Career Statement: Combined 17 years in healthcare as both a consultant and direc

tor with an emphasis in improving the bottom line and identifying trends and opp
ortunities for improvement in ethics and compliance. Most recently, managed pro
jects and audits at various medical facilities in part of a large group effort t
o improve account receivable days with payer and compliance to improve RAC defen
sibility. Unique perspective on past due claims based on the billing, paying, c
linical and compliance side in previous experiences. Extensive regulatory knowle
dge, including HIPAA, HITECH, SAUX, JCAHO, Medicaid, Medicare part A,B,E. Patien
t privacy and patient rights. Involvement regarding process improvement, system
improvements and integration of all allied and business office departments. Prev
iously a facility privacy officer and enjoyed working with all the people in the
facility to reach the resolution of issues and create useable policies and proc
edures for the future.
Hoping to take on a role where versatility and drive will add to the productivit
y of an already established company.
EXPERIENCE:
Texas Health Resources August 2010-
Senior Compliance Analyst
* Responsible for investigation of privacy issues at all Texas Health Resources
facilities.
* Privacy scorecard completion and and document management.
* Policy creation and revision based on HIPAA and HITECH
* Responsible for compliance functions as related to billing, physician contract
s, government audits and appeals.
* Charge master Standardization across the system.
Campbell Wilson/ Healthcare Services September 2007 - February 2010
Senior Consultant Dallas, Texas
* Helped create RAC STAT tracking tool.
* Wrote procedures for bringing new HMO Medicare clients on to the billing syste
m.
* Implemented member verification position descriptions and policies and procedu
res for member benefit verification.
* Consulted and managed projects and audits at various medical facilities that r
esulted in measurable improvement after implementation.
* I spent two years consulting for the Chargemaster standardization and complian
ce at Baylor Healthcare Systems. I wrote training manuals for charge reconciliat
ion for Baylor systems as well as created and implemented new charge tools and c
ompliance checker edits for Baylor All Saints Medical Center, Baylor Irving Medi
cal Center and Baylor Garland Medical Center.
* I Audited Observation charts for Lufkin Memorial Hospital and Nationwide Child
ren's Hospital of Columbus, Ohio to determine billing compliance and missed reve
nue opportunities. I also wrote and implemented policies and procedures for use
of InterQual criteria for both facilities.
* Reviewed Chargemaster data for Tomball Regional Hospital and Lufkin Memorial H
ospital for compliance and correct coding.
* I wrote the training manuals for Campbell Wilson Nurse Auditor team's for work
ers comp verification and appeals process and automated data tool for workers co
mp and managed care.
* Reviewed and flowed charging processes for THR Hospital formerly RHD.
* Worked with clients on to identify and r resolve any and all Sarbanes-Oxley re
d flags.
HCA-Medical Center of McKinney March 2001 - October 2007 Executive Dir
ector of Compliance and Case Management McKinney, Texas
* Managed two managers, six Social Workers, nine case Managers and four ancillar
y business staff.
* Responsible for executive on call and facility compliance.
* I was a member of the JCAHO preparedness and reporting team.
* I was responsible for overseeing Psych facility Social Workers, Case Managers
and facility court hearings. I also, served as the Psych and Acute Care HIM dire
ctor for six months.
* I was a member of the executive round table to determine future steps for the
facility. I was responsible for:
o Charge master standardization and Compliance, DRG physician scoring and educat
ion development
o InterQual case management criteria application to maintain appropriate length
of stay
o Corporate Integrity investigations, state reporting, defense audits and divisi
on office reports for financial issues related to length of stay
o Responsible for Ethics committee issues: patient end of life decisions, employ
ee ethics disputes, disruptive physician issues and Patient Bill of Rights oppor
tunities
o Maintained current government education regulation standards for EMTALA, Sarba
nes-Oxley, HIPAA, State Reporting, Billing Compliance and facility self reportin
g.
o Defended all audits by outside payers, with a proven success rate for positive
outcomes
o Managed inpatient rehab department RAC audit.
o Reporting to the Board of Directors on all facility ethics issues and resoluti
ons.

HCA Patient Account Services February 1998 - March 2001

Educator/Manager Las Colinas, Texas
* Managed the Patient Account services Education department.
* Helped set up and train all staff at the newly formed patient account services
center. I wrote training manuals on: Corporate Compliance, Ethical Responsibili
ty, Billing Compliance Patient Accounting, Managed Care Logging, Meditech system
usage for Patient Access, HIM, and Patient Accounting GL posting.
* I instructed face to face classroom based training on ethics and compliance as
it pertained to staff and physician disputes, billing compliance managed care l
ogging, patient accounting, OIG Compliance, billing integrity and on occasion nu
rse audit as well as remedial computer skills.
HCA Medical Center of Plano April 1990 - February 1998
Patient Access Director Plano, Texas
* Managed sixty eight (68) patient access staff at all points of entry into the
facility, as well as all of insurance verification
* I hired and educated all patient access staff. I was responsible for all the m
anaged care education, employee QA, and performance evaluations as well as maint
aining compliance in Meditech and all custom defined screens.
* In 1995 I built the dictionaries for Meditech and helped the facility go live.
* I Set up an up front collection process (including previous balances) that tot
aled over one million dollars a month when I was promoted to the position of edu
cator.

EDUCATION:
Ohio State University Columbus, Ohio
* Business
Bliss College Columbus, Ohio
* Associate Degree, Business administration

SKILLS:
Microsoft Visio Intermediate
Microsoft Excel Expert
Microsoft Word Expert
Microsoft PowerPoint Expert
Microsoft Access Intermediate
Meditech Expert
Eclypsis Beginner
Crystal Report Writer Beginner
3M Coder Intermediate
Compliance Checker Software Expert
InterQual Expert
Milliman Intermediate
Project Management within budget Expert
Rx Claim
PBM Analysis
SAUX Audit compliance Intermediate
Expert
Expert
Corporate Integrity Investigations and Resolutions Expert
Government Reporting Expert
Chargemaster Standardization Expert
Compliance and Chargemaster Audits Expert
CAREER HIGHLIGHTS
I created facility ethics reporting mechanisms to make sure all disputes were in
vestigated and resolved.
I managed and educated a large staff on compliance checker software, SOX, RAC an
d Billing Compliance.
I served as a Facility Privacy officer and dealt with unscheduled state auditors
, RAC notices, SOX audits and Federal Billing Compliance audits.
I created a charging process for a 380 bed hospital that brought the hospital fr
om a loss to a profit in three months.
I participated in helping a twelve hospital system go live on Meditech, by creat
ing dictionaries, education and custom reports.
I created a data base to compare physician length of stay with DRG length of sta
y, eventually providing a scoring mechanism and educational opportunities for Ph
ysicians, Case Mangers and discharge planners.
I Planned and opened a Care Decision Unit (CDU) to eliminate unnecessary Observa
tion hours.
I created a medical screening process (EMTALA Compliant) for Emergency Room pati
ents to determine non emergent patients that could be sent to a clinic or a phys
ician's office. The process lowered the Emergency Department wait time by 45 min
utes and eliminated 62% of the self pay non emergent patients.
I created a process for up front collection including past balances that helped
Patient Access Staff collect over a million dollars a month.