SONYA M. TAYLOR
The Woodlands
Summary
Dynamic healthcare leader with a proven track record in developing and executing financial strategies that enhance both top and bottom lines while driving operational excellence. Expertise includes operations, contracting, business development, auditing, marketing, and regulatory compliance, with a strong focus on maximizing reimbursement and cost containment to ensure outstanding patient outcomes. Over 13 years of experience in health insurance and Medicare, complemented by robust business analysis and technical skills. Specializations include managed care leadership, contract negotiations, relationship management, risk management, revenue cycle management, project management, and process improvement.
Overview
27
27
years of professional experience
Work History
Independent Consultant
06.2015 - Current
- Manages the development, implementation and successful completion of all Managed Care Quality Improvement program projects including, but not limited to HEDIS/Stars Measures, Medical Management, Revenue Cycle Management, CMS Clinical Guidelines/Standards, CMS HCC Risk Adjustment, Physician/Staff Training and Education on all performance improvement initiatives, health plan updates and CMS-mandated projects.
- Manages day to day operations while completing due diligence on prospective sites, negotiates Managed Care contracts, develops standard operating procedures, and develops Managed Care training for contracted providers and staff.
- Oversees tracking, trending, and reporting of internal and external Medicare quality management data and CMS HCC reporting.
- Monitors and coordinates design and development of internal data retrieval tools, flow charts and review processes for HEDIS/STARs, CMS HCC Risk Adjustment, Utilization Management, and QI activities.
- Manages all HEDIS / STAR Measures and CMS HCC Risk Adjustment implementation for all contracted providers.
- Provides staff training and development activities to achieve objectives of orientation, knowledge and skill enhancement, proficiency/productivity, and professional growth for HEDIS/STARs Measures, Revenue Cycle Management, CMS HCC Risk Adjustment, and other quality improvement activities.
- Manages and supervises HCC auditing staff; prepares auditing reports and schedule, maintains comprehensive auditing records, and oversees data collection, reporting and tracking.
- Performs HEDIS/Star Measures data abstraction, data management, data analysis, report generation, and education to all management members and physicians within the IPA.
- Supports medical staff and leadership by identifying and facilitating process improvement opportunities to improve clinical care facilities.
- Manages implementation of evidence-based practices using data and performance improvement methodologies.
Quality Improvement Manager
MONTGOMERY HARRIS AREA PHYSICIANS IPA
THE WOODLANDS, TX
01.2012 - 06.2015
- Managed quality initiatives, revenue cycle management, clinical outcome processes and review of clinical benchmarks to identify trends and areas of improvement.
- Performed HEDIS/Star Measures data abstraction, data management, data analysis, report generation, and education to all management members and physicians within the IPA.
- Supported medical staff and leadership by identifying and facilitating process improvement opportunities to improve clinical care facilities.
- Oversaw implementation of evidence-based practices using data and performance improvement methodologies.
- Served as resource and expert in performance improvement methodologies to clinical staff as needed.
- Conducted educational training, mentoring in performance activities related to HEDIS, HCC coding, and Utilization Management.
Quality Improvement Specialist
ACCESS HEALTH PROVIDERS
HOUSTON, TX
04.2010 - 01.2012
- Conducted, coordinated, and monitored quality activities and initiatives for all Texan Plus Health Plan products.
- Maintained, monitored, and developed strategies for evaluation of member and/or patient care services.
- Analyzed and recommended performance improvement initiatives, process improvement opportunities, and/or corrective actions related to HEDIS and CMS Star ratings.
- Ensured compliance standards and regulatory requirements were met for HEDIS, CAHPS, and HOS.
- Served as liaison for Northwest Diagnostic Clinic IPA and Universal American Insurance as evidenced by collecting, analyzing, identifying trends, writing reports, and presenting findings to appropriate committees, managers and/or staff.
- Provided on-going quarterly education seminars to over 40+ physicians on quality trends, outcomes, HCC coding/ Risk Adjustment Factors and new CMS requirements.
Continuous Quality Improvement (CQI) Coordinator
TALBERT HOUSE AND AFFILIATES
CINCINNATI, OH
07.2003 - 10.2009
- Maintained all quality improvement records and files for 44 programs in accordance with external stake holders’ requirements, program management, and evaluation purposes.
- Demonstrated knowledge of application and methodology of research statistics as evidenced by administering, collecting, and analyzing consumer outcome data.
- Served as a liaison and consultant for program development and outreach projects within the community.
Quality Assurance Evaluator
HAMILTON COUNTY COMMUNITY MENTAL HEALTH BOARD
CINCINNATI, OH
03.2002 - 07.2003
- Evaluated performance measures for 50+ local mental health agencies.
- Prepared and maintained reports, records, and technical evaluations with mental health agencies for quality assurance, program evaluation, and certification procedures in accordance with the Ohio Department of Mental Health.
- Implemented system wide changes regarding the reporting of consumer outcomes and treatment plans to increase continuity of care after discharge.
Quality Improvement Specialist/Database Administrator
THE CHILDREN'S HOME OF CINCINNATI
CINCINNATI, OH
05.1999 - 03.2002
- Managed data collection, analyses, tracking, and reporting to identify improvement needs of operations and services.
- Designed and managed databases and computer applications for several agency functions including extracting data for internal and external reporting requirements.
- Served as agency liaison to help all service units identify and implement new program needs.
Education
Bachelor of Arts - Psychology
University of Cincinnati
01.1997
Skills
- Strategic problem assessment
- Effective team leadership
- Commitment to precision
- Client relationship management
- High ethical standards
- Execution of best practice strategies
- Risk analysis and management
- Revenue cycle optimization
- Results-oriented accountability
- Process improvement
- Collaborative strategic planning
- Process optimization
- Data-driven decision making
Timeline
Independent Consultant
06.2015 - Current
Quality Improvement Manager
MONTGOMERY HARRIS AREA PHYSICIANS IPA
01.2012 - 06.2015
Quality Improvement Specialist
ACCESS HEALTH PROVIDERS
04.2010 - 01.2012
Continuous Quality Improvement (CQI) Coordinator
TALBERT HOUSE AND AFFILIATES
07.2003 - 10.2009
Quality Assurance Evaluator
HAMILTON COUNTY COMMUNITY MENTAL HEALTH BOARD
03.2002 - 07.2003
Quality Improvement Specialist/Database Administrator
THE CHILDREN'S HOME OF CINCINNATI
05.1999 - 03.2002
Bachelor of Arts - Psychology
University of Cincinnati
SELECT PROFESSIONAL HIGHLIGHTS
- Increased revenue stream that resulted in $30M overall revenue impact and ensured all contracts achieved a sustainable profit margin of 40% or higher for contracted Independent Physician Associations.
- Designed and implemented training on managed care policies, processes, and tools as well as software applications and state and federal regulations; delivered training to hundreds of physicians and staff in classroom/office settings.
- Recovered $10.6M in risk adjustment revenue and $1.4 M in ACO revenue for contracted Independent Physician Associations.
- Recovered $5M in revenue of unpaid managed care field claims for contracted participating providers.
- Developed startup operations, including the implementation of Risk Adjustment (HCC) and HEDIS/STARS tracking systems for contracted Independent Physician Associations.