Revenue Operations

• The firm has billed over $83.7 million dollars in charges for over 198,000 visits.
• Leadership have afforded clients to realize an average of 93.30% net collection rate (excluding start up practices not with the firm over 1 year)
• Since 2005, formally evaluated the revenue operation processes and conducts practice assessments for solo and group practices in both academic and private practice setting.
• Established start-up practices leading to growth, stability, and funds through patient collections to enable recruitment and hiring of additional providers.
• Developed a proven track record of performance in revenue operations and development of protocol for efficient operations.
• Operated under TPA license in receiving provider claims, conduct re-billing and served as management service organization for specialty specific Independent Physician Association in Houston and Louisiana area.
• Assisted in the selection, evaluation and review of multiple practice management systems for solo practice physician practice including preparation of spreadsheet of considerations to aid practice in selection of its practice management system.
• Consulted with a solo practice on options regarding outsourcing of billing efforts compared to retaining them within the practice and assisted in the selection of a third party billing company
• Evaluated multiple billing system platforms preparing spreadsheet of considerations to aid practice in selection of its practice management system.
• Conduct training of healthcare provider staff in aspects of the Revenue Process, management of upfront collections, customer service and scheduling management.
• Created training program and online protocol manual for medical practice operations.
• Operate under TPA license in receiving provider claims, conduct re-pricing and re-billing of provider submitted self-funded employer claims for a behavioral healthcare network in Nevada with over 350 providers in northern and southern Nevada.
• Successfully manage, supervise and oversee work and work product of staff within clinical practices providing direction and training.
• Review and prepare comment on practice management forms used in clinical practice in effort to streamline and minimize administrative burdens.
• Implement The Revenue Process® including actual performance of billing and collection functions, accounts receivables management for academic nursing centers and private practice physicians.
• Conducted a practice assessment reviewing systems and infrastructure to transition in house the outsourced responsibilities of billing and collections.
• Implemented tools for coding compliance in multiple practitioner practices including preparation of compliance program.
• Assessed aged accounts receivables, conducted analysis and research in preparation of a work plan later implemented.
• Managed aspects of a Comprehensive Outpatient Rehabilitation Facility in a UB92 billing environment responsible for billing, collections, managed care contracting, credentialing and as a member of management, strategic planning and development.
• Conducted analysis of explanation of benefits identifying $3900 in underpaid claims annualized to over $46,000 in wrongly paid physician claims for a solo practitioner.
• Provided training and education on proper handling of clinic operations including organizational infrastructure and staffing requirements. 
• Conducted an assessment providing recommendations later implemented regarding the billing operations for an international travel medicine company with hospitals and physicians in multiple countries.
• Designed a Revenue Process® implemented with multiple advanced practice nurse managed centers and physician practices. 
• Served on selection committee for third party administrator to handle the claims processing of a practices global package pricing service.
• Defined the revenue management process and operations for a national rehabilitation service healthcare provider
• In an outsourced manner functioned as the physician office administrative staff during clinic transition.
• Appointment to a leadership role in redesigning the revenue process in concert with the implementation of a new billing system for the University of Texas Houston Medical School. 
• Coordinated operations with both fiscal intermediary and hospital system corporate office for 11,500 capitated covered lives representing 4 percent of total Uniformed Services Family Health Plan enrollment.
• Supervised HMO reimbursement calculations for capitated physician groups affiliated with the Uniformed Services Family Health Plan.

