Experienced with strategic planning and project management. Utilizes leadership skills to drive team performance and operational excellence. Track record of delivering high-impact results through innovative problem-solving and effective communication.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Revenue Integrity Director
Conifer Health Solutions
01.2017 - Current
The Director of Revenue Integrity (RI) serves in a mid-cycle senior leadership capacity. Demonstrates client and unit specific leadership to all RI personnel by designing, directing, and executing key Conifer RI processes. Directs all Charge Description Master (CDM) and charge practice initiatives/processes/education; facilitates revenue management and revenue protection for all Center of Excellence (COE) facilities and health systems (large national integrated health systems); regulatory review, reporting and system implementations; projects requiring expertise across multiple hospitals and business units. Provides clarity for short and long-term objectives, prioritization of all projects, and feedback to RI Managers and Team members for individual and professional development. Leverages project management skills, analytical skills, and time management skills to ensure all requirements are accomplished within established timeframes. Acts as the primary interface with Market level Executive Leadership. Leads the National level Enterprise Conifer Observation Team. Trusted with guidance for accurate and compliant observation charging, reporting, etc. for all CSH/CHI facilities contracted with Conifer. Serves as RCA Denials tool representative for all Lexington COE sites developing and implementing root cause solutions for payor denial trends. Manages discharged not final billed (DNFB) levels for RI across all sites including billing edit resolution. Leads revenue leakage efforts through information technology solutions (i.e. WayStar, Craneware, etc.) as well as efforts related to a CRP (Charge review plan) annual audit schedule with each client.
Lexington COE Facilities (KY, TN, IA, AR) & Enterprise Observation Team (serving all of Common Spirit Health/CHI)
National Revenue Integrity Coordinator CDM
Conifer Health Solutions
04.2013 - 12.2016
Provides Market Based Organizations (MBOs) daily maintenance support of Charge Description Masters (CDMs). This includes CDM maintenance and Common Procedure Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) recommendation and assignment. Provides education, implementation support, and monitors designated MBOs CDMs for adherence to changes required by The Centers for Medicare and Medicaid (CMS) and local Medicare fiscal agents. Assure CHI MBOs CDMs are routinely and consistently maintained according to CMS billing and CDM maintenance guidelines and procedures. Works with MBO managers to make appropriate revisions for Medicare and CPT/HCPCS coding. Provide all CDM related timely communications from various sources. Research coding/charging/billing requirements for new services, drugs, and supplies. Maintain knowledge of current billing regulatory environment. Responsible for procedural pricing for all Kentucky One Health facilities. Responsible for researching, managing, coordinating, and implementing CDM and charge capture initiatives and processes to ensure revenue management and revenue protection. Ensures the overall integrity of the CDM. Conducts audit/review activities to ensure appropriate revenue management, claims production, and coding integrity. Research and maintains compliance with state, federal, and other third-party payor billing and reimbursement guidelines. Conducts special projects and studies to facilitate revenue management as required. Serves as Premier project contact for all facilities including mapping and error resolution. Solely implements the quarterly and annual updates from Medicare for all facilities.
Lexington COE Facilities (KY, TN, IA, AR)
CEO
McDowell Home Health
12.2009 - 03.2013
Chief Executive Officer for Medicare and Medicaid certified, licensed, 501c3 home health agency servicing eight counties in central Kentucky. Responsible for all Agency operations including marketing, finances, human resources, contract review and negotiations, etc. Manage a staff of registered nurses, physical, speech and occupation therapists, nurse aides and administrative personnel. Responsible for the strategic direction of the Agency as well as all policies and procedures. Develop and manage the annual Agency budget, conduct the annual Agency evaluation, and ensure compliance with all Federal & State laws governing Home Health.
Financial Analyst
Ephraim McDowell Health
11.2000 - 12.2009
Manage the primary fiscal analysis function throughout the entire Health system to include Ephraim McDowell Regional Medical Center and Fort Logan Hospital. Maintain and direct an in house decision support/financial strategic analysis system (budgeting software, benchmarking software, Meditech system applications, etc.). Responsible for organization-wide annual operational budgeting processes for over $280 million in gross charges and $127 million in operating expenses. Budget responsibilities include development, deployment, training, and analysis. Coordinate all financial/operational benchmarking efforts across the entire health system. Provide timely productivity reports and analysis to all management staff. Develop and analyze monthly departmental variance reports on a dollar and per statistic basis. Provide analysis of hospital income and expenditures with comparisons to previous periods. Evaluate procedures to improve methods for controlling lost charges, reducing costs of operations, and workflow improvement. Perform annual charge item rate setting analysis and adjust item prices. Maintain an accurate chargemaster through established processes and consistent reviews. Function as health system contact for completion of Medicare, Medicaid, TriCare, and all other associated cost reports in conjunction with outside consultation. Serve as reimbursement analyst for entire system. Prepare necessary materials for regular audits and work with auditors. Develop queries and varied reports through the detailed use of numerous information systems to include Meditech general ledger and abstracting report development. Provide clinical analysis of Physician volume trends, DRGs, APCs, etc.
