HEALTH CARE AND OPERATIONS EXECUTIVE
Business and financial operations administrator with demonstrated success identifying and implementing innovative approaches to conventional processes in healthcare operations. Extensive experience in large, complex, and distinguished health systems requiring cross-functional stakeholder management with integrated decision-making. A collaborative leader adept at coalition building to promote practice efficiency, profitability, and change management across the enterprise. Strategic focus on technology-driven platforms and advanced business models to enhance and augment operational capabilities. Expansive knowledge in revenue cycle operations, patient access, physician compensation models, decision support, and capitation arrangements.
Areas of Expertise
Revenue Cycle Operations; Patient Access Services; Ambulatory Clinic Management; Financial Management and Analysis; Information Systems Design; Physician Compensation Modeling
PROFESSIONAL BACKGROUND
SCRIPPS HEALTH San Diego, California 2013 - 2017
Senior Director, Revenue Cycle Operations
A high-visibility leader responsible for end to end revenue cycle strategies and operational performance to ensure priorities and techniques align well with the organization’s strategic initiatives and objectives across 31 clinics and 5 hospitals. Established and lead Revenue Cycle Operations Governance Board with enterprise-wide leadership representation from Scripps Medical Groups (Clinic & Coastal), Corporate Audit & Compliance, Finance, Corporate Accounting, Corporate Contracting, Information Systems, Human Resources and Scripps Health Plan to establish end-to-end revenue cycle stakeholder collaboration, transparency, and accountability.
As a senior leader provided direct oversight to revenue cycle operations that included 300+ FTEs representing multi-functional teams (registration, eligibility verification, referrals, authorizations, charge capture, coding, provider relations, insurance follow up, self-pay, customer service, payment posting, EDI, credits/refunds, correspondence, analytics/reporting and revenue integrity for both unfunded and funded payer sources). Accountable for the direct management of third party vendor solutions providing extended business office support (on and offshore).
Selected Accomplishments
- Designed and implemented a new management model based on Encounter Scoring that monitors quality, visibility, timeliness and metrics. Encounter Scoring Management resulted in an enriched Net Collection Rate of 93.7% (formerly 91.2%) as well as increased throughput volumes, reduction in waste/rework and improved employee satisfaction.
- Developed and implemented multi-year revenue cycle strategies leveraging superior technology solutions with enhanced automation that decreased operating expenses by $7.45M over four years while infusing standardized workflows.
- Predictive Analytics: Member of Scripps Enterprise Data Governance that led the procurement and implementation of an integrated data warehouse solution combining multiple disparate legacy systems into a single repository eliminating costs associated with maintaining separate legacy systems and siloed data. SAP HANA and SAP Predictive Analytics was implemented, and within 3 months Blue Cross/Blue Shield agreed to 3 underpayment settlements totaling $4.1M.
- Revenue Cycle Optimization: Developed and implemented strategies to identify revenue opportunities otherwise classified as lost revenue for coding, medical necessity, authorizations, timeliness, bad debt and reimbursement gaps resulting in increased revenue of $8.94M (net) in 21 months.
- Acquisition and New Practice Integration: Key member of the Acquisition On-Boarding Team responsible for evaluation of practice performance metrics for new and potential acquisitions related to access, coding, documentation, billing, collections and physician compensation analytics. Successfully incorporated Pacific Coast Women’s Health Group, El Camino Pediatrics, Vista Radiation Oncology (3 locations), Pacific Bariatric, and Imaging Healthcare Specialists (8 locations).
- An executive leader for the $550M Epic implementation of an integrated and enterprise-wide technology platform representing 38 of 41 modules across Epic’s Core Clinicals, Enterprise Intelligence, Specialty Clinical, Ancillary & Specialty Departments, Revenue Cycle, Patient Access and Patient Engagement & Mobile replacing 5 electronic medical records and 2 revenue cycle management systems across 41 Scripps facilities.
- Participated and contributed to system-wide initiatives within Scripps’ Corporate Strategy designed to improve patient satisfaction and quality of care on the foundation of Scripps’ lean management tool, Value by Design, powered by a frontline, team based approach that identifies and eliminates waste while adding more value to patients.
-- Primary Care Redesign: Standardized clinical processes to maximize patient-team interactions in team-based care delivery space, reengineered registration processes maximizing in-person time and space, rededicated space for patient education, re-purposed clinical staffing for medication management and augmented routine in-person office visits with virtual visits.
-- Population Health: Partnered with executive leaders to ensure seamless incorporation of exclusive payer arrangements, expand risk-based contracts (capitated and shared savings), integrate an exclusive 20,000+ member employer-direct ACO, and launch a Track 3 Medicare Shared Savings Program in 2017.
-- M.D. Anderson: Scripps’ partnership with M.D. Anderson (MDA) combines existing cancer expertise with a number one-ranked cancer center’s extensive capabilities. As the senior leader for revenue cycle, developed a new patient access strategy to expedite processes for patient access (registration, eligibility verification, referrals, authorizations, scheduling and billing) which reduced turnaround time from 3-4 days to 4-8 hours enabling expedited access to advanced collaborative oncology resources.
-- Pharmaceutical Management Committee: Key committee member charged with standardizing drugs and managing costs in ambulatory care setting. Identified revenue opportunity of $2.1M resulting from non-standard clinical workflows and insufficient documentation in addition to $4.8M by implementing a new process for white and/or brown bagging for a total annual revenue increase of $6.9M.
-- Surgical Case Optimization: Member of the OR/ASC Committee designed to reduce surgical cost by transitioning select surgical cases typically performed in a hospital operating room (OR) to an ambulatory surgery center (ASC). In 17 months, over 10 surgical and observation case classifications were transitioned to ASC settings reducing system-wide surgical expense by $3.9M and increasing main OR availability for complex surgical cases.
UNIVERSITY OF CALIFORNIA SAN DIEGO HEALTH SYSTEM San Diego, California 2010 - 2013
Director of Reve...
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