• Job Target: Unspecified
• Employment Status: Employed - Will Consider Right Opportunity
• Experience Level: Not Specified
• Seeking: Contract/Temporary/Project
• Industry: Accounting/Finance Resumes

• Salary:
• Degree: Not Specified
• Security Clearance: None
• Travel: Heavy
• Relocate:: No

Objective

Consultant experienced in healthcare reimbursement, financial management, practice administration, project management, compliance, contract management, and staff development. Utilize extensive background in managing healthcare accounts receivable to obtain reimbursement, secure coding for billing, modify carrier coverage policies, increase cash collections, improve Days Accounts Receivable (DAR), optimize revenue, maintain regulatory compliance, and develop and refine training/processing procedures. Payers include Medicare, Medicaid, managed care (capitation, HMO, PPO), commercial, workerís comp, and self pay, utilizing a variety of specialized systems. ï Worked with team to obtain and implement new CPT, HCPCS, and APC codes issued for Computer-Aided Detection (CAD) in mammography in 2002, 2003, and 2004 with reimbursement by Medicare ï Led efforts to secure approval of CAD by the Blue Cross Blue Shield Association Technology Evaluation Center (TEC) ï Orchestrated issuance of CMS Program Transmittals to Medicare Carriers and Intermediaries to correct improper CAD denials ï Improved cash flow, management and J.V. partner confidence for DME, and reduced DAR by 20% ï Increased percentage of clean claims to 98% and added NEIC ECS capability ï Implemented new Revenue Management P&P and reduced audit variances from 40% to 5% Broad-based background in operations, contract management, negotiations, and risk management. ï Reversed negative coverage policies of more than ten major carriers including Humana, Wellpoint, Highmark, BCBS of Massachusetts, and Excellus ï Expanded coverage and reimbursement for CAD to 90% of all eligible insurance companies ï Negotiated contracts with 23 HMOís and PPOís in first six months at Metropolitan Medical Associates ï Reduced insurance premiums with implementation of risk management and safety systems ï Coordinated and assisted with negotiation and sale of large medical group for superior payout Proven management, systems implementation, technology improvements and productivity track record. ï Directed 100-person reimbursement team for very large pharmaceutical, infusion and DME operation ï Accelerated payment processing by two days while reducing staff 50% using electronic remittance ï Selected new MSO practice management system and implemented within targeted timeframe ï Reduced employee turnover by 60% through new incentive program and job training Results-oriented team leader adept at problem resolution, financial analysis and reporting, negotiation, and achieving corporate financial objectives. Strong listening, communication and interpersonal skills. Excellent knowledge of healthcare billing and management systems.

Job Target

Unspecified

Professional Experience

Education