Director of Managed Care and Credentialing at American Health Imaging, providing affordable outpatient radiology services for 30+ practices in Alabama, Florida, Georgia, and Texas. Established credentialing and privileging program compliant with OIG, CMS, TJC, URAC, NCQA, CAQH, ACR, and IAC. Manage credentialing and privileging for 250 radiologists, neurologists, chiropractors, and 150+ radiologic technologists.
Direct report to President and CEO; participate on Executive Leadership Team providing strategic oversight for all payer types. Developed portfolio of 500+ participating contracts, enhancing revenue, reducing bad debt, and increasing patient access to affordable healthcare.
Echo OneApp, MD-Staff, Fuji RIS/PACS, Imagine, Misys Tiger, Availity RCM, CMS PECOS and NPPES (NPI), Tableau, Adobe (Acrobat Pro, InDesign, InCopy, Illustrator, Captivate Prime [LMS platform]), MS Office suite (Word, Excel, Outlook, Power Point), MS Access, MS Visio, MS OneNote, MS SharePoint, Trello, Google (Drive, Data Studio, Docs, Sheets, Slides, Collections), Evernote, iWork (Pages, Keynote, Numbers.)
American Health Imaging, Inc. (US Radiology Specialists)
Director of Managed Care and Credentialing
October 2006 - August 2020 (14 years)
Air Methods Corporation
Internal Auditor and Corporate Trainer
February 2005 - October 2006 (1 year 7 months)
Denver, CO and Los Angeles, CA
American Medical Response
June 1998 - June 2003 (5 years)
Manage practitioner, technologist, and center credentialing and privileging. Recommend adjustments to policy and procedure based on CMS Federal Register updates, including MACRA, MIPS, and FPPE/OPPE. Perform Medicare/Medicaid enrollments, revalidations, and recredentialing. Notify payers of new center openings, relocations, new modalities/equipment, and new practitioners. Load centers and practitioners with payers as in-network. Update payer authorization verification sites.
Create practitioner, center, and contract profiles using MS Access, Echo OneApp, and MD-Staff. Develop workflows and map credentialing applications allowing for streamlined credentialing and payer enrollment processes. Perform primary source verification, exclusions/sanctions, and NPDB queries. Develop credentialing databases, build reporting mechanisms, design data tables for form publication. Recommend privileges to Credentialing Committee; enlist Medical Directors and Supervising Physicians for escalations and appeals.
Manage payer enrollment with Medicare, Medicaid, CLIA, Tricare, TriWest, Department of Labor, commercial payers, liens, worker's compensation, clinical research contracts, EFT and ERA applications. Coordinate physicist visits; assist with registration of radiation-emitting equipment with the Department of Community Health. Assist with audits by federal agencies.
Negotiate contract language and fee schedules; provide revenue projections based on rates with payers, forecast trends. Recommend participation with new lines of business. Audit payments, identify and mitigate risks; recommend policy to improve efficiencies. Resolve authorization, claim, and payment issues. Manage single case agreements. Established digitized library of contracts. Enter demographic data into clearinghouse.
Review guidelines and protocols with OIG, CMS, TJC, NCQA, CAQH, URAC, ACR, and IAC. Ensure accreditation data feeds are received by CMS PECOS. Research CAQH CORE policy; coordinate with Revenue Cycle team on CMS 5010 claim edits.
Research annual procedure code updates; maintain chargemaster, contract databases, payer contracts, fee schedules, and CMS PECOS, EFT, ERA applications. Review Federal Register updates, draft policy for leadership, create flowcharts and train staff on new policies/procedures. Maintain Policy and Procedure Manual. Project Manager for Medicare AUC program. Manage CMS applications: 855B, 855I, 855R, 460, and 588 forms.
Air Methods is the largest provider of air medical, search and rescue, and government transport with revenue $500+ million. The United Rotorcraft Division specializes in the design and manufacture of aeromedical and aerospace technology. The Tourism Division is comprised of Sundance Helicopters and Blue Hawaiian Helicopters. Air Methods' fleet of aircraft features over 450 helicopters and fixed wing aircraft, 5,000+ employees.
Traveled between five national offices (Los Angeles, Denver, Salt Lake City, Omaha, St. Louis), military bases, and 300+ flight bases. Designed company-wide policies and procedures. Trained military personnel, medical staff, and staff on SOx compliant policies and procedures, state required training, and HIPAA. Developed and launched training program for new employees. Communicated results to internal audit team, Audit Committee, leadership, and KPMG.
Project Manager for Federal Section 1011 and CMS Condition Code projects. Coordinated with FEMA and Department of Defense during hurricanes Cindy, Dennis, Katrina, and Rita to provide search and rescue and emergency medical transports. Identified deceased patients and first responders for victims of hurricane disaster for Hardship Committee.
Publicly traded: AIRM (2006)
Privately held: 2017
American Medical Response (AMR) is the largest ground medical transportation company in North America. AMR serves more than 2,100 communities in 40 states, providing 3+ million patient transports each year, and employ more than 18,000 paramedics, EMTs, nurses, physicians, and support staff.
Developed and implemented new policies and procedures for all payers types. Created workflows for team; audited accounts to ensure compliance with fee schedules. Reduced bad debt and improved collections by reorganizing structure of department. Positions with claims billing and cash posting prior to being promoted; employee of the month twice in same year.
Project Manager for FEMA and emergency medical response crews during 9/11 attacks. Identified deceased patients and first responders as victims of 9/11 for Disaster Relief Committee.
CPCS (Certified Professional Credentialing Specialist): pending exam
CPMSM (Certified Professional Medical Staff Management): pending exam
Photography, travel, kayaking, knitting, cooking, duck rescue; captain of company kickball team.
PATH Foundation designs and constructs public networks of walking and cycling trails and light transit: Atlanta Beltline, Silver Comet, Stone Mountain, Arabia Mountain, Chastain Park, and Freedom Park. Coordination of VIP corporate sponsors at fundraisers: Coca-Cola, Arthur Blank Foundation, Cox Enterprises, Nike, Georgia-Pacific, Turner Broadcasting Network.
Amateur Athletic Union (AAU Sports USA) is one of the largest, non-profit, volunteer, sports organizations in the US dedicated to the promotion and development of sports and fitness programs. AAU Diving National Championships are held at the Georgia Tech campus Olympic Recreation Center. Participation in diving meets at Clemson University, University of Georgia, and local diving clubs.
Second Chance Greyhounds is an all-volunteer 501(c)(3) working to form partnerships with correctional facilities throughout Georgia and Florida who foster and train former racing greyhounds. In return for the good manners that they learn, the dogs provide an outlet and the opportunity to experience unconditional love. Second Chance Greyhounds works with dog racing tracks to ensure retired hounds are rescued, rehabilitated, and adopted to loving forever homes.
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