Experience

Remedy Billing

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Chief Executive Officer

  • Jan 2019 - Present



Inspira Financial

• United States
• Financial Services
• 1 - 100 Employee

• Direction of Utilization Review & Benefits

  • Jan 2017 - Jan 2019

  • Ensure consistent data collection from the staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting to meet external requirements• Provide analysis and reports of significant trends, patterns, and impacts to resources.• Manage with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary• Supervise a staff of RN Case Managers, Discharge Planners, Social Workers, and other support staff• Ensure benefits are being obtained accurately and accordingly within a timely manner• Identify opportunities for process improvements necessary to facilitate department functions• Educate staff as necessary to ensure consistent performance and adhere to standards• Supervise the daily office operations such as coaching, discipline, payroll, scheduling, and other HR related activities• Ensures the Utilization Review Department completes all Initial, Concurrent, Peer Reviews, Expedited Appeals Reviews, and Retrospective reviews in a timely manner to ensure continuous coverage.• Educate staff on Clinical Information and Knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff and healthcare partners• Salesforce beginning knowledge in coding, developing work flow rules and processes to capture the most accurate data• Salesforce knowledge of developing reports and dashboards so we may capture current and historical analytics Show less

• Utilization Review Supervisor

  • Oct 2016 - Jan 2017

  • Manage all new accounts related to Utilization Review to ensure a smooth transitional process for the first 6 months.• Manage and monitor both Initial & concurrent reviews to ensure that the patient and facility are getting the right care in a timely and cost-effective manner.• Collaborate with Clinicians daily to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources• Tripled Facilities bill charges on multiple occasions by obtaining the longest lengths of stay in the nation. Show less