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Click here or scroll down to respond to this candidate Candidate's Name , CPC
Street Address
Phone: (512) PHONE NUMBER AVAILABLE email: EMAIL AVAILABLE
Highly accomplished practice administrator and revenue cycle professional with over 30 years of
healthcare leadership and management experience. Certified coder with extensive experience in
compliance, auditing and provider education/training. Broad understanding of healthcare industry,
based upon positions at large insurance carriers related to claims adjudication/auditing and third
party administrator functions. Confident leader; solid background in human resource management.
Experience:
FirstCare Health Plans 10/19/2015 - Current
Configuration Manager
Acts as a liaison between the Network management team and provider population for the
negotiation and implementation of new pricing LOAs, contract revisions and other pricing
algorithm requirements.
Oversees system modifications or implementation of newly established IPO, capitation or fee
for service pricing configuration changes. This includes establishing and maintaining
compensation rates for hospitals, physicians, and ancillary services.
Develops and negotiates reimbursement rates for new providers. Includes accurate, easy to
understand analysis of the negotiated rates
Works with Network Development in establishing network goals and priorities
Monitors and reviews new pricing configuration to assure the providers claims are pricing
accurately and as contracted. This includes maintaining documentation of review completed
Works with UPM department on special UPM reimbursement initiatives
Updates and maintains hospital reimbursement reports for all product lines
Reports include inpatient base rate comparisons, outpatient reimbursement comparisons, and
observation cost per case
Works with system configuration staff to operationalize all pricing needs
Analyzes and compares fee schedules
Analyzes all reimbursement, including outliers, transfer adjustments etc
Update and maintains hospital reimbursement rate summary
Renegotiate contracts when requested or contractually required
Oversees 5 Reimbursement Configuration staff
Oversees 4 Group Set-up staff enters group rates, rider and plans
Wellness Med Clinics / Injury2Wellness 01/01/2014 - 12/31/2016
Clinic Director - Owner
Oversee and managed the administrative and operational activities of Wellness Med Clinics
and Injury2Wellness clinics
Oversee credentialing of providers with payers
HR in hiring providers and staff
Implemented HealthFusion EMR to use on day one of operations.
Meet with providers every month to discuss WRVUs, coding, compliance, revenue
Oversee documentation and billing compliance for both clinics
Oversee accounts payable and receivable.
Oversee revenue cycle
Help in designing both clinics along with my partners.
All other admin duties.
South Texas Regional Medical Center 02/2012
12/31/2013
Director of Practice Management
Oversee and managed the administrative and operational activities of multi-specialty clinics:
OB/GYN, Cardiology, Orthopedics, Pediatrics, Family Practice, and Diagnostic.
Oversee and managed the administrative and operational activities of Family Practice clinics
in Poteet, TX and Three Rivers, TX
Oversee and managed the administrative and operational activities of Urgent Care clinic,
Diagnostic center and Occupational clinic.
Oversee and managed the administrative and operational activities of 43 staff members,
including; Physicians, PAs, NPs,
Oversaw documentation and billing compliance. Met with Chief Compliance Officer every
month to report any violations or issues of the month.
Met with CEO to discuss on a monthly bases: A/R, Billing, Physician recruitment, Provider
contracts, clinic status, physician and staff issues.
Met with providers every month to discuss WRVUs, coding, compliance, revenue and status
of clinics.
Met with CHS corporate regional director quarterly to discuss profit/loss on each clinic and
providers.
Helped in designing 50,000.00 sq foot MOB, along with CEO, CFO and building architect.
Oversaw the move of all outpatients clinics into their new locations in the MOB.
Union Treatment Centers 8/2009 01/2012
Medical and Physical Therapy Clinic
Regional Clinic Director
Oversees and manages the administrative and operational activities of 6 regional clinics(San
Antonio, Austin, Killeen, Corpus Christi, Beaumont, Tyler)
Reports to and takes direction from COO on issues pertaining to the overall operations of
regional clinics.
In conjunction with other managers, plans, develops, and implements policies, procedures,
goals, and objectives to ensure quality health care and service, adherence to departmental and
state policies and other health insurance requirements, and uniformity and consistency
between clinic; analyzes clinical records and reports to identify operational issues or trends, or
progress in meeting performance measures
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Creates and implements strategies to improve utilization of services, staff, and facilities;
assures that statistical and clinical records are maintained to meet state requirements; consults
with and seeks advice from the Medical Director or COO regarding medical compliance and
protocols; ensures maintenance of clinic facilities and medical equipment, and arranges for
fixed asset replacement; prepares narrative or statistical reports of regional activity for
management review.
Analyzes and monitors regional clinic operations, such as patient flow, scheduling,
appointments, and staff-to-physician ratios; evaluates and adjusts staff assignments and
negotiates changes in physician schedules to meet clinic demands; researches data and
responds to a variety of operational issues that cross program lines; resolves and responds to
complaints from patients and staff; keeps staff informed and disseminates information on a
variety of administrative, fiscal, operational, and programmatic issues.
Monitors and controls revenues and expenditures; analyzes regional data to identify funding
needs for a variety of programs and services; consults with management staff regarding
priorities and availability of funding and other resources to meet regional needs.
