Principal Clinical Analysis Consultant - Machinify
(2026-01)
- Responsible for the design and deployment of nSight Formulas
- Able to continue with a 92% accuracy rate working with OCR
- Able to write multitiered Formulas that provide avenues to match a claim that has the appropriate clinical indicators or not
VP Clinical Analyst / Principal Clinical Analysis Consultant - Performant
(2024-04 - 2025-12)
- Responsible for the design and deployment of nSight Formulas
- Created a catalogue of seventy-eight formulas
- No finding formulas: matching claims that meet the clinical indicators for a condition
- Finding formulas illuminate claims that match claims that do not meet the clinical indicators for a condition
- Accuracy rate 92%
VP of Clinical Knowledge & Analytics - RecordsOne
(2019-06 - 2024-03)
Clinical SME for a Revenue Cycle Software Company.
- Responsibilities included: client relationships (CHI, Wise Health, and Medovent)
- 2022 more involved in sales and marketing
- Designed and implemented new reporting for CDI & Coding (Dashboards and table reports)
- Designed the BPCI, Case Management and OP CDI modules
- R & D
- Part of the implementation process when the modules went live
- Oversight of all the nSight Formulas including design, build, test and update
- Oversight of new features for the UI including the 'Pull List' which is a formula based analytic tool. This tool created the opportunity to analyze a large volume of data in a very efficient manner
Managing Partner - HQM Consulting
(2013 - 2019)
National consulting firm working with healthcare system's revenue cycle and quality programs. Building an atmosphere of trust and collaboration to achieve optimal clinical quality outcomes.
Interim System Director Clinical Documentation Improvement - MEDSTAR HEALTH CARE System - Maryland, Virginia, and Washington, D.C.
(2018-03 - 2018-11)
Nine hospital healthcare system. Assignment ended.
- Corporate oversight for 3m360 adoption & implementation
- Corporate oversight into the design and implementation of policies that address System(s) Disruption of Service (EMR & CDI Software)
- Corporate oversite and design of concurrent QA/Safety program
- Provided definitions for 'No Harm Error,' 'Mild /Adverse Outcome' 'Hazardous Conditions,' 'Near Miss' and Sentinel Events'
- Designed a process to review targeted PSIs, HACs, and 'Serious Event Reports' that included a multi-disciplinary team
- Corporate engagement to improve staff's productivity working within the EMR software
- Made recommendations to implement policies & procedures to modify 'copy & paste within the EMR software
- Design & implement new CDI Corporate Structure: Align nine facilities under central corporate management (deploy locally)
- Designed QA CDI Program
- Designed expansion Outpatient CDI
- Designed expansion Pediatrics/NICU CDI
CDI Consulting Manager - CCM CONSULTING - Provident St-Joseph in Lubbock, Texas
(2017-12 - 2018-03)
St. Joseph Health System range of services across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington through a diverse family of Catholic, other faith-based and mission-driven secular organizations. Contract completed.
- Assess and audit the Texas organization's accuracy and workflows (as well as in California)
- Provide a road map for process improvements
- Implemented a concurrent QA/Safety reporting process including policies and procedures
- Implemented QA CDI Team
- Design Concurrent CDI Program
- Provide leadership to the implementation of new software (Iodine)
- Provide a roadmap to successfully move all CDI education internally for the entire healthcare system
- Corporate oversight of expansion of the 'Iodine' software: pilot software in TX
Interim Sr. Director of Clinical Documentation - FIRST STRING CONSULTING - San Diego, CA
(2017-08 - 2017-12)
Texas Health Resources provides care in most North Texas communities through the 24-hospital health system. Contract completed.
- Assess and Audited workflows for the health system's CDI program
- Assess current CDI /Coding software and make recommendations to adopt 'Optum 360'
- Design concurrent QA/Safety Program
- Provided an Executive Summary to the VP of RCM & CEO of the organization that included: Provided a roadmap for the program to move from $12M to $105M in two years
- Designed Education program for new and current staff
- Designed a system wide Educational Program for Physicians
- Designed and implemented the corporate QA/Patient Safety reporting process to include a multidisciplinary team
- Implemented an automated safety reporting process
- Implemented a process that targeted certain PSIs, Mortality, HACs and 'Serious Events Reports'
- Database audit with recommendations for replacement/and or improvement
- Set new metrics for under-performing teams
- Divided staff into two teams with a manager
- Created an Educational manager
- On board new Sr. Director
Interim CDI Consulting Manager - M*MODAL
(2017-02 - 2017-06)
Cloud-based clinical documentation solution for speech recognition, medical transcription, and CDI solutions. Contract completed.
