About Healthcare Solution Design
An experienced Healthcare IT and Operational Professional who has worked in all phases of several EHR Epic full-cycle implementations and various IT implementations. She worked her way from operations to analyst and has provided the knowledge and experience needed for executing successful go-lives and post go-lives. Over the years, she has provided leadership for Operational Readiness, Risk Management, Change Management, Ownership Adoption, Project Management, Testing and Training, Application & Ancillary Systems Interface Build/Design, and SOX/ Sarbanes-Oxley Best Practices.
15+ years of Revenue Cycle, IT Design, and Financial Management, experience in for profit, not for profit and academic/teaching hospital systems and new service line development. She is recognized for hiring and developing talent that supports successful implementations and designs. Managed professional & hospital billing application & operational teams.
As a strong self-starter and team player, she leveraged her expertise in healthcare to grow and build partnerships with Operational and IT Project teams. She is known for process improvements and system implementations that drive efficiency and resource optimization. History of managing AR exceeding $400M monthly.
Work with Decision support to drive legacy and future reporting/extracts and Data Analytics for better Revenue Cycle KPIs to help with setting of goals and risk management.
Designed & spearheaded Orders Conversion** for Implementations (Lab | PT | OT |RAD ONC |Cardio Rehab | Infusions.) Worked within Community Connect & SBO for both Professional and Hospital based organizations.
Years Of Experience
- 17+ Years in the Healthcare Industry
- 20+ Years in Information Technology
- 12 Healthcare Organizations Go-Lives & Optimizations
- Community Connect & SBO
- Billing Application build & testing for IDNs, Academic Medical Centers & Community Hospitals / Clinics
- Resolute HB & PB Certified
- Home Health Application,
- Beaker Laboratory Billing
- EpicCare IP & Ambulatory, Radiology, Willow, ASAP,
- HL7 & Epic Bridges & Interface Build/Design
- Reporting Workbench & Clarity
- Go-Live Activation/ Cutover planning
- Solution Design, PCMH & ACO, quality measures, KPIs & Metrics, best practices
- Catholic Health Initiatives (CHI)
- Conifer Health Systems
- Kaiser Permanente & National Claims Administration
- Cedars Sinai Medical Center
- Memorial Care
- QueensCare Health Centers
- UCLA Medical Center
- UC Davis Medical Center
- Sutter Health – Northern CA
- Alegent Creighton Health
- Franciscan Health Systems
- Maine Medical Center
- Sky Lakes Medical Center
- Project management over staff in two National Region for clinic/hospital Operations & IT analysts’ teams up to 35
- Use methods from Change & Project Management, including GE CAP, ADKAR, Prosci, Impact Analysis, Lean methodologies
- Interacted directly with C-Level | VPs | Directors | Managers
Revenue Cycle Management, supported HB/PB claims contracts in both operations and build. Helped with CBO staffing plans and strong revenue integrity consultant & project manager using compliance and best practices in creating policies/procedures and workflow development to support system build and design, vendor system integration, MedAssets, statements, eligibility verification (RTE), propensity to pay, SBO/CBO models, denial management, Revenue Cycle metrics, KPIs and data analytics/reporting.
Resolute Professional Billing Admin, Certified in 2015
Beaker CP Admin, in progress, 2015
Experienced as a Revenue Cycle Management consultant in over twelve different implementations. Over the years, she has provided leadership for Revenue Integrity Management Operational Readiness,
Served as the SBO/CBO readiness and IT application consultant with build design and workflow responsibilities leading 8+ Resolute analysts and providing billing application designed requirements to 15+ clinical analysts, including recently managed 40 + testing resources, along with previously managed 20+ report writers, trainers, and instructional designers.
Moved Client’s organization toward a SBO/CBO model in two separate states at the same time launching EPIC revenue cycle applications and merging new organization together. Performed analysis of the Epic system for chargemaster compliance, charge capture, front & back end, orders, pre and post procedures, and claims cycles.
Enterprise Design Solutins sub contractor for CTG/DBHealthcare for Catholic Health Serives of Long Island, NY
Senior Executive Hospital Billing Epic Contracts consultant (July 2017 to Present)
- Performed very in depth analysis to solved build and help with suggesting contract design and remodeling and claim edits that help to drive better claim reimbursement.
- Analyzed solved claims issues presented. Built & tested over 100 plus payor Contracts, suggested changes for claim edit rules, CDF, claim forms profile variables
- Provided guidance and input to HIMS issues in configuration, payor settings, workqueues CDM Consolidation, DRG ICD-10-PCS, cross reference coding table, coding edits and DNB edits, Code integration edits, provided design suggestions for encoder, 3M, APC grouper configuration and workflows for consecutive accounts, and deficiencies.
- Drove claim testing that centered around 200 to 500 accounts that were used to test Claims and contracts Participated in integrated testing centering around new workflows.
- Helped the team understan how Remittance Code Actions and alternate payor could work for CHSLI. Discussed overrides – Charge router, type of bill, claim code, automate value, System Action, CDF, occurrence codes and reviewed for all listed then provided input to issues by suggesting updates to current or foundation logic.
- Reviewed issues in DNB & Stop Bill designed and suggested design for Built for claim edit Workqueues.