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Operational Consultant/Project Manager Resume Example

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OPERATIONAL CONSULTANT/PROJECT MANAGER
Professional Summary

I am a multi-talented results driven healthcare professional with an extensive background in the healthcare industry. This gained experience has allowed me to be highly skilled in all non-clinical healthcare disciplines of this arena. I have been able to utilize my 16 plus years of experience in guiding companies through greater efficiency, compliance standards, and profitability through the enhancement business office, patient access, billing and revenue cycle operations as well as utilizing and expanding referral sources.

Education and Training
BA: Mass Communications Jackson St. University MS

Mass Communications and minor in Computer Information Systems
Select One: Project Management Professional (PMP) Certification Career Academy, In Progress
Skill Highlights
  • Staffing management ability
  • Proven patience and self-discipline
  • Confident public speaker
  • Conflict resolution
  • Patient-oriented
  • Personal and professional integrity
  • Financial aptitude
  • Relationship and team building
  • Sound decision making
  • Staff training and development
  • In-depth claims knowledge
  • Claims analysis and review specialist
  • Cultural awareness and sensitivity
  • Critical thinking proficiency
  • (CAC) Computer Assisted Coding
  • Practice Manager
  • Patient Access Manager
  • Project Management
  • Assessments
  • Collaboration with other departments
Professional Experience
Operational Consultant/Project Manager 08/2013 to Current
 Optum Eden Prairie, MN
  • Patient access (scheduling, preregistration, insurance verification/financial counseling) Registration/Admission (ED, inpatient, outpatient, ambulatory) Patient Financial Services (charge capture, pre-billing, billing, denials, variances, follow-up, cash posting, account resolution) Decision support and analytics Assessments and Optimization Managed care contracting Collaborate with client revenue cycle team and other departments in order to facilitate resolution of process issues and implement world-class solutions.
  • Develop work plans, project tasks and manage project in accordance with the budget
  • Provide informed feedback including assessments of processes, standards, suggestions and improvements Assist in the sales process as requested Develop work plans, project tasks and manage projects in accordance with budget.
  • Provide interim staffing services as required.
  • Cooperate with other health related agencies and organizations in community activities.
  • Decision Support
  • Analytics
  • Computer Assisted Coding
  • Managed Care Contracting
  • Actively maintain up-to-date knowledge of applicable state and Federal laws and regulations
  • Month End, Quarterly, and Yearly reporting
Healthcare Consultant/Project Manager 03/2011 to 08/2013
 HBS Corp Cooper City, FL
  • Project Management
  • Solution Design
  • Management within the CBO and RBO for all business office functions
  • Claims Management and Auditor of monthly financial documents and other reports
  • Proficient in all areas of healthcare billing and follow-up for all financial classes to include government as well as commercial disciplines
  • Denial Management by identifying payors denials and targeting problem areas to create a method of solution for revenue enhancement for hospitals and large multi practice physician groups
  • Trained and educated staff to become more proficient in accomplishing set goals and increasing their percentages
  • Revenue Cycle Processes for all areas
  • Revenue and Cash Enhancement
  • Cash Acceleration Projects
  • Departmental initiatives
  • Intimate knowledge of managed care and healthcare reimbursement
  • Ensuring client needs and goals are met in a timely manner
Senior Consultant/Project Manager Senior Consultant, Project Director, Compliance Auditor, and Project Manager 06/2001 to 03/2011
 Independent Healthcare Financial Consulting Corp Lake Charles, LA
  • Business Development and Marketing
  • Claims Management and Auditor of monthly financial documents and other reports.
  • Denial Management by identifying payors denials and targeting problem areas to create a method of solution for revenue enhancement
  • Implementation of Policies and Procedures to reorganize and improve the revenue cycles
  • Provided education on the compliance and standards that must be maintained in order to comply with and pass JCAHO surveys.
  • Consulting specialties include Home Health, Acute Care, Professional Services, MRDD, Medical Group Practice, Long Term Care, Hospital inpatient and outpatient, Inpatient and Outpatient Rehabilitation, in profit and non-profit sectors
  • Software analyst and trainer that included HMS Patient Access and Revenue Cycle modules as well as other programs.
  • Developed a plan for Process and Improvement for all departments
  • Physician Office and Hospital Assessment review of the reimbursement cycle, collections, front end processes, and billing Coding and Reimbursement reviewing for the Billing of Medicare, Medicaid, Commercial, and Private Payors
  • Medicare Cost Reporting and Revenue analysis ranging from 1.5 million to 200 million
  • General Accounting duties, general ledger, taxes, payroll etc., A/R Cash Acceleration specialist
  • Hospital and Physician Group Business Office consultant, reviewing A/R, Collections, and Admissions
  • Practice Management and Physician Group management included 165 physicians of various specialties
  • Directly supervised 167 employees at non- profit hospital in southern Louisiana Directly supervised 32 employees at for profit hospital in southern Louisiana
  • Directly supervised 66 employees at for profit hospital in Florida Directly supervised 27 employees at for profit hospital in central Louisiana Directly supervised 13 employees at for profit hospital in Florida.
Senior Associate 06/2009 to 03/2010
 Tatum LLC Atlanta, GA
  • Main focus healthcare revenue cycle
  • Conducted assessments and audits
  • Created education tools as well as conducted training sessions
  • Created tools for revenue and project analysis as well as cash predictor models as a monthly tool for cash goals
  • Month End closing process as well as reporting
  • Utilized Meditech, AS400, HMS as well as other programs
  • Worked with various CBO (Central Business Office) departments on department concerns.
Traveling Project Director 11/2003 to 02/2009
 Perot Systems Healthcare Nashville, TN
  • Controlled, monitored, and resolved initial inventory and additional placements Performs assessments to determine CDM pricing strategies
  • Worked closely with IT and Clinical to ensure coding is in line with Federal and State guidelines and made suggestions for improvement.
  • Forecasted monthly trend projection with an average of 97% accuracy in achieving monthly goal
  • Evaluated hospital front end registration admitting processes and facilitate methods of improvement
  • Quarterly performance reviews conducted with staff as well weekly individual one on one sessions to discuss QA and productivity
  • Average upfront collections $300k monthly due to coinsurance and deductibles.
  • A/R management projects $5 - $13 million with a resolution rate of 98% with an inventory worth $13 million
  • Anticipated, presented solutions and prevented potential financial liability to the client and Perot Systems
  • Projects worked directly from clients systems with such programs as HMS, Rain tree, SMS, and other programs.
  • Focused on Revenue Cycle management for hospital and physician group of 213 physicians of various specialties
  • Project Leader for CDM and Updates of CDM also CDM building tables and reconciliation
  • Audits done to ensure proper CDM coding to make certain coding is properly represented for appropriate reimbursement
  • Ensures CDM stay within compliance and regulatory guidelines and Resolved credit balances Conducted presentations to management and client concerning issues, programs or projects
  • A/R reduction and Bad debt collections Commercial, Self-Pay, Medicare, and Medicaid follow-up
  • Worked denials with appropriate measures taken for resolution
  • Collected $46 million for this project to date
  • Assisted in completion of Medicare Cost Report, Medicaid Bad Debt, and Charity Care
  • Staff supervision of up to 43 employees in hospitals up to 349 beds
  • Direct supervision of 43 employees at for profit hospital in Illinois, direct supervision of 14 employees for non- profit acute care hospital in Hawaii, and direct supervision of 27 employees at for profit hospital in north central Texas
  • Timely and accurate completion of month end reporting and QA'd staff accounts and Patient and insurance refunds
  • Coding and reimbursement reviews designed to ensure proper billing procedures are followed and Payment arrangements made with patients in accordance with hospital guidelines.
AR Operations Coordinator/ Regional Director 08/1997 to 06/2001
 Amedisys Baton Rouge, LA
  • Developed and implemented policies and procedures that where compliance driven.
  • Directed and watched over the documentation and education needed to ensure the Facilities met and exceeded standards, which prevented any issues that could affect JCAHO accreditation and surveys.
  • Worked Start up projects and Directly supervised 62 FTE's
  • Billed and Provided Cost Reporting for 5 states
  • Implemented Policies and Procedures and Reduced A/R days
  • Filed Medicare, Medicaid, and Managed Care Claims
  • Graphed and analyzed information using programs for A/R Director and gathered data directly related to this departments Specialties included Home Health, Outpatient Rehab, Acute Care, Staffing, and Infusion Therapy.
Skills