Directly or through subordinates, supervises professional, supervisory, and support staff;
provides functional supervision to staff in other areas. Coordinates staff training on
operational procedures.
Ability to: plan, organize, and coordinate clinic activities; interpret and apply policies and
procedures; learn program services; learn and apply federal and state regulations; provide
direction to professional and support staff; plan, assign, organize, prioritize, and delegate
work of self and others; establish standards and evaluate staff; research and analyze data,
draw conclusions, develop and implement solutions to problems; make oral presentations;
establish and maintain working relationships with physicians, community health
organizations, colleagues, and staff; prepare narrative and statistical reports; maintain
confidentiality; resolve conflicts; represent UTC with tact and diplomacy..
Think First
Healthcare technology and consulting company
Independent Consultant 04/2009 08/2009
Advice and work with clients on best practices, work flow, revenue cycle, coding.
WL Practice Management Consultants Owner
Healthcare revenue, technology, compliance and operational consulting
Independent Consultant 03/2008 - Current
Advice and work with clients on best practices, work flow, revenue cycle, coding, proper
documentation, and compliance
Provide ongoing CPT and ICD-9 education/training to providers, nursing and billing staff;
perform chart audits to ensure coding compliance.
Analyze current contracts and payor mix to maximize reimbursement.
Analyze provider credentialing, practice payroll and accounts payable
Analyze A/R management, reimbursement, revenue cycle, all insurance claims follow
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up, appeals on denied claims and patient collection processes.
Neurology Center of San Antonio, P.A.
Specialty Practice, 4 physicians
Practice Administrator 02/2006 03/2008
Supervised a staff of 15; set up buddy system for training; oversaw staff development,
problem resolution and performance evaluation.
Managed physician-owned infusion center with over $5 million in annual revenue.
Responsible for cash flow, revenue cycle processes and A/R management.
Responsible for provider credentialing, practice payroll and accounts payable.
Created employee handbook.
Texas Transplant Institute/Childrens Hospital Intensive Care Associates
Two 501a multi-specialty practices, 21 physicians
Physician Billing and Coding Manager 01/2005 02/2006
Supervised 12 billing and clinic staff, which included work allocation, orientation and
training, staff development, problem resolution and performance evaluation.
Responsible for turnkey revenue cycle management. Over $1.7 million in combined
monthly gross charges.
Internalized formerly outsourced billing process; managed transition phase and
implementation of three new practice management systems. Created new billing
department; responsible for all staff hiring and training.
Developed, implemented and maintained CPT and ICD-9 coding orientation manuals for
physician staff at both specialty groups. Conducted education/training on E&M, surgical,
and anesthesia services; performed chart audits to ensure coding compliance.
Routinely monitored and investigated the impact of coding on insurance reimbursement.
Supervised other coders to ensure accuracy and compliance.
Maintained inpatient and outpatient fee sheets for cardiologists, pediatric neurosurgeon,
pediatric anesthesiologists, pediatric intensivists, and bone marrow and solid organ
transplant physicians.
Community Medicine Associates/University Health System
Multi-specialty practice, 49 primary care providers, 7 locations, 3 acute care clinics
Coding and Reimbursement Manager 09/2001
12/2004
Supervised ten billing staff members. Assisted in supervision of 34 front desk staff at all
seven clinic sites.
Responsible for cash flow, revenue cycle processes and A/R management. Average
monthly billed charges exceeded 1.5 million dollars.
Responsible for billing and collections department budget of $500,000.00
Developed, implemented and maintained coding orientation manual for new providers;
provided ongoing CPT and ICD-9 training to providers, nursing and billing staff.
Developed, implemented and maintained front desk operation manual.
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Maintained all dictionary information within the Allscripts prescription and charge entry
system.
Maintained fee schedules in IDX for third party payors; created patient statement in IDX.
Pediatric Orthopedic Associates
5 Pediatric Orthopedic Surgeons
Business Manager 04/2000 09/2001
Supervised 11 employees which included billing/collections, front desk, referral
coordinators and customer service staff.
Responsible for revenue cycle process from charge capture to appeals.
Monitored physician surgical CPT and ICD-9 coding prior to billing to optimize
reimbursement and ensure coding compliance.
Maintained CPT and ICD-9 coding dictionary in practice management software (MEDIC).
Developed information grid for use by physicians to ensure CPT/ICD-9 compatibility and
compliance with Correct Coding Initiative, to prevent unbundling errors, up-coding,
down-coding and other billing errors.
Other Healthcare Experience:
Operations Manager MB Systems TPA 1997 2000
Auditor/Quality Control Manager PacifiCare 1996 1997
Billing/Insurance Manager Cardiovascular Associates of S.A. 1996 1996
Claims Processor Administrative Services Consultants 1995 1996
Senior Claims Analyst/Auditor Aetna Health Plans 1990 1995
Application/Scoring Coordinator The Psychological Corporation 1986 1989
Statistics Analyst Primefax 1984 1986
Unit Secretary Medical Center Hospital 1980 1983
Education: University of Texas at San Antonio 79 82
Certifications: Certified Professional Coder, AAPC (00088236)
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