John Mendez
Summary
Strategic Pricing & Consumer-driven strategies Revenue Integrity & Charge Master consolidation & maintenance Complex Managed Care negotiations, contract language, and payer performance strategies Hospital Operations & Internal Consulting within integrated health system (Surgery, Pharmacy, Laboratory/Radiology, Professional services, et.al) Hospital acquisitions, IT system integration, & Epic go-lives Revenue Cycle expert including SWAT team development improving financial performance, engagement of associates, and patient/customer experience.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Executive Director, Revenue Integrity
Children's Nationa Hospital
03.2023 - Current
- Proven ability to learn quickly and adapt to new situations.
- Partnered with Pharmacy leadership to coordinate and implement quarterly AWP Price Changes. Resulting in more accurate charging.
- Mentored junior managers in team leadership strategies, especially dealing with diverse personalities.
- Introduced innovative approaches to charge management. Expanding the role of the CDM Team to service line based..
- Led initiatives to address DRG Downgrade and readmission denials effectively. Developing a closed loop communication report out. Installing a process to send denials to a Vendor to work on contingency instead of writing them off.
- Offered strategic advice to the supply chain regarding clinical requests, focusing on revenue cycle optimization.
- Spearheaded the transition of ED professional coding to ED physicians to enhance efficiency.
- Implemented a successful strategy for capturing sedation charges accurately.
- Currently evaluating the cost-benefit analysis of scanning and prepping medical records internally versus outsourcing. By insourcing will save approximately $800,000.
- Responsible for managing vendor contracts within Coding, HIM, and Charge Services departments.
- Proactively built strong interdepartmental relationships to facilitate smoother operations.
- Analyzed Surgery Time Based Charges and adjusted them to result in a $5M net revenue gain.
Senior Director, Revenue Optimization
Orlando Health
02.2022 - 12.2022
- Collaborated with facility CFOs to ensure daily charge capture and reconciliation occurred in revenue generating departments
- Implemented monthly site visits at the hospitals for team to become engrained in stakeholder operations
- Increasing satisfaction of the hospital operators
- Established a web-based patient estimation tool to make it easier for patients/customers to determine their out-of-pocket costs
- Pioneered strategic pricing for the organization achieving a net return of ~$30 Million
- Instituted the pricing transparency strategy and compliance for the organization
- Served on the organization’s 340B Steering Committee
- Worked on aligning Pharmacy charge structure to be in line with market standards.
Assistant Vice President, Revenue Management
Orlando Health
09.2016 - 02.2022
- Helped facilitate a successful EPIC implementation at 10 acute care facilities
- Succeeded in getting back to charge base lines within 7 days
- Led the Revenue Cycle Team in the merger and integration of 2 acquired acute care facilities
- Provided strategic leadership across the health system for acute and ambulatory operations on the implementation of a new payment processor
- Integrated the installation with the EPIC go-lives for ease of service for patient/customers
- Led redesign of hospital and health care organization with 10 acute care facilities in the areas of consumerism, charge capture, and pricing
- Partnered with physicians to develop self-pay rates and packages in areas of bariatrics, cosmetics, digestive health and cancer care
- Achieved 100% Cash Goal for FY19, FY20 and 99% Cash Goal for FY21
- Managed a final denial rate of
- Orchestrated Vendor Summits resulting in a reduction of vendors and a consolidation of business partners
- Negotiated vendor contracts to achieve overall cost savings between 2% and 10% depending on the contracted service
- Managed outsourced coding vendor to a 95% quality score and a DNFC of 2 days
- This resulted in getting the claims out the door and cash in the door faster
- Designed and implemented a charge capture strategy and a charge capture technology tool
- Increased Employee Engagement Scores by 20 percentage points over prior year.
System Director, Revenue Cycle
Mercy Health
01.2014 - 04.2016
- Led strategy of hospital and health care organization with 23 acute care facilities in the areas of consumerism, managed care reimbursement, charge capture, and pricing
- Implemented $186 Million in new net revenue initiatives in FY 2013-2016
- Negotiated complex issues with Managed Care Organizations; provided strategy and guidance to Managed Care field team
- Collaborated with corporate pharmacy & hospital pharmacy to standardize charge structure resulting in $32 Million net revenue FY15
- Served as Subject Matter Expert for and Collaborated with Hospital executives and physicians and served as subject matter expert in consumerism, strategy, regulatory changes, 501r, 340B and other pharmacy and revenue initiatives
- Designed, implemented, and mentored to achieve revenue recognition opportunities with hospital leadership
- Led IT Migrations including Epic builds and implementations by serving as the executive overseeing revenue recognition, charge capture, and the Charge Description Master
- Created strategic pricing plan for $6 Billion healthcare system
- Assessed market needs by modeling pricing scenarios by hospital including accounting for regulatory issues, peer market competitors & managed care contracts
- Developed state of the art call center to provide patients with out-of-pocket estimates for healthcare costs
- Presented Strategic imperatives and Market research to hospital executives and large groups.
Divisional Manager, Revenue Integrity
Mercy Health
07.2007 - 01.2014
- Led Revenue Integrity team across Southern Division of 13 hospitals in multiple states
- Proposed and implemented strategic pricing that resulted in approximate $6 Million Dollar net revenue gain
- Led the Charge Master Transition Team in a systems conversion of a purchased hospital to Mercy Health Partners charging methodology and systems
- Directed the successful implementation of a revenue cycle charge capture system for seven hospitals within the Central Division of Catholic Healthcare Partners
- Improved third party reimbursement resulting in new net revenues of $8 Million annually
- Revitalized the charge capture and analysis program for the eight hospitals within the Mercy Health
- Integrated physician practice based ancillary services to provider-based services for a newly purchased physician practice
- Evaluated current managed care contracts for maximum net revenue gain when setting strategic pricing initiatives
- Managed a staff of seven analysts and clinical nurse auditors.
- Provided financial oversight for hospital interest in four joint ventures: Cath Lab, Surgery Center, Sleep Lab, and Radiation Oncology
- Built SWAT team in Revenue Cycle to improve performance, assist with acquisition of new hospitals & providers, and enhance patient-centric practices.
Education
Master of Health Services Administration -
Xavier University
Cincinnati, OH12.2006
Bachelor of Arts in Political Science -
University of Tennessee
Knoxville, TN08.2002
Skills
- Transformative leadership
- Change Management
- Results Orientation
- Contract Negotiation
- Vendor Relations
- System Conversions
Affiliations
- Chapter Past President, Southwest Ohio Chapter Healthcare Financial Management Association
- Treasurer, Florida Chapter Healthcare Financial Management Association
Certification
Fellow, Healthcare Financial Management Association (FHFMA)
Timeline
Executive Director, Revenue Integrity
Children's Nationa Hospital
03.2023 - Current
Senior Director, Revenue Optimization
Orlando Health
02.2022 - 12.2022
Assistant Vice President, Revenue Management
Orlando Health
09.2016 - 02.2022
System Director, Revenue Cycle
Mercy Health
01.2014 - 04.2016
Divisional Manager, Revenue Integrity
Mercy Health
07.2007 - 01.2014
Master of Health Services Administration -
Xavier University
Bachelor of Arts in Political Science -
University of Tennessee
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