Medisoft, Visio IDX ,CDM, SSI Omni Pro ,McKesson ,Raintree ,X-Pack, Medic, Managed Care contracting Medical Manager ,Document Imaging Med-A Florida Shares, Medicare Intermediary systems ICD-9 & ICD-10 coding, AS400, Excel , Access Cubs, Compliance Guru, Columbia Host, Collections, Microsoft Project, Crystal Reports, QuickBooks ,SMS, IMS, ACS ,E-Premis, HMS ,HBOC, TxMedNet, Peoplesoft ,Meditech ,Star Navigator, Cerner, GE Centricity

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Resume Overview

Companies Worked For:

  • Optum
  • HBS Corp
  • Independent Healthcare Financial Consulting Corp
  • Tatum LLC
  • Perot Systems Healthcare
  • Amedisys

School Attended

  • Jackson St. University
  • Career Academy, In Progress

Job Titles Held:

  • Operational Consultant/Project Manager
  • Healthcare Consultant/Project Manager
  • Senior Consultant/Project Manager Senior Consultant, Project Director, Compliance Auditor, and Project Manager
  • Senior Associate
  • Traveling Project Director
  • AR Operations Coordinator/ Regional Director

Degrees

  • BA : Mass Communications
    Select One : Project Management Professional (PMP) Certification

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