Virginia Gleason

• Managed complex clinical and revenue cycle engagements for hospitals and health systems, demonstrating versatility and adaptability based on the client's patient population, medical staff, executive leadership team and financial vulnerability.
• Delivered exceptional results under tight deadlines by prioritizing tasks and managing resources efficiently throughout each engagement.
• Collaborated with cross-functional clinical and financial teams to identify cross-department gaps and deliver comprehensive solutions for clients, ensuring seamless project execution.
• Established credibility with executive-level stakeholders and medical staff by providing valuable insights and practical recommendations on key regulatory, compliance and revenue cycle functions.
• Acted as a change agent within client organizations, promoting continuous improvement through servant leadership.
• Designed and implemented training programs to enhance the skills of consultants, resulting in improved service delivery and client satisfaction.
• Strengthened the consulting practice by recruiting top talent, mentoring junior staff, and fostering a culture of high performance.
• Demonstrated thought leadership within the industry through contributions to local and regional conferences, and seminars on topics including clinical middle revenue cycle, denials mitigation, impact of the Supreme Court overruling the Chevron Doctrine and optimizing an internal physician advisor program.
• Exceeded revenue targets consistently by identifying upsell opportunities within existing client engagements.
• Led a team of consultants to develop and implement strategic projects, resulting in improved operational efficiency for clients.
• Optimized internal processes within the consulting practice to improve service delivery while reducing costs and increasing profitability.

I founded Compliance Plus Healthcare Solutions, LLP to assist law firms representing hospitals, healthcare systems and physician organizations in complex litigation involving third-party payer reimbursement.

• Served as expert witness for community hospitals, non-profit health systems and physician organizations providing complex analysis and testimony resulting in multi-million dollar settlements on behalf of clients.
• Authored expert witness reports for Federal and State courts.
• Provided testimony on complex reimbursement, claim and clinical denial subject matter.
• Educated Federal and State arbitrators on the complexities of healthcare claims and reimbursement through expert testimony resulting in favorable verdicts for clients.

• Collaborated closely with data engineers to identify emerging trends from diagnosis and procedure codes within claims data during the COVID-19 pandemic. Served as clinical data analyst to the claims warehouse.
• Provided claims data analysis through appointment to the National COVID-19 Healthcare Coalition.
• Led cross-functional data analytics team preparing client-facing deliverables for complex diagnoses, procedures, diagnostic testing and overall management of low-volume / high-cost clinical encounters.
• Developed and implemented process improvement and operational redesign of clinical middle revenue cycle operations for 40+ hospitals and health systems.
• Implemented, monitored and reported on all aspects of Health and Human Services, Office of Inspector General Corporate Integrity Agreements; leading the hospitals through successful resolution and maintaining status as a Medicare participating facility.
• Guided operational implementation of multiple healthcare technology solutions providing direction to finance, utilization review, case management, clinical documentation integrity and compliance departments.
• Provided operational guidance through Electronic Medical Record conversions and implementations. Experience with EPIC, Cerner, 3M 360, Allscripts/Careport, Athena, Xsolis and Waystar.
• Collaborated closely with departments across client organizations to drive success jointly as one cohesive unit.
• Established strong relationships with clients and stakeholders, ensuring long-term partnerships and repeat business.
• Established effective communication among team members for enhanced collaboration and successful project completion.
• Developed comprehensive project plans with clear timelines, milestones, and budget requirements, ensuring timely delivery of high-quality results.
• Delivered exceptional customer satisfaction by proactively addressing client concerns and meeting or exceeding expectations throughout the engagement process.
• Monitored progress against established goals, adjusting schedules and resources as needed to keep projects on track.
• Coordinated with cross-functional teams to resolve project issues and mitigate risks.
• Served in capacity of Interim Director of departments including Case Management, Utilization Review, Transitions of Care, Outpatient Case Management and Clinical Documentation Integrity.
• Authored and presented specialty based ICD-10 documentation education to physicians, residents and ancillary staff for large university medical center.
• Served as project manager and/or project lead consultant on projects including: compliance, defensible patient status, clinical denials mitigation, revenue cycle optimization, patient access, centralized scheduling, clinical documentation integrity, physician advisor program, medical staff operations, payer contracting and risk management.

• Developed high-performing Recovery Audit Contractor response teams within client organizations.
• Authored and implement hospital-wide compliance program for safety net hospitals.
• Served as project lead for Recovery Audit Contractor preparedness and medical necessity audit services.
• Directed team including physician advisors, advanced practice practitioners, audit nurses, coders and revenue cycle consultants.
• Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
• Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
• Facilitated cross-functional collaboration for improved decision-making processes within client organizations.
• Proactively identified potential risks and implemented mitigation strategies to minimize negative impacts on clinical middle revenue cycle operations.

Practice focusing on healthcare regulatory law representing hospitals, physician practices, nursing homes and home health agencies.

Med/Surg and Pediatrics