Experienced and Enthusiastic Health Care Manager

Disciplined and Aggressive ◊ Productive Project Manager ◊ Effective Communicator

Nationally Renowned Technical Expertise ◊ Networking and Relationship Building

Profile :  Visionary and goal-oriented health care manager with over 17 years experience in the health care industry looking for new challenges and opportunities.  Proven success in policy development and implementation, monitoring and oversight of health care operations, and product and project management.

  • Developed and implemented corporate compliance programs for both facility and large physician practices, as well as a research institution
  • Managed profit and loss for multi million dollar budgets
  • Nationally celebrated expert speaker on health care coding and compliance issues

Work History

Work History

Institutional Compliance Officer

Responsible to oversee University Hospital and its Faculty Practice Plans' compliance with all federal and state laws and regulations and third party payer guidelines on behalf of the Institutional governing body. Provided critical leadership to the Hospital and Faculty Practice Plan compliance functions and Hospital and physician practice staff and served as an integral part of the Hospital senior management team. Served as an expert HIM and compliance resource for all Upstate staff. Coordinated and tenaciously conducted investigations to resolve compliance issues

Key Achievements:

  • Responsible for development and implementation of a complete hospital compliance plan, pursuant to guidance from the DHHS Office of Inspector General
  • Created and implemented an innovative approach to health care compliance auditing and monitoring at Upstate
  • Developed and facilitated multiple adaptive training programs for faculty physicians, interns and residents, practice administration, audit professionals, and other Upstate staff
  • Managed development and implementation of multiple policies related to compliance, coding and billing for Faculty Practice Plan
  • Managed development of hospital administrative policies designed to promote ethical and compliant operations
  • Worked with Institutional Privacy Administrator and Chief Information Officer to assure compliance with HIPAA regulations
Jan 2002 - Present

President/Principal Consultant


Responsible for the top to bottom operation of a small health care compliance consulting firm.  Regular projects include compliance gap analyses, compliance effectiveness surveys, compliance program development, HIPAA compliance risk analyses and monitoring, research compliance reviews and monitoring, medical record auditing, educational activities for providers and health care staff, and other various activities.

Key Achievements:

  • Perform regular educational workshops for major coding accreditation body
  • Developed compliance auditing and monitoring work plan for community hospital, and assisted with performing pieces of that work plan, such as E&M auditing and facility ED auditing
  • Developed education plans for corporate compliance training, provider coding education, as well as HIPAA privacy campaign to increase HIPAA compliance effectiveness.  Performed training following these program plans
  • Managed a RAC Audit appeal program for an academic medical center, winning 85% of the first level CMS appeals in the amount of $875,000 
2006 - 2008

Director of Compliance and Risk Management

Binghamton University

Responsible to oversee Binghamton University compliance with all federal and state laws and regulations, SUNY and Research Foundation policies and procedures, and Internal Control guidelines on behalf of the Senior Staff of the Institution.  Manage multifunctional staff and oversee compliance functions related to environmental health and safety, internal controls, and research, including human subjects, animal welfare, and export controls. 

Key Achievements:

  • Developed Office of Compliance and Risk Management, a new function at BU
  • Produced and implemented a Quality Assurance program for Human Subjects research at BU, as well as a significant expansion of the Human Subjects Office
  • Serve as a subject matter expert for Institutional Review Board, Institutional Animal Care and Use Committee, Institutional Biosafety Committee, Radiation Safety Committee, Lab Safety Committee, and other similar groups on campus
  • Function as the HIPAA Officer for the Binghamton University campus
  • Act as a liaison between Campus administration and the Research division on matters of compliance
  • Developed and managed training programs on compliance across the entire campus
2002 - 2006

Manager of Product Development/Clinical Techincal Editor

Ingenix, Inc

Execute and direct operations for new product development of Ingenix branded electronic services and print publications in the hospital/institutional market.  Responsible for new product development process from ideation through delivery to customer.  Previously served as Clinical Technical Editor for Ingenix, as well as within the Six Sigma program for quality improvement.

Key Achievements:

  • In 2005, presented more than 25 new product concepts, and developed over 15 new products on time and on budget for use in hospitals and physician practices
  • Managed writing and editing duties for a wide array of Ingenix publications
  • Provided state of the art coding, compliance, and reimbursement expertise to Ingenix, as well as outside professional organizations through national speaking engagements
1999 - 2000

Financial Analyst

Our Lady of Lourdes Memorial Hospital

Responsibilities included preparation of Medicare cost reports and associated documentation, budget development and negotiation with hospital functional departments, and finance interface with the business office/patient financial services division.

Key Achievements

  • Negotiated and administered all third party payer contracts for the facility
  • Provided extensive decision and compliance support for the Chief Financial Officer/Corporate Responsibility Officer
  • Developed and implemented an innovative audit program for payer contract compliance
  • Acted as a liaison between senior management, our Management Services Organization, and the Business Office
1992 - 1999

Medical Claims Specialist


Provided excellence in leadership and mentoring for medical and dental claims staff.  Analyzed and adjudicated medical and dental insurance claims and coordinated health benefits with multiple insurers. Responded promptly and accurately to participant inquiries on claims and plan benefits. Maintained and strengthened prudent business relationships with clients and health care providers by providing superior customer service.

Key Achievements

  • Coordinated and facilitated all in-service training and represented SIEBA, LTD. at external training functions
  • Acted as Provider Relations representative for the SIEBA Preferred Network, providing advice and assistance to facilities and professional offices on a regular basis
  • Created and implemented new guidelines for completion of enrollment
  • Designed training program to educate clients on proper enrollment techniques