Decision Support Manager
Ephraim McDowell Regional Medical Center
12.1997 - 10.2000
Maintain and direct an in house decision support/financial strategic analysis system and adapt program to changing needs. Operate a cost accounting information system to meet hospital’s needs and provide complete and accurate records and reports. Responsible for organization wide operational annual budgeting processes of over $250 million to include preparation and fiscal analysis. Develop and analyze monthly departmental variance reports on a dollar and per statistic basis. Provide analysis of hospital income and expenditures with comparisons to previous periods. Evaluate procedures to improve methods for controlling patient accounts receivable, reducing costs of facility operations, and improve workflow. Prepare necessary materials for regular audits and work with auditors. Make recommendations concerning methods of reducing operating costs and increasing income. Develop queries and other products through the detailed use of various information systems for analysis.
Education
Masters in Healthcare Administration -
University of Kentucky
01.2001
Squadron Officer School - undefined
Maxwell Air Force Base
01.1997
Bachelor of Science - Economics
United States Air Force Academy
01.1992
Skills
Relationship building
Strategic planning
Verbal and written communication
Decision-making
People management
Operations management
Strategies and goals
Project coordination
Employee development
Goal setting
Budget control
Budget management
Issues resolution
Contract and vendor management
Financial reporting
Rules and regulations
Legal and regulatory compliance
Affiliations
Member Healthcare Financial Management Association (HFMA)
Deacon Lexington Avenue Church of Christ – Danville, KY.
2004 HFMA Charting Your Way Through The Medicare Cost Report
2005 QHR Learning Institute Financial Officer Career Development Program – September 29 – 30, 2005; Brentwood, TN.
2006 QHR Learning Institute Reimbursement Boot Camp Medicare Reimbursement, Third Party Accounting, Cost Reporting – Jan 23 – 27, 2006; Brentwood, TN.
2006 Mastering Chargemasters – KHA sponsored course on 2006 Medicare code changes; February 17, 2006 Louisville, KY.
2007 HFMA’s Accounting and Finance Conference - April 18 – 20, 2007. Nashville, TN.
2007 Strategies to Improve Critical Access Hospital Margins – BKD sponsored course; October 23, 2007
2008 QHR Learning Institute Critical Access Hospital Cost Reporting, Reimbursement, and Contractual Accounting – August 19 – 20, 2008; Brentwood, TN.
MILITARY SERVICE
Feb - Dec 1997 Deputy Commander, Medical Resource Management Flight, 74th Medical Group, Wright-Patterson Medical Center Wright-Patterson Air Force Base, Ohio
Responsibilities: Provided leadership and management to a 50-member flight. Assisted in planning, programming, and accounting for $160 million in medical resources. Developed and executed a $57 million operation and maintenance budget. Provided oversight for the Third Party Collection program, billing and collection operations totaling $8.8 million. Managed unit healthcare data analysis element and collection activities.
1995 - 1997 Executive Officer to the Commander, 74th Medical Group Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
Responsibilities: Provided executive-level support for the commander of the Air Force’s second largest medical center. Managed all office functions and served as medical group liaison to base, Air Force, and Department of Defense organizations. Reviewed all correspondence, assigned action, and ensured proper staffing prior to commander review. Prepared myriad types of written correspondence, award packages, and decorations for commander’s signature. Interfaced with Air Staff, various Major Command, and aeronautical Systems Center general officer, colonel, and Senior Executive Service personnel daily. Also served as Managed Care marketing liaison and Group Protocol Officer.
1994 - 1995 Facility Management Element Leader, 78th Medical Group Robins Air Force Base Hospital, Robins Air Force Base, Georgia
Responsibilities: Managed all facility programs for physical maintenance, repair, and improvements to buildings and utility systems. Programmed and directed design of contract projects and evaluated construction of both minor and major healthcare facility projects. Interfaced with facility staff to ensure maintenance requirements tasked to outside agencies were completed in a timely manner. Responsible for maintenance and function of vacuum, medical gas, communication, and alarm systems. Served as senior advisor to Base Civil Engineer and the Healthcare Executive Committee for all facility improvement and repair projects. Also served as Installation Fitness Program Administrator.
1993 - 1994 Commander, Medical Squadron Section/Director, Medical Readiness, 78th Medical Group, Robins Air Force Base Hospital, Robins Air Force Base, Georgia
Responsibilities: Exercised command jurisdiction over 209 enlisted personnel. Counseled enlisted personnel and took necessary actions to resolve problems or complaints. Coordinated complex personnel issues and problems with appropriate base agencies. Advisor to the commander, key staff, and supervisors on all enlisted personnel matters. Responsible for all on-the-job training, general military training, and maintenance of all training records. Managed and directed the activities of Medical Readiness. Managed all disaster and mobility functions to include exercises and deployments. Also served as Vehicle Control Officer and Installation Fitness program Administrator.
1992 - 1993 Director, Medical Readiness, 78th Medical Group, Robins Air Force Base Hospital, Robins Air Force Base, Georgia
Responsibilities: Served as Unit Mobility Officer and Disaster Preparedness Officer. Developed, coordinated, and published medical plans to support wartime and peacetime readiness and disaster missions. Managed $280,000 worth of readiness equipment and supplies. Coordinated training for 148 mobility personnel in four duty codes. Key advisor to the commander on all readiness and disaster activities. Coordinated with Base Mobility Officer and Center Plans and Programs Officer in support of Medical Readiness. Also served as Patient Advocacy Officer, Vehicle Control Officer, and Installation Fitness Program Administrator