Expert Details
Substance Use Disorders, Healthcare, Call Center Operations, Compliance, Quality Improvement, Strategic Planning, Mail Order, and Healthcare
ID: 724726
Oregon, USA
Expert is a results-oriented, tested “C” class executive with extensive experience at driving the strategic direction and enhancing the operational functioning of organizations. Reputation for serving as the executive point of contact for all stakeholders, recommending data-driven change strategies, and establishing global leader status for start-up and well-established companies. Known also for aligning business activities with organizational vision and mission, maintaining cross-functional workplace cultures, and exerting a positive, engaging leadership style that generates levels of accountability and motivation required to increase revenue, contain costs, and drive sustained business profitability.
Listed below some of Expert's notable transferable skills.
● Develops and implements strategic initiatives designed to enhance company strengths, eliminate operational weaknesses, exploit marketplace opportunities, and respond to external challenges that threaten the achievement of company objectives.
● Leverages business acumen, technological insight, and interpersonal savviness to develop sound, data-driven strategies that address operational challenges before they actually take place, and optimize financial resources to drive sustained business growth.
● Collaborates with cross-functional teams to develop financial forecast models that reflect company capabilities and marketplace realities, and ensure alignment between business objectives and company vision and mission.
● Fosters workplace cultures that promote continuous improvement and encourage accountability, inclusion, mutual respect, and collaboration.
It is important to note that he possess a proven track record of leading teams responsible for strategic non-profit and public organizations in the areas of planning, policy development, contract negotiations, labor management, fund development, wellness community relations, and meeting all applicable rules, policies, and ethical standards. Expert's highlights are, but not limited to; strong management and administrative skills, solid understanding of finance and operations, and his ability to apply strategy, tactical planning methods, and entrepreneurship to develop organizations. He is especially proud of his reputation as being a leader who maintains a deep commitment to company values, possesses exceptional communication and strategic thinking skills, and who always keeps the client/customer/patient health and safety “top of mind.”
Areas of Expertise:
● Organization Leadership
● Strategic Initiatives
● Process Improvement
● Profit / Loss Management
● Business Growth
● Contract Negotiations
● Budget Management
● Organization Turnarounds
● Operational Systems
● Risk Mitigation
● Team Leadership
● Change Management
CAREER HIGHLIGHTS
Worked with an executive management team responsible for managing and operating wellness/healthcare centers and healthcare facilities in AZ, CA and FL with cumulative revenue in excess of $700M.
Responsible for managing all Health Care SIU (special investigations unit) payer audits and health plan enrollment payer contract negotiations.
Collaborated with an Audit Executive Committee, RCM and General Counsel to ensure compliance with all policies and procedures, and accomplishment of targeted company objectives.
Raised millions for a NEWCO startup, launched a private placement (PPM) and participated in a public offering on the OTC Markets.
Education
| Year | Degree | Subject | Institution |
|---|---|---|---|
| Year: 2001 | Degree: BA | Subject: Business Management | Institution: University of Phoenix |
| Year: 1979 | Degree: AS | Subject: Respiratory Care | Institution: Broward College |
Work History
| Years | Employer | Title | Department |
|---|---|---|---|
| Years: 2005 to Present | Employer: Undisclosed | Title: President & CEO | Department: C- Suite Executive |
Responsibilities:● SME in a variety of areas, including executive management, operations, strategic fiscal management, supply chain contracting, procurement, marketing, RCM - billing reimbursement, healthcare - wellness, telemedicine, business administration, and executive strategic planning and development.● Managed the development of unique products for senior and hospitality markets, wellness, medical supply – HME/DME, and retail markets. ● Retained to update companies’ policies and procedures to prepare, train and coach senior management through the health care accreditation process. ● Engaged as an SME to work with investors to facilitate a merger with three U.S. healthcare wellness HME companies in Kansas City and a Canadian VC group representing a Canadian pharmaceutical public company. ● Provided compliance guidance to clients with OIG, Federal and State regulatory agencies that were served with allegations of regulatory violations in lead generation, and payer billing practices, and national pharmacy violations that resulted in favorable decisions. ● Developed an dynamic 3-5 year financial pro-forma model designed to enhance, track, and provide real time projections, facilitate sales growth and cash – cost savings. |
|||
