National Director Of Clinical Reimbursement resume example with 15+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
Exceptional clinical, operational, and reimbursement management expert with an unmatched leadership prowess and the ability to build teams and strategies from the ground up to achieve aggressive goals and deliver rapid results. Multi-faceted and compassionate nursing professional with exceptional clinical, didactic, and leadership skills.
Transformational and strategic clinical reimbursement executive and operations leader with differentiated career path marked by success building innovative reimbursement strategies that optimize clinical revenue, transforming teams into powerhouse leaders, and significantly increasing per diem rates by $100 per day via strategically implemented programs.
Applauded track record of defining and executing strategic and innovative initiatives that deliver rapid impacts on health care quality ratings, appeals management, clinical performance, and regulatory compliance. Dives deep into both financial and clinical problems to build and deploy rapid solutions, programs, and internal functions.
Skills
Executive Leadership
Clinical Reimbursement
PDPM/Case-mix
Legal Nurse Consulting
Clinical Program Strategy & Development
Clinical Appeals and Denials Management
CMS Star Ratings Improvement
Benchmarking/Innovation
Communication & Public Speaking Team Building
Analytics/Performance
Case Management
Work History
NATIONAL DIRECTOR oF CLINICAL REIMBURSEMENT, 03/2017 - Current Brightspring Health Services – Kerrville, TX,
Defines tools, processes, and technology needed to perform in-depth and accurate fee-for-service reimbursement in alignment with forwarding documentation and billing standards.
Lead a talented team of up to 14 healthcare facilities - rebuilding reimbursement operations, clinical metrics, and strategies while deepening team knowledge of all applicable rules and regulations.
Partner with cross-functional leaders to examine operations, uncover gaps, and ensure alignment between compliant processes and procedures.
Champion implementation of PDPM review calls to deliver end-to-end coverage of reimbursement in alignment with regulations and rules - reducing regulatory findings, enhancing clinical revenue, and bolstering clinical programs for funding opportunities.
Collaborate with interdepartmental leaders in compliance, billing, and health services in policy development that enhanced and streamlined processes.
Develop and direct quality measures improvement program - resulting in payment incentives from state value-based programs, including QIPP and NM SNFVBP.
Develop and direct quality measures improvement program – resulting in payment incentives from state value-based programs, including QIPP and NM SNFVBP.
REGIONAL DIRECTOR oF CLICANIL REIMBURSEMENT, 11/2013 - 03/2017 ROCKPORT HEALTH SERVICES – City, STATE,
Led a multistate region to serve as the expert consultant in utilization review, clinical reimbursement, and regulatory compliance and identify solutions to address high-risk areas.
Partnered with both corporate and facility-based teams and stakeholders to uncover reimbursement requirements and opportunities and refine forward solutions.
Navigated both clinical and billing demands of Medicare and managed care contracts and processes.
Built a high-performing team of 13 while driving revenue, appeals, and quality measure project demands.
Developed policies and procedures for cross-functioning departments - later utilized in key clinical programs and projects.
Standardized processes and improved documentation practices to reduce risks 30%.
Qualified 12 facilities for incentive payments from the state QASP program for 2 consecutive years resulting in approximately $1M is stated funded incentive payment.
Recognized as a strong team lead and called upon to serve as interim vice president.
DIRECTOR OF NURSING, 01/2012 - 11/2013 PANORAMA MEADOWS NURING CENTER – City, STATE,
Engaged in and implemented sound and strategic clinical operations surrounding new acquisition - stabilizing healthcare staffing, improving client satisfaction, and ensuring all clinical services rendered are positioned for success.
Served as vital leader to the administrator, VPO, and COO on integration of Premier B.H. Inc.
Fostered rapid growth opportunities and maintain regulatory compliance.
Collaborated cross-functionally across multiple disciplines to define and execute integration strategy and excellent care delivery models while also supporting the modification of company policies.
Supervised 40+ healthcare staff and maintained less than 2% over time and maintain attrition rate to no more than 15%.
Propelled patient admission rate by 40% via active involvement in marketing and building of key partnerships with hospital groups and physicians.
Recognized early as a high-performer - selected by the VPO to train and mentor directors from affiliated healthcare centers.
LEAD MDS COORDINATOR, 01/2006 - 01/2012 COUNTRY VILLA HEALTH SERVICES – City, STATE,
Transitioned as a charge nurse to MDS to drive clinically sound and financially strategic processes surrounding the RAI process.
Spearheaded the complete scope of the RAI process and enhanced patient care through in-depth comprehensive care planning.
Drove increased focus on coding accuracy - cultivating a more data-driven and performance-focused environment.
Developed a robust daily PPS program and triple-check process.
Spearheaded risk management programs to maintain high ratings in quality measures and desired clinic outcomes.
Recognized early as a high-performer - selected to participate in the Leadership Accelerated Development Program.
Education
Master of Science: Nursing Leadership And Management, Expected in - Capella University - Minneapolis, MN GPA:
Bachelor of Science: Nursing, Expected in - Western Governor’s University - Salt Lake City, UT GPA:
Bachelor of Science: COMPUTER SCIENCE, Expected in - California State University - Dominguez Hills - Carson, CA GPA:
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