Katie Curran
Indianapolis,IN
Summary
Strategic healthcare revenue cycle and regulatory leader with 13+ years improving reimbursement performance, audit readiness, and denial prevention across multi-facility psychiatric systems. Expert in Medicare regulatory interpretation, ALJ litigation strategy, accreditation compliance, and payer policy execution across TJC, CARF, CMS, and multiple state Departments of Health. Leverages automation, EMR optimization, advanced analytics, and workflow redesign to scale operations, enhance documentation integrity, and reduce reimbursement friction. Maintains a 95% expedited overturn rate and authors 100% of ALJ filings for a 10-hospital psychiatric network, driving high-value revenue recovery and operational predictability.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Director of Utilization Review
Assurance Health System
01.2019 - Current
- Built multi-facility RCM and UM departments across 10 inpatient geriatric psychiatric hospitals, integrating Medicare, Medicaid, and Medicare Advantage requirements
- Directed and developed high-performing RCM/UM teams across 10 facilities through hiring, coaching, performance management, and ongoing training.
- Lead enterprise appeals and regulatory response strategy, personally drafting 100% of ALJ filings using deep knowledge of CMS rules, Medicare Advantage policies, NCDs/LCDs, and medical necessity frameworks, while maintaining favorable outcomes on over 90% of filings
- Built scalable RCM operating models using automation, EMR-driven workflows, and operational controls that increase clean claim rates, shorten revenue cycles, and reduce preventable denials.
- Maintain a 95% expedited (“fast track”) overturn rate across 10 Medicare-participating psychiatric hospitals, safeguarding high-risk revenue streams.
- Designed enterprise analytics reporting ecosystems leveraging EMR data to deliver real-time KPIs, payer trends, performance risk flags, and decision-support dashboards.
- Developed and managed large-scale education initiatives to align clinical, administrative, and executive teams around documentation, RCM workflows, and regulatory changes
- Led major digital transformation initiatives including automated Medicare notice distribution, electronic UR audit infrastructure, and automated documentation checkpoints to streamline regulatory workflows.
- Provide enterprise regulatory oversight and audit preparedness for TJC, CARF, commercial payers, CMS surveyors, and multi-state survey agencies
- Led change management, onboarding, and licensing, regulatory, and compliance initiatives during expansions, multi-state new facility openings, and workflow redesigns.
- Partnered with C-suite, legal, compliance, clinical, and operations leaders to drive enterprise objectives and ensure financial performance.
- Conduct internal mock audits, clinical documentation reviews, and regulatory gap analyses to ensure accreditation readiness and defensibility across multi-state operations.
- Developed comprehensive SOPs, payer guidance documents, process standards, and training programs to align utilization management, appeals, documentation requirements, and RCM compliance.
Utilization Review Case Manager & Team Lead
Assurance Health System
07.2015 - 01.2019
- Led utilization management operations covering authorizations, concurrent review, denials, and real-time reimbursement decisions for Medicare, Medicaid, and Medicare Advantage patients across multiple geriatric psychiatric facilities.
- Managed first- and second-level appeals with high success by applying CMS coverage guidelines, LCDs/NCDs, and payer interpretation to support medical necessity arguments.
- Served as 24/7 escalation point for admission eligibility, Medicare technical validation, and utilization decisions impacting reimbursement and compliance.
- Built payer engagement models that reduced administrative cycle delays and improved payment speed and authorization accuracy.
- Conducted internal documentation audits and medical record reviews to validate defensibility for RAC, CMS, TJC, state surveyors, and other regulatory bodies.
- Developed training resources, SOPs, and policy frameworks to standardize utilization management and strengthen organizational compliance maturity.
Health Insurance Specialist & Trainer
Rehab Medical
05.2012 - 07.2015
- Oversaw complete revenue cycle functions—verification, authorization, claims, appeals, denials, contracting issues, payment posting—for Medicare, Medicaid, and commercial payers across a multi-state DME organization.
- Created and delivered company-wide training programs building workforce competency in Medicare and Medicaid policy interpretation, documentation standards, and billing requirements.
- Worked with executive leadership to design standardized workflows and policies that improved reimbursement accuracy, reduced error rates, and supported scalable operational growth.
- Led digital and process automation initiatives using SharePoint, structured workflows, and electronic forms to reduce manual tasks and increase operational throughput.
- Conducted proactive audits to identify compliance vulnerabilities, billing errors, and potential fraud exposure, strengthening revenue integrity and regulatory alignment.
- Maintained current knowledge of evolving CMS, payer, and state obligations to ensure continuous compliance and operational alignment.
Education
Bachelor - Social & Behavioral Science
Indiana University-Purdue University Indianapolis
Indianapolis, INMaster of Business Administration (MBA) - Healthcare Management
Western Governors University
Indianapolis, INSkills
- End-to-End Revenue Cycle Management (Medicare, Medicaid, MA, commercial)
- First Level, Second Level, ALJ Appeals & Regulatory Litigation Strategy
- Medicare Policy Interpretation (NCDs/LCDs, CMS manuals, MA guidelines)
- Audit & Accreditation Readiness (TJC, CARF, CMS, State DOH)
- RCM Operating Model Design & Workflow Engineering
- Digital Transformation & Automation Implementation
- EMR Optimization, Custom Reporting, Data Analytics & KPI Development
- Denials Prevention & Root Cause Analysis
- Multi-State Leadership & Team Development
- Change Management & Cross-Functional Collaboration
Certification
Case Management Certification
Timeline
Director of Utilization Review
Assurance Health System
01.2019 - Current
Utilization Review Case Manager & Team Lead
Assurance Health System
07.2015 - 01.2019
Health Insurance Specialist & Trainer
Rehab Medical
05.2012 - 07.2015
Bachelor - Social & Behavioral Science
Indiana University-Purdue University Indianapolis
Master of Business Administration (MBA) - Healthcare Management
Western Governors University