Revenue Cycle Operations Consultant and Interim Director

Claudia J. Groenevelt ad9mmq@r.postjobfree.com Atlanta, GA

HEALTHCARE REVENUE CYCLE EXECUTIVE, MBA, CRCR

Committed to Operational Transformation, Decisive Leadership, and Performance Excellence

DIRECTOR PRINCIPAL SR DIRECTOR SR. ANALYST or related opportunity that leverages 30 years of outstanding leadership and achievement, delivering creative operational, system, and financial solutions to manage revenue cycle operations and P&L responsibilities effectively. Expertise includes:

Entrepreneur and owner of successful revenue cycle management (RCM) consulting company, merged 16 years later with a large CPA firm, wrote all proposals after identifying client needs, sold and completed all engagements, prepared reports, and assisted in the implementation of recommendations and opportunities

Subject matter expert in RCM operations for all providers in the continuum of care

Director/VP Interim Management for all categories of providers for up to three years

Exceeded targets and client expectations in high-change and competitive environments, participative leadership style focused on continuous process improvement, goal achievement, and cross-functional collaboration, driving team and individual results

Denials management leader and trainer, development of custom KPIs (establishing reporting to monitor accountability and productivity)

Systems Shortlist: Meditech (Magic and 6.15), Cerner, Soarian Clinicals and Financials, HDX, SSI Group, IDX, NextGen, EPIC (limited), eClinicalWorks, CPSI, McKesson (now Change Healthcare), InterQual, Allscripts, Change Healthcare, 3M, patient tracking systems, HEDIS, Advisory Board Analytics, Relay Health, CD-9, ICD-10, CPT, Corridor, Zirmed, HomeCare/HomeBase, SSO, Waystar, eSolutions, AOD, Harmony, PointClickCare, ADL, AccuMed, McKesson Homecare, Medent, and MedAssets

Lecturer, Revenue Cycle Management, MS Healthcare Management program, Simon Business School, University of Rochester, HFMA Article Reviewer

CORE COMPETENCIES

Change Leadership Continuous Process & Quality Improvement Denials Management

Coding, DRG, APC, APG Provider and Payor Relations HIPAA & Compliance

Root Cause Analysis Federal & 3RD Party Regulations P&L/Budget Management

Client-facing Consultant Remote Management Utilization Review

RCM & Customer Service Training Data-driven decision-making Staff Mentor

PROFESSIONAL EXPERIENCE

NATIONAL DIRECTOR OF ELIGIBILITY AND AUTHORIZATIONS (E&A) KINDRED AT HOME 10 MONTHS

Responsible for obtaining all eligibility and authorizations for Kindred at Home (KAH), with over 120 staff at two locations, 473 branches, $1.6 billion in annual revenue, and 255,000 admissions annually.

Accomplishments

Reduced eligibility and authorization workflow by half

Automated re-enrollment process for the first time, saving hundreds of thousands of dollars in temporary staff fees

Developed metrics tied to performance (also for the first time at KAH)

Revised all policies and procedures for KAH, including branch responsibilities

Developed a methodology to determine the staff required based on workflow stages and admissions

Worked with a vendor to automate all insurance verifications as soon as a patient was entered into the system and integrated with HomeCare/HomeBase (HCHB) by populating the financial fields automatically, improving accuracy and reducing the need for more staff as volume increases

INDEPENDENT CONSULTANT INTERIM VICE PRESIDENT/SR. DIRECTOR REVENUE CYCLE 8 YEARS

Provided interim management services for 20 years and other RCM services, offering interim management as an interim revenue cycle leader from 2015 to March 2021 and from January 2022 to the present. Examples below:

Scope of Work: Over 400 reports, 12 direct reports, net patient revenue of $2 billion, 600+ physicians, 1,500+ acute care beds, >30+ offsite clinics, 390 bed SNF, CAH, home care, trauma center, and off-shore data entry.

Leadership and Team Building: Reduced the number of outstanding or incomplete pre-authorizations from 1,800+ to 300+ in three months for a large home care agency, resulting in a one-time cash flow infusion and ongoing faster claim turnaround. Built a team transformed through education, new policies, procedures, reassignments, and encouragement. Met with top payors weekly until the backlog was resolved.

Claudia J. Groenevelt

Denials Management: $7.5 million collected on resubmission of denied ED professional claims resulting from a system interface issue for

a mid-size academic hospital. Worked with payors to resubmit 7,500 claims for the past 18 months.

Analytical Ability and Collaboration: Realized a 32% reduction in unbilled (DNFB) after identifying and resolving interface and system hold issues, working with HIM, case management, nursing, physicians, and IT.

Subject Matter Expert: Identified 42% of charity care claims classified incorrectly. Developed allowances for charity care and bad debt, established new policies, procedures, dashboards, estimated reserves by payor and plan, and educated all finance staff.

PRINCIPAL/DIRECTOR BONADIO RECEIVABLES SOLUTIONS, LLC 2006-2014

Provided outsourced billing services to physician practices, hospitals, and clinics. Expert witness regarding third-party payor regulations and compliance. Full P&L responsibility. Conducted over 150 operations reviews of all functional areas of the revenue cycle from ED/referral/patient access to discharge and final payment, improving scheduling, coding, billing, collections, and third-party follow-up. Conducted hundreds of cash recoveries and collected millions of dollars for clients by educating staff in effective claims follow-up, identifying process weaknesses, cross-training, and implementing recommended changes to systems and operations. Offered interim management services for hospitals and medical practices in a VP Revenue Cycle capacity for up to three years. Educated patient access staff in appropriate interactions with patients and customer service.

Accomplishments:

Assisted a large academic medical center in preparation for conversion, beginning eight months before go-live, reduced the number of accounts on the aging by 41%, resulting in a significant improvement in cash flow and fewer accounts to convert to the new system

Evaluated the entire revenue cycle process and provided cash recovery services to a medium-sized specialty group that resulted in additional income of $3M in the first year (many more conducted with significant cash collections)

Identified unbilled services for a mid-size hospital that led to a revenue increase of $4.5 million

PRINCIPAL/OWNER GROENEVELT CONSULTING, INC 1990-2006

Responsible for the launch and operation of my own innovative consulting company specializing in revenue cycle management and process improvement for healthcare providers. Built trusting, long-term relationships with healthcare providers and payors and developed new service offerings for a full range of billing, performance improvement, productivity, and educational services. Worked with payors to resubmit untimely claims in mass appeals. Provided outsourced billing services to medical practices and clinics.

Accomplishments:

Marketed, sold, and provided services to physician practices, clinics, hospitals, home care agencies, nursing homes, DME suppliers, and transportation services

Developed multiple consulting services: operations review, a unique approach to cash recovery, interim management, audit of claims quality, potential fraud, internal controls, and data entry

Earned an outstanding reputation statewide, leading to an offer to merge with The Bonadio Group, a Top 50 CPA firm nationally

Other Experience – KPMG: Director of Patient Accounting Services for the NE US

University of Rochester Medical Center – Service administrator, Dept of Pediatrics

EDUCATIONAL & OTHER BACKGROUND INFORMATION

THE UNIVERSITY OF ROCHESTER, Rochester, NY

Master of Business Administration, Simon Executive Program

Bachelor of Science, Sociology

Honors: Selected for full sponsorship for the Simon Executive MBA full-time program by the University of Rochester Medical Center, completed BS and MBA in six years while also working full-time as an administrator.

CRCR: HFMA Certified Revenue Cycle Representative 2018

Healthcare Financial Management Association Medical Group Management Association Billing Advocate Volunteer

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