| Years | Employer | Title | Department |
| Years: 2008 to Present | Employer: Undisclosed | Title: Accreditation Surveyor – Consultant | Department: HME / DME |
Responsibilities:● Serving as a consultant specializing in Medicare home medical equipment and HME accreditation.● Ensured that Medical Supply – HME and related businesses developed and implemented comprehensive healthcare accreditation policies, education, standards, and programs. ● Served as peer reviewer in evaluating company operations, Medicare compliance, and patient care services. ● Developed a systematic approach for regulatory and operational patient care, equipment programs, Medicare – Medicaid chart reviews, and data analysis using best practice for business operations. ● Utilized evidence-based health care data analysis and evaluation for operational improvement reporting mechanisms. ● Developed program reviews to help accredit entities for State programs, private payers and Centers for Medicare and Medicaid (CMS) approval. |
|||
| Years | Employer | Title | Department |
| Years: 2017 to 2020 | Employer: Hippocrates Wellness Institute - Consultant | Title: COO/General Manager | Department: Executive Management |
Responsibilities:● Coached management through staff empowerment and successfully turned a running $6M loss into a $900K YE profit.● Created plans to enhance the 50 acre, 20+ building property into a modernized institutional zoned not for profit campus international wellness institute. ● Outsourced numerous departments and services that resulted in a 50 FTE staff reduction and cost savings ~ $3-5M. ● Mitigated all high risk services and programs that resulted in outsourcing and/or successful settlement(s) of outstanding new DOH state investig |
|||
| Years | Employer | Title | Department |
| Years: 2016 to 2017 | Employer: Treatment Management Company | Title: Sr VP Administration | Department: Adminstration |
Responsibilities:● Reengineered via change management TMC’s national enrollment Operation/Payer – RCM processes.● Rebuilt TMC’s medical records – HIM document acquisition department(s), developed a national payer matrix, which included KPI’s and QA benching for compliance monitoring. ● Created a clinical staff peer review process and KPI reporting program for medical and clinical staff to ensure regulatory compliance and safe harbor for the organization. ● Served as the primary executive for all SIU (special investigations unit) payer audits and health plan enrollment payer contract negotiations. |
|||
| Years | Employer | Title | Department |
| Years: 2014 to 2016 | Employer: Coastal Detox | Title: COO | Department: Adminstration |
Responsibilities:● Served as COO SME to assist in the development and growth of a new recovery SUD Company.● Worked side-by-side with owners and investors to build infrastructures for multiple locations and implement all operating policies for FL DOH, DCF and Joint Commission Accreditation. ● Transitioned the company from utilizing outside billing services to building an in-house billing department with payer enrollment, RCM and KPI internal controls. ● Ensured compliance across the county, state and federal billing and clinical spectrums of care. ● Worked with owners to design architectural plans that lead to the building and opening of a new 40 bed medical detox center (Coastal Detox) that included design modifications, county permits, licenses for DCF, EMR installation and training, Joint Commission, policy implementations, and staff recruitments. ● Worked with the State Board of Pharmacy, DEA, SAMHSA, and numerous other regulatory agencies to gain certificate of occupancy for an inpatient medical – pharmacy treatment center. Upon completion of both projects, Expert returned to hisconsulting practice and joined Treatment Management Company. |
|||
| Years | Employer | Title | Department |
| Years: 2007 to 2015 | Employer: Connectyx Holdings (CTYX) | Title: Chief Executive Officer - Cofounder | Department: Administration |
Responsibilities:● Raised $6M in startup capital to form a NEWCO that resulted in the purchase of a public shell company traded on the OTC Markets (CTYX).● Created and developed a national cloud-based SAS Private Payer and Medicare Part B RCM Payer ERA Compliance – Denial management product (MRN Manager©). ● Developed unique products for billing RCM markets, wellness, and medical supply and physician markets. Spearheaded the formation of a networking consultant group of healthcare, technology and wellness companies that marketed their products and services under the CTYX – Connectyx brand. ● Developed a telemedicine program that was instrumental in launching a USA medical monitoring company that specialized in PERS and personal emergency response systems. ● Pioneered CTYX‘s national I.C.E. (In Case of Emergency) marketing program combining telemedicine and Medflash® as one of the first interactive PERS – ICE nationwide programs. ● Acquired Medflash, an early stage PHR (personal health record). Led the technology team resulting in re-engineering a national cloud based program that was marketed and sold by Walgreens, Fred Myers and other national big box stores. |
|||
| Years | Employer | Title | Department |
| Years: 2014 to 201 | Employer: Just Believe Recovery Centers | Title: COO - Compliance Officer - HR Director | Department: Administration |
