Healthcare Samples
HOSPITAL FINANCE, PROCESS IMPROVEMENT & RISK MANAGEMENT
Engaged by a 300+ bed hospital to evaluate and enhance Finance, Accounting, and Patient Financial Services processes to optimize cash and risk management. Implemented daily cash reporting, led creation of clearing accounts to gain posting and processing efficiencies, addressed volume disparities, aligned tasks with appropriate pay grades, and facilitated cross-functional accountability & performance objectives.
HOSPITAL FINANCE AND OPERATIONS RESTRUCTURING
Partnered with the Director of Revenue Cycle at a 200+ bed hospital in performing analytics and staffing analysis for Patient Financial Services. Formulated proposal for restructuring the commercial and government billing and collections groups and assisted with the planning and execution of cross training, systems access, and tool ramp up.
IPA RISK model assessment
Identified and implemented a value based physician contract for an IPA in the NYC market with membership exceeding 100,000 covered lives. Recruited and educated physicians, developed performance measurement logic, and implemented risk sharing contracts across the organization, moving the majority of physicians from volume to value based payment.
MEDICAL CENTER BILLING RECOVERY ANALYSIS
For a leading Academic Medical Center, performed an assessment of billing function surfacing an unknown backlog of paper claims representing $4.4M in daily increased risk of timely filing denials. Developed, pitched, and sold a series of process improvements and risk mitigation techniques to ensure the risk never surfaced again and paper claims remained current. For the same hospital, performed a comprehensive analysis of a current ATB surfacing patients that had discharged but the primary or secondary insurance had not been billed in excess of $10M.
HOSPITAL ICD10 INTEGRATION MANAGEMENT
Partnered with the Director of Health Information Management (HIM) to develop ICD10 training plans, project impact on staff, source vendors, and mitigate risk of increased Coding WIP. For the same group, performed a certified mail cost benefit analysis based on volume and value of denials requiring medical records be sent to payers.
METRO HOSPITAL REVENUE MANAGEMENT ANALYTICS
Implemented routine high risk/high dollar meetings for the VP of Revenue Cycle at a prominent Boston Metro Hospital. Developed root cause trending of accounts reviewed during meeting to identify themes and potential educational opportunities, effectively mitigating repetitive occurrences.
RURAL HOSPITAL BILLING & VENDOR ANALYSIS
Assessed Self Pay operations at a critical access hospital in a remote town. Evaluated vendor contracts, performed cost benefit analysis, assessed vendor dollar thresholds and timing, and revamped Self Pay process to decrease vendor obligations and enhance Self Pay collections.
HOSPITAL PATIENT ACCESS ANALYTICS
Performed Insurance Verification scoping analysis for the Director of Patient Access at a Portland Based Hospital. Analysis revealed 80% of revenue in 20% of services and offered a more strategic way to verify insurance. For the same hospital, reviewed IP vs. OP and scheduled vs. non-scheduled patient mix to determine optimal structure for group and stratified insurance verification.