Contracting and Network Development

• Serve in the role as an administrator for a Houston metropolitan Independent Physician Association having over 200 multi-specialty physician, chiropractic, and ancillary care providers.
• Negotiated and conducted contracting with over 150 different carriers and network throughout the country.
• Negotiated expense reduction programs for medical practices providing practices a savings of 42% on certain expenses within the practice.
• Manage contract portfolio, contract renewals, reimbursement changes and operational matters for solo, small group healthcare providers as well as academic nursing centers.
• Negotiate transplant center of excellence contracting inclusive of professional, facility, donor, organ procurement, and outlier provisions in a case rate zoned manner.
• Coordinated efforts and special research projects related to claims payment concerns where breach of managed care contract and violation of state prompt pay laws were violated.
• Firm coordinated and served as project lead for network development in the State of Texas and State of Missouri for Medicare PPO special needs plan with focus on hospital contracting, physician group and ancillary providers.
• Assisted in the hospital contracting and network development for Medicare HMO plan in Texas and Medicare HMO plan in New Hampshire, Maine and Arkansas. 
• Firm conducted network development for Medicaid HMO plan in the State of Texas for large physician groups and hospitals.
• Conducted network development for plan specific to its workers compensation network after changes in the state legislature caused restructuring of Texas workers compensation program. 
• Firm conducted network development for the TRICARE Prime product of the Department of Defense in New Hampshire, Maine, North Carolina, and Virginia responsible for hospital, physician and ancillary contracting.
• Serve as administrator for Independent Physician Association having physician membership exceeding 200 physician members with membership to include in addition a chiropractic, optometry and ancillary networks within the IPA.
• Manage network of primary care physicians in Texas responsible for contracting, credentialing and provider services.
• Developed, implemented and contracted case rate, specialty carves out and capitation pricing for primary care, specialty and tertiary care services.
• Create contracting strategies, language review templates, conduct rate analysis, define negotiation parameters and implement tools for contracting representing both healthcare facilities and healthcare providers.
• Conducted facility, professional and ancillary network development contracting as a consultant to a former employer, Sierra Health Services, Inc. 
• Responsible for the management of a second opinion network of clinical providers for a regional Texas uninsured PPO.
• Defined and implemented a multi-state contracting strategy, business plan, new clinic pro forma’s and marketing strategy with collateral material for a multi-site rehabilitation back and spine program. 
• Negotiated timeshare agreements for physician practice set-up within an existing physician practice.
• Presented contract and case rate analysis data including language and financial impact data governing committees for approval. 
• Creation and implementation of tools and processes to aid in successful operations and education of physician group practice.
• Managed contracting process of over 70 contracts representing over 120 product lines resulting in 4.8 million dollars of service a month for the faculty practice of nearly 500 physicians trained in more than 92 medical and surgical specialties
• Negotiated and contracted 90% of the executed physician service agreements for the University of Texas Medical School's faculty practice plan as of Spring 1999. 
• Supervised HMO reimbursement calculations for capitated physician groups affiliated with the Uniformed Services Family Health Plan. 
• As an employee of Sierra Health Services, Inc., performed solicitation, selection, negotiation, and implementation of facility, physician, and ancillary contracting in a capitated, risk pool, DRG and global fee environment in the Houston and later as manager over the network expansion in the Beaumont Texas service area.

Credentialing

• Coordinate credentialing, application completion, tracking and re-credentialing tasks for solo and small group physicians including a faculty practice plan and two university clients.
• Manage the delegated credentialing network of a primary care provider network in Texas.
• Drafted policy and procedures for provider network desiring to position the IPA for delegated credentialing.
• Manage a centralized credentialing service for purpose of monitoring credentials and completion of all applications for provider participation and privileging. 
• Wrote and updated a policy and procedure manual inclusive of regulatory requirements for NCQA and URAC criteria approved by and utilized by a credentials committee.
• Managing and directing the provider service and credentialing operations of multiple physician networks.
• Responsible for the credentialing of a 25-hospital and 2,800 physician HMO provider network including provider servicing and maintenance of statewide PPO and POS network.
• Supervised the credentialing operations for the physicians of the University of Texas Medical School and the Houston network of Sierra Healthcare Services subsidiary, Texas Health Choice (formerly HMO Texas) 