Responsibilities:● Implemented an infrastructure for health insurance payer medical billing and a regulatory PI – QI department.● Developed policies related to DCF and Joint Commission Accreditation, and developed and launched a 250-bed recovery-based hospital in Carbondale, PA. ● Transitioned company from outside billing services to an in-house billing department with RCM and KPI internal controls to ensure compliance across the private payer billing and clinical spectrums of care. ● Updated and implemented in-house cloud based staff training programs and HR policies. ● Reduced staff turnover by providing ongoing training, education, and professional development opportunities. |
|||
| Years | Employer | Title | Department |
| Years: 1998 to 2007 | Employer: Liberator Medical Supply | Title: COO | Department: Administration |
Responsibilities:● Served as a healthcare COO/SME to assist in the development and growth of a newco - Medicare mail order medical supply HME Company.● Collaborated with the owner to implement an infrastructure for marketing, RCM, call center, mail order fulfillment program, operating policies, and senior healthcare and mobility products. ● Assisted the senior management team to maintain compliance with all Medicare and Medicaid payer regulations. ● Responsible for marketing, payer billing, and RCM management, compliance and billing, purchasing, supply contracts staff training, regulatory audits, and implementing and updating the company’s web base HME product portal. ● Worked directly with industry manufacturers to negotiate long term contracts that included rebates and shared marketing programs. ● Collaborated with the Owner and CFO to create long term models for market forecasts and budgets related to the HME business markets. |
|||
Government Experience
| Years | Agency | Role | Description |
|---|---|---|---|
| Years: 2008 to Present | Agency: Medicare Part B | Role: Medical Supply HME/DME Auditor | Description: He was a surveyor for ACHC whom has deeming authority with CMS to audit Medicare Part B Medical Suppliers |
Career Accomplishments
| Licenses / Certifications |
|---|
| Registered Respiratory therapist - RRT Results-oriented, tested “C” class executive with extensive experience at driving the strategic direction and enhancing the operational functioning of organizations. Reputation for serving as the executive point of contact for all stakeholders, recommending data-driven change strategies, and establishing global leader status for start-up and well-established companies. Known also for aligning business activities with organizational vision and mission, maintaining cross-functional workplace cultures, and exerting a positive, engaging leadership style that generates levels of accountability and motivation required to increase revenue, contain costs, and drive sustained business profitability. Areas of Expertise: ● Organization Leadership ● Strategic Initiatives ● Process Improvement ● Profit / Loss Management ● Business Growth ● Contract Negotiations ● Budget Management ● Organization Turnarounds ● Operational Systems ● Risk Mitigation ● Team Leadership ● Change Management CAREER HIGHLIGHTS Worked with an executive management team responsible for managing and operating wellness/healthcare centers and healthcare facilities in AZ, CA and FL with cumulative revenue in excess of $700M. Responsible for managing all Health Care SIU (special investigations unit) payer audits and health plan enrollment payer contract negotiations. Collaborated with an Audit Executive Committee, RCM and General Counsel to ensure compliance with all policies and procedures, and accomplishment of targeted company objectives. Raised millions for a NEWCO startup, launched a private placement (PPM) and participated in a public offering on the OTC Markets. |
Fields of Expertise
executive management, business development, business management, project management, operations management, business analysis, business process management, quality assurance, auditing, call center operation development, durable medical equipment, ehealth, electronic medical record, health care, medical equipment marketing, medical reimbursement, Medicare fraud, substance abuse, technology operations management, compliance, process engineering, leadership, business startup, medicare abuse, health care call center, health care management, Medicare, stock option, health care quality assurance, financial modeling, corporate finance, medical billing, initial public offering, telemedicine, business, business plan, e-business strategic planning, business strategy, business operations, customer management system, team building, medical device inspection, medical oxygen concentrator, medical computer system, benchmark, medical database, health care industry quality management, wheelchair, medical record, disposable medical device, corporate strategic planning, home health care, interactive patient-record system, quality management, medical equipment, management decision-making, health care system, health assessment, catheter, business process re-engineering, executive recruiting, business strategy review, Mergers & Acquisitions, staffing analysis, Continual Improvement