Senior Healthcare Consultant Resume Example PBC Advisors, LLC

SENIOR HEALTHCARE CONSULTANT

Professional Summary

An accomplished healthcare industry professional, a proven leader in development and implementation of a FTC guided Clinical Integration program and Accountable Care Organization. Resourceful and skilled experience in reimbursement, contracting, provider relations and operations and achieving cash flow objectives in diverse business settings through process improvement, people development, and technology adoption.

Skills

Work History

09/2015 to 03/2016

Senior Healthcare ConsultantPBC Advisors, LLC

PBC Advisors, LLC provides business and management consulting and accounting services to health care professionals and practices.
PBC has established a reputation for excellence with a combined 300 client medical practices and hospitals.
PBC Advisors works exclusively with hospitals, physician practices, and medical groups and has significant expertise in the Chicagoland area.
Managed several clients including individual, group, and IPA/PHO physician practices.
Secured managed care contracts for individual and group providers in the Chicagoland area.
Created and developed Clinical Integration and ACO policies for a new ACO.
Provided onsite and electronic Delegated Credentialing Audit for a large health plan.

01/2015 to 09/2015

Consultant Implementation AnalystCommunity Care Partners/ACE

Project Manager for NorthShore University HealthSystem's Community Care Partners Accountable Care Entity (ACE).
Accountable Care Entities (ACE) and Care Coordination Entities (CCE) (Medicaid Reform) is a new approach to meeting the triple aim (increasing quality of care, lowering cost, and improving population health outcomes) for the Medicaid population.
NorthShore University HealthSystem's Community Care Partners has created a primary provider/specialty network of physicians including their own medical group in conjunction with area independent physicians, Lake County Health Department, Vista HealthSystem and Erie Family Health Center comprising over 900 physicians.
Working closely with Illinois Department of Healthcare and Family Services (HFS), Marketing, Network Management and Clinical, to support the creation and development of a robust network for ultimate implementation of a shared risk plan in 2016.

01/2014 to 04/2014

ConsultantHealth Care Services Corporation HCSC

11/2010 to 12/2013

Arrow Strategies Executive DirectorChicago Health System Tenet Healthcare MacNeal Health Providers, Inc

Project Manager for HCSC Value Based Care Models focused on Accountable Care Organization (ACO) implementation for BCBSIL, BCBSTX, BCBSOK, and BCBSNM.
The program also includes Intensive Medical Home (IMH) and Extended Medical Home (EMH.) Partnering with our provider networks and also building a scalable, secure, high quality fully integrated system.
Working with Network Management, Marketing, Communications and Clinical to support the implementation of a shared risk model.
High quality health care focused on collaboration to ensure better treatment and health for our members.
I am part of the Enterprise Project Management Office (EPMO) for Strategic Services Organization (SSO.) VBC Projects initiated for near-term and strategic long-term solutions.
A multi- year set of initiatives.
CHS) and is a legal entity incorporated in November 1985 to set up the infrastructure for an independent network of MacNeal Hospital physicians and other healthcare providers known as MacNeal Health Providers (MHP) to contract with capitated managed care organizations and insurers.
In addition, Chicago Health System has a TPA license to provide the same types of services for other IPA's who wish to participate in the risk capitated managed care organization.
The goal of the MHP network is to deliver quality and cost effective healthcare to members covered under these contracts and to allow physicians.
Chicago Health System was acquired by Tenet Health System and now CHS is Tenet Health's premier organization for the Chicago Market contracting its employed and hospital entities.
of Clinical Integration/Accountable Care Organization Manage, oversee, develop and implement the Clinical Integration Program based from the FTC published guidelines for the Chicago Market consisting of the 4 primary Tenet Hospitals.
Managed, created and implemented the recruitment and training plans and provider relation oversight for all physicians and office staff for the IPA.
Exceeded 2011/2012 projected physician enrollment by 20% and achieved actual plan numbers two months ahead of schedule.
30% budget savings in the first year of Clinical Integration program operation.
Aggressively recruiting and is projected to beat forecasted numbers before 2013.
Application accepted for CMS MSSP as a designated ACO as of July 2012.
Achieved 30% growth in the ACO program in the past 18 months.
Developed communication plan, develop and train physician offices regarding CMS required metric and thresholds to achieve.

07/2009 to 10/2010

Executive Program DirectorConvergence Technologies

Broadband Wireless Technology.
The American Recovery and Reinvestment Act provided the Department of Commerce's National Telecommunications and Information Administration (NTIA) and the U.S.
Department of Agriculture's Rural Utilities Service (RUS) with $7.2 billion to expand access to broadband services in the United States.
Of those funds, the Act provided $4.7B to NTIA to support.
the deployment of broadband infrastructure, enhance and expand public computer centers, encourage sustainable adoption of broadband service, and develop and maintain a nationwide public map of broadband service capability and availability.
Completed $350MM in grant applications for 22 wireless technology providers located in the Midwest and Western areas of the United States.
Awarded 6 of the 22 grant applications equating to most successful grant assistance program in the nation.

01/2004 to 01/2009

Director of AR ManagementCVS/CAREMARK

An $87B, 200,000-employee integrated pharmacy services provider, combining a pharmaceutical services company with a U.S.
pharmacy chain composed of 6,800 locations.
Director of AR Management - Specialty Pricing Managed the validation, implementation, and maintenance of specialty drug contracts, including single and multiple plan fee schedules, with annual revenues of $6 billion.
Managed reimbursement cycle for $360M specialty pharmacy division including Medicare B, C and D plans.
Saved $1.5M annually by developing system requirements through detailed user analysis and increased efficiency through major system enhancements.
Served as a project lead and point of contact for multiple successful acquisitions for specialty contracts and pricing schedules through due diligence of acquired billing systems and developed requirements, crosswalks, and successful implementation.
Audited Third Party (Managed Care) contracts MAC pricing with current company Rate Card pricing.
Created and implemented process controls for quality review of all contracts and fee schedules with an error rate decrease of 20% over two years including ICD9 and HCPC coding accuracy.
Reduced DSO 50%, from 42 days to 21, and increased cash receipts though accelerated adoption of Electronic Funds Transfers from 60% to 90% within three years.
Built and maintained billing procedures for high dollar therapies such as IVIG, Hemophilia, Transplant and Growth Hormone.
Worked closely with management, sales team and potential clients in fee schedule development and contract implementation.
Decreased contract implementation turnaround ~66%, from 15 days to 5 days, using new controls and processes leveraging Lean Six Sigma methodology.
Developed Risk Matrix for Sarbanes Oxley and Internal Audit for quality assurance controls.

Education

1988

Master of Science: Education
Baylor University - Waco, TX

1987

Bachelor of Science: Education
University of North Texas - Denton, TX

Resume Overview

Companies Worked For:

PBC Advisors, LLC
Community Care Partners/ACE
Health Care Services Corporation HCSC
Chicago Health System Tenet Healthcare MacNeal Health Providers, Inc
Convergence Technologies
CVS/CAREMARK

School Attended

Baylor University
University of North Texas

Job Titles Held:

Senior Healthcare Consultant
Consultant Implementation Analyst
Consultant
Arrow Strategies Executive Director
Executive Program Director
Director of AR Management

Degrees

Master of Science : Education
Bachelor of Science : Education

Senior Healthcare Consultant Resume Example

Resume Score: 60%

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