistance.
  • Entered and maintained departmental records in company database.
  • Adapted to workflow changes and implemented continuous process improvements to overcome obstacles.
  • Managed agendas and calendars, boosting productivity and improving organizational initiatives.
  • Oversaw successful planning and execution of staff meetings, parties and events.
  • Managed payroll, transactions, invoicing and budgeting to decrease financial inconsistencies.
  • Created daily reports to advise practicing providers on corrective actions and process improvements.
  • Drove workflow improvements by streamlining processes.
  • Developed revisions for systems and procedures by evaluating operational practices and identifying improvement opportunities.
  • Devised and implemented improvements to reporting procedures.
  • Networked with industry professionals to foster partnerships and identify new and improved solutions.
  • Conducted in-depth troubleshooting of program problems and employee concerns and recommended corrective actions to resolve issues.
  • Maximized branding outreach by facilitating marketing initiatives.
  • Increased revenue by developing key programs focused on promoting business.
  • Onboarded new employees with training and new hire documentation.
  • Accomplished multiple tasks within established timeframes.
  • Cross-trained existing employees to maximize team agility and performance.
  • Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
  • Maintained computer and physical filing systems.
  • Coordinated special projects and managed schedules.
  • Compared vendor prices and negotiated for optimal savings.
  • Evaluated employee records and productivity to complete employee evaluations.
  • Developed standard operating procedures for all administrative employees.
  • Utilized client and staff feedback to maintain customer partnerships and increase revenue.
  • Established and developed strong administrative team by delivering ongoing coaching and motivation and fostering career advancement.
  • Prepared meeting materials and took clear notes to distribute to stakeholders.
  • Oversaw quality control and productivity rates to increase revenue and production times.
  • Communicated corporate objectives across divisions through regular correspondence and scheduled status updates.
  • Initiated timely project management within budget constraints for multi-faceted problems concerning executive leaders.

Education

Masters - Healthcare Administration

AMERICAN INTERCONTINENTAL UNIVERSITY
11.2021

Bachelors - Healthcare Administration

AMERICAN INTERCONTINENTAL UNIVERSITY
10.2017

Associates of Applied Science -

INTERNATIONAL BUSINESS COLLEGE
10.2005

High School Diploma -

WUERZBURG AMERICAN HIGH SCHOOL, Wuerzburg, Germany

Skills

  • Revenue Cycle Management
  • Proficient in Medicare Risk Adjustment strategies
  • Patient Center Medical home
  • MicroSoft Office Proficiency
  • CMS Risk Adjustment Guidelines
  • Understanding of OIG
  • DCE/ ACO Operations
  • HEDIS/ Quality Metrics
  • Adaptable to Changing Conditions
  • Social Perceptiveness
  • Compliance Assessments
  • Business Relationship Management
  • Operational Reporting
  • Continuous Improvement Process
  • Employee Training Oversight
  • Electronic Document Management System
  • Accounts Payable and Accounts Receivable
  • Conflict Resolution Tactics
  • Proactive and Focused
  • Staff Recruitment and Hiring
  • Problem Anticipation and Resolution
  • Prioritizing and Planning
  • Management of Financial Resources
  • Revenue Operations
  • Past Due Account Management
  • Employee Performance Reviews
  • Operational Efficiency
  • Operational Standards
  • Coding/ Documentation Audits
  • Recordkeeping Accuracy
  • Corrective Actions
  • Correspondence Writing
  • Compliance Requirements
  • Business Intelligence Gathering
  • Risk Assessment and Classification
  • Securities Safekeeping
  • In-Depth Research
  • Best Practices and Standards
  • Spreadsheet Tracking
  • Remote Video Conferencing
  • Market Condition Analysis
  • Stakeholder and Investor Relations
  • Word Processing
  • Asset Control
  • Patient Care Assessment
  • Medical Recordkeeping
  • Accurate Documentation
  • Clinical Quality Improvement
  • Active Learning
  • Delegation and Motivation

Accomplishments

  • Establish positive, consultative relationships with health plans
  • Coordinate with health plans, vendors, etc to complete projects
  • Coordinate with offshore team to develop/ oversee review, extraction, submission of HCC
  • Coordinate events with health plans such as eye exams and other mobile units
  • Promote quality performace to improve healthcare outcomes
  • Coordinate and update management on clinical quality metrics and HEDIS processes
  • Establish and maintain an action plan to improve HEDIS scores
  • Implement processes to evaluate member compliance reports for each HEDIS measure
  • Evaluate HEDIS improvement opportunities
  • Collaborate with providers and health plans on HCC/ HEDIS documentation
  • Ensuring correct HCC documentation for plan submissions
  • Manage HEDIS projects to include assignments, adherence and quality
  • Conducting quality audits and maintain all data and process controls for compliance
  • Utilize analytics and indentify targeted providers for Medicare Risk adjustment training
  • Work with providers on education, documentation for managed care plans
  • Review and abstract medical records from EMR/ Paper charts
  • Development/ Maintenance operations of ACO preferred network and community consultants to achieve goals of the ACO
  • Interpret / analyze data related to ACO performance, Practice performance while identifying problems/ opportunities to develop action plans
  • Able to communicate with stakeholders regarding key project objectives
  • Understanding of referral sources and able to provide linkage between source and in office clinical teams
  • Able to interact with diverse patient population
  • Able to identify and respond to medical/ psychiatric emergencies/ LOC protocols
  • Understanding of LCD
  • Understanding of benefit verifications with managed care health plans
  • Codes/ abstracts and analyzes using International classification of disease tenth version for CMS risk adjustment purposes
  • Complete understanding of CMS risk adjusting guidelines
  • Retrospective and concurrent chart reviews
  • Excellent understanding of medical terminology, disease process, anatomy and physiology
  • Ensuring diagnosis codes for each chronic/ major medical condition have been captured and supported by clinical documentation
  • Able to field questions/ concerns and provide solutions
  • Able to meet productivity and accuracy standards
  • Able to conduct department in- service trainings for Clinical and Administrative
  • Influential in transitioning members to managed care health plans
  • Oversight of medical center operations including purchasing, payroll, adherence to budgets, review of monthly financials
  • Strong focus on quality of care and patient satisfaction
  • Implementing patient surveys
  • Create/implement and review policies and procedures for facility
  • Organize recruitment/ hiring/ training or qualifies employees
  • Able to consult medical providers to clarify missing or inadequate chart documentation
  • Ensuring correct documentation of member encounters
  • Develop and deliver diagnosis and coding tools to clinical staff
  • Understanding of PQRs/

Affiliations

RISE National

NAACOS

International Society of Female Professionals

AAMA

AAPC

Certification

  • Certified Medical Assistant, AAMA - 2005
  • AHCCA- Advance HCC Auditor, RISE National - 2021
  • CPCO- Compliance Officer , AAPC - 2019

Timeline

Director of Revenue Cycle Management - Aegis Medical Group/ Primary Care Alliance DCE
01.2019 - Current
Chief of Clinical Operations/ Center Administrator - Premier Medical Associates
10.2005 - 01.2019
AMERICAN INTERCONTINENTAL UNIVERSITY - Masters, Healthcare Administration
AMERICAN INTERCONTINENTAL UNIVERSITY - Bachelors, Healthcare Administration
INTERNATIONAL BUSINESS COLLEGE - Associates of Applied Science,
WUERZBURG AMERICAN HIGH SCHOOL - High School Diploma,
Jennifer Moore, MBA, AHCCA, CMAHealthcare Administration