- Designed and implemented a CDI Program to bridge a paper process to M*Modal's automation (Alameda Health System, Oakland Ca.)
- Designed & implemented concurrent QA/Safety program
- Targeted Decubitus Ulcers (extremely high incidence)
- Provided an educational program for the staff nurses & providers to become wound certified
- Worked with CMS to ensure wounds acquired during hospitalization were accurately reported
- Provided an audit program to ensure the program was compliant
- Policies and Procedures: Provided a manual process to bridge to technology (provided oversight with implementation of Sorian EMR & MModal CDI software)
- First month metrics: $330,000
Interim Director CDI Consulting/Assessment Services - Oxford HIM - San Diego, CA
(2016-08 - 2017-02)
Years of recruiting experience and specializing in fields where superior resource solutions are most in demand. Contract completed.
- Inpatient QA/Safety Program
- Outpatient (physician practice to outpatient services within the inpatient setting)
- Designed updated ICD 10 Training for new and experienced CDI Specialist in the Inpatient setting
- Designed an Outpatient Training program for CDI Specialist new to Outpatient Services
- Designed a Root Cause Analysis Process for PSIs, HACs, and 'Serious Event Reports'
- Designed a Quality Metric Dashboard
- Designed a CDI metrics Dashboard
Educator Consultant - ROI/LANGELY CODING CONSULTING - Baltimore, MD
(2016-07 - 2016-07)
ICD 10 Boot camp
Interim Director of CDI - THE ADVISORY BOARD CONSULTING - Maui Memorial Hospital
(2015-04 - 2016-06)
Consulting firm specializes in the Educational and Healthcare sectors providing long-term approaches to enhance performance. Contract completed.
- Implemented a successful CDI program employing a manual process
- Hired and trained three CDI RN's
- Developed and implemented policy and procedures for the CDI process
- Implemented con-concurrent & retrospective Query Process
- Designed & implemented QA/Safety program
- Implemented a PSI, HAC, and Mortality review team
- Implemented a concurrent Safety Review process
- Implemented the reconciliation process between coding & CDI
- Data analysis for: Risk Adjustment, DRG assignment & Medicare Compliance
- Implemented a plan to address the challenges of the query process ROI on target to exceed the conservative projection of three million
- Actively participated in selling an additional contract and extending the CDI Director contract
- Provided oversight with implementation of Sorian EMR
Revenue Cycle Consultant - MARICOPA INTEGRATED HEALTH SYSTEM - Phoenix, AZ
(2014-01 - 2015-01)
- Completed an assessment of the documentation and reimbursements of the inpatient population in Behavioral Health
- Developed a strategy to capture the SOI and ROM along with developing a strategy to petition the state of AZ for increased reimbursement for the Medicaid population that generated $20 million increase to Maricopa's bottom line
- Assisted CFO in contract negotiations with the contracted physician group that staff the twelve outpatient clinics in and around Phoenix: Uncovered a 30% no show rate of schedule appointments as an aside to the outcome of the analysis
- Data analysis for: Risk Adjustment, DRG assignment & Medicare compliance
- Defined the advantages of the new APR-DRG SOI/ROM classification to assess for query opportunities implemented in August of 2014
- Audited Emergency Room documentation developed and implemented a program to capture the acuity of the population admitted to the ER in real time
- ICD 10 Project Manager: Developed ICD 10 training tools for the Physician practices within the Maricopa health system
- Designed and implemented concurrent QA/Safety process
- Automated reporting process developed with Epic
- I worked with IT & Nursing / Medical Leadership to track targeted PSIs/HACs within the EPIC software
Clinical Documentation Consultant - ST. JOSEPH ORANGE - Pontiac, MI
(2013-11 - 2014-01)
- Reorganize and audit the Clinical Documentation Program
Clinical Documentation Specialist (Department of Surgery) - JOHNS HOPKINS HEALTH SYSTEM - Baltimore, MD
(2012-12 - 2013-11)
Out of nearly 4,700 hospitals reviewed, The Johns Hopkins Hospital ranked #1 in Maryland and #3 in the nation in U.S. News & World Report's 2018–19 Best Hospitals list. Thirteen specialties at The Johns Hopkins Hospital are now among the top ten in the nation. Ten specialties are in the top five.
- Increased Cardiac Surgery's CMI from 3.1 to 3.88 third quarter 2013
- Recovered $14 million, third quarter 2013
