Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
Successful Executive with over 10 years of demonstrated ability in delivering mission-critical results. Offering outstanding communication and cross-cultural team management skills. Entrepreneurial attitude for optimal profitability. Ambitious team leader adept at creating strategic alliances with organizational leaders and effectively aligning with and supporting key business initiatives.
Skills
Operational leadership
Organizational turnaround
Medical Necessity Criteria
Utilization Review
Cost reduction strategies
Risk analysis and management
Staff Management
Training & Development
Regulations expertise
Operational planning
Consulting
Work History
Partner, 11/2020 - Current Initialized Capital – San Francisco, CA,
Compiled research data and gave professional presentations highlighting findings that decreased denial rate by 36% in first year and recommended optimizations through scalable process improvement helping sustain results through first two quarters.
Implemented policies and standard operating procedures for organizations that has lead to measured consumer satisfaction of 91%.
Enforced compliance with government regulations and company policies that lead to dismissal of government action against one of contracted organizations saving $700k.
Worked aClaireside attorneys, administrative assistants and fellow legal assistants on complex cases and legal processes that helped in administration of justice for multiple clients.
Investigated policies currently under discussion to assess impact on overall operating procedure for organizations in Healthcare field.
Helped conceive and oversee grassroots support or opposition for proposed changes to business strategies of organizations contracted with.
Established and implemented business procedures and process improvements.
Streamlined company processes and procedures while enhancing customer satisfaction rating; while increasing revenue each quarter by 26% average.
Refined organizational structure to consolidate, streamline and delineate necessary functions.
Negotiated and drafted contracts with business partners, clients and vendors, saving company over $250k in first year.
Developed quarterly business plans to evaluate cost projections.
Established Quality Excellence and Billing Efficacy policies to promote company culture and vision.
Communicated with insurance providers to resolve any denied claims and created auditory functions to automate claim denial appeal that achieved decrease in claw backs and secondary denials by 41%.
Performed admission reviews based on medical necessity of Behavioral Health specifications, while following all recommendations of ASAM criteria.
Obtained authorizations from multiple insurance carriers for various levels of care.
Vice President, 03/2013 - 01/2017 First Hawaiian Bank – Wahiawa, HI,
Identified opportunities to improve business process flows and overall departmental productivity.
Established performance goals for Clinical Operations and Utilization Review department(s) and provided methods for reaching milestones through measurable metric monitors.
Supervised daily operations of multi-million dollar (2m) operation.
Spearheaded cross-functional initiatives across Billing and Clinical Authorization departments to achieve business goals for bottom-line profits that exceeded 31% annual growth rate every year.
Diminished regulatory risks by overseeing adherence to payer policies, Federal mandates, State and Local requirements related to best business practices.
Performed prior authorization review of services requiring notification while increasing initial authorizations by 57% over three year period.
Supervised and maintained all utilization review documentation through facility Electronic Medical Records System(s).
Performed ongoing assessments to evaluate mental health needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care.
Developed backend platform to help train clinicians on identifying medical necessity criteria through AI based automation and facilitated automated claims process that eliminated false claim or erroneous claim submission by 99%.
CEO, 06/2011 - 01/2017 Quorum Health Resources – Brentwood, NY,
Managed partnerships and strategic business relationships, including negotiating contract terms and handling conflicts.
Built productive relationships with industry partners and competitors to support strategic business objectives that increased revenue 300% over five year period.
Worked with department heads to stay current on needs and offer high-level support for day-to-day operations.
Identified and capitalized on short- and Claire-term revenue generation opportunities to maximize bottom-line profitability.
Monitored use of best practices at all levels and implemented corrective actions to bring employees into compliance decreasing spending by annual average of 9%.
Prepared organization for forecasted demand levels through effective operational planning.
Met dynamic needs by keeping internal systems scalable and highly responsive while decreasing employment overturn by 33% in first year of operation.
Led strategic and business initiatives to successfully grow revenue in areas such as Residential Treatment Model and Tertiary Care Scalability while growing income from $400k in year one to $5.2m by year five.
Education
Master of Arts: Counseling Psychology, Expected in 08/2022 - Capella University - Minneapolis, MN GPA:
Post Graduate Certificate: Legal Studies, Expected in 01/2019 - Northeastern University - Boston, MA GPA:
Bachelor of Arts: Liberal Studies, Expected in 09/2016 - Thomas Edison State University - Trenton, NJ GPA:
Post Graduate Certificate: Substance Abuse Counseling, Expected in 01/2016 - Ashworth College - Norcross, GA GPA:
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