Strategic Planning

• Conducted assessment of five solo physician practices for purpose of identifying synergy and work flow processes of each, prepared financial models and presented options in forming a group practice.
• Participated in the preparation of a Robert Wood Johnson grant.
• Prepared clinical practice pro forma’s for multiple academic nursing centers.
• Designed and implemented the credentialing and contracting strategy for a new physician who joined a solo physician practice resulting in a group practice model. 
• Prepared clinical revenue projections based on assumptions for inclusion in a HRSA grant (Health Resources and Services Administration) 
• Conducted market assessment leading to a full business and marketing plan for a Connecticut advanced practice nursing center.
• Prepared clinical practice pro forma's.
• Created a business development strategy for increased patient referrals and encounters to an established clinical practice.
• Conducted market analysis and assessment of workers compensation and occupational health growth opportunities for a Texas hospital system.
• Negotiated and represented specialist physician in compensation and bonus negotiations with physician employer.
• Handled transition of responsibilities as AVP of Business Development and Marketing for the medical school practice plan six months following resignation to begin Health Associates. 
• Served as advisor to a board of directors in the development and operations of a million dollar healthcare enterprise.
• Facilitated business development plan and defined marketing efforts for university physician contracting directly with employer groups, third party administrators, insurance and managed care health plans.
• Participated in the survey and preparation processes leading to federal qualifications and HCFA approvals for a point of service Medicare risk product, and state application for an HMO service area expansion in Texas. 
• Oversight and budget development for the healthcare operations of network development, provider, contract and credentialing administrations ensuring forward movement of activities through project management.
• Preparing and managing the implementation of policies and procedures for medical management and provider relations structuring the Health Services Delivery department of a Houston HMO. 
• Managed the development of a hospital-based utilization review program developing administrative policies and procedures that resulted in a 40 percent decrease in unnecessary specialist referrals while reducing out-of-network hospitalizations and average length of hospital stays. 
• Preparing, presenting and receiving approval of medical standing orders, requesting annual funding, and planning the development and staffing of emergency aid stations for rural Ohio counties.
• Served as spokesperson and advisor representing Ohio University as a liaison with the Athens County American Red Cross.

Employee Benefits Administration

• Manage nearly 1 million dollars in annual healthcare premium dollars for Texas businesses.
• Coordinate the evaluation, research and census gathering for consideration of healthcare group purchasing of healthcare benefits for physician practices. 
• Evaluated physician practice healthcare benefits serving as their agent in reducing premium costs in plan re-design as much as 52% per month.
• Service and manage employee and individual benefits totaling over 4.2 million dollars in premium in 2002.
• Negotiated a proposed 25% increase in premium to a 5% increase resulting in employer savings exceeding $500,000.
• Prepared a proposal saving a 400 life employer group a savings of 1.1 million (self-funded) dollars and also a 1.2 million dollar (fully-insured) annual savings. 
• Prepared an employer direct arrangement for an 80 life employer group unable to afford traditional insurance options.
• Organized a non-traditional healthcare access model for an employer group unable to afford insurance premiums for its 80 employee company that provided HAI coordinated access to primary care, specialty care, pharmaceutical and vision services in a fixed fee environment. 
• As an employee, served as Group Sales Representative for an insurance company and health plan for both large and small group accounts including Fortune 500 employers.
• As an employee, served as Account Manager responsible for medical insurance renewals and service of small and large group accounts. 

Corporate Wellness

• Negotiated employer sponsored onsite wellness programs and health clinics with two employers each having over 500 employees.
• Represented physician organization and served as liaison with 524 bed medical center in creation of corporate wellness program.
• Program Consultant to a comprehensive clinical wellness team providing rehabilitation, primary care, occupational health, bariatric medicine, and fitness services.
• Prepared Corporate Wellness program inclusive of assessment and practitioner intervention that when implemented identified two cardiac health risks that allowed for immediate clinical intervention.
• Represented a Texas Medical Center hospital as the hospitals liaison in facilitating meetings and marketing of its corporate wellness program to Houston employers. 
• Served as a Board Member for the City of Houston's Well City Work Place project.
• Served as a consultant to the Board of Directors and later board member for Wellness Leasing, Inc.
• Published articles in publications including Houston Business Journal on corporate wellness and employee productivity. 
• Administered and coordinated health, safety, and emergency activities for over 1700 individuals administering medical care as directed by physician standing orders interacting with community hospitals, physicians, and local agencies.

Transplantation

• Serve as President and Chairman of the Board for the Tertiary Care Network
• Serve as Past President and former Chairman and President of The American Organ Transplant Association.
• Market a national center of excellence program for transplant and tertiary care services to employer groups, insurance companies and third party administrators. 
• Negotiate transplant center of excellence contracting inclusive of professional, facility, donor, organ procurement, and outlier provisions in a case rate zoned manner.
• Created presentation and marketing packet for presentation to insurance companies, TPA's, PPO's and employer groups of a Transplant Center of Excellence.
• Facilitated and drafted a plan for the marketing consortium of transplant facilities in the Texas Medical Center working with four competing centers.
• Managed special projects including coordination of business plan and contracting efforts for solid organ transplant services with hospital partner.