Intellex Acquires Expert by Big Village

We're thrilled to announce that Intellex has acquired Expert by Big Village, effective March 22, 2024. This strategic move enhances our capabilities and strengthens our commitment to delivering exceptional solutions to our customers.

Stay tuned for more updates on how this acquisition will benefit our clients and experts.

For inquiries or more information, please contact us at info@intellex.com.

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Expert Details

Healthcare Industry: Ecosystems and Data

ID: 732023 California, USA

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Expert brings over 20 years of healthcare industry experience encompassing acute care hospitals, ambulatory centers, health plans, and physician groups in the clinical, operational, financial, and technological realms of the continuum of care. Inasmuch, She has demonstrated the importance of the convergence of technology and the clinical and business perspectives of medicine.

As a senior healthcare professional with a unique blend of expertise, including acute care facilities, ambulatory centers, health plans, and physician groups encompassing the clinical, operational, financial, and technological perspectives of the healthcare industry, clinical practice protocols have been developed. Physician profiling report cards and revenue streams with national contract negotiations in managed care and group purchasing organizations have been created.

Expert aligned development in Healthcare REITs and Ambulatory Surgical Center in medical real estate, mastered due diligence with factoring receivables, created a start-up whose premise was revenue cycle management and clinical information systems. Expert aligned the clinical and business perspectives by developing clinical practice protocols at a 2000 physician IPA, negotiating contracts for a national PPM in the hospital-based physician arena; ER, Hospitalist, Anesthesiology, etc., developing a 500 Physician IPA with a national hospital system, which included conducting all managed care negotiations and revenue cycle management functions, and directing materials management in the acute care arena. Additionally, Expert created facilities' supply chain management/GPO relationships and implemented various software technologies in the acute, ambulatory, physician, and health plan arenas.

Notable Achievements:
- Managed the development of physician practices associated with a physician foundation/hospital system that provides primary and specialty medical care, research, and education. The Physician Foundation and medical groups comprise over 120 employed physicians and 175 providers.
- Negotiated hospital and physician contracts for an 11-physician Hematology/Oncology Group Practice with eight clinics and eight hospitals.
- Audited external billing and collection services.
- Advised management team at corporation providing nursing, hospital staffing, and temporary staffing services to hospitals. This corporation offers a unique insight into developing automated staffing solutions for per diem and traveling staff.
- Automated staffing solutions, saved time, increased productivity, and decreased costs associated with procuring and scheduling temporary healthcare staff. All the staffing processes were designed to meet or exceed JCAHO.
- Advisor for a global health care provider network, intended to foster cooperation and collaboration with providers worldwide. As a preferred provider organization (PPO), insurers and employers can access inspected and reviewed healthcare facilities and caring professionals worldwide. The PPO network allows medical tourists accessibility to the same rates, discounts, and fully-inclusive case rates negotiated by more extensive health plans.
- Advisor for ASP model start-up, whose business included a HIPAA/HL7 and PCI-compliant processing tool which verifies a patient’s insurance coverage, accurately calculates out-of-pocket costs and processes payments in one system and at the time of service. This model improves revenue cycle management.
- For 50 primary physician practices with ten sites, audited visit coding and reimbursement, including recommendations for strengthening visit revenue, coding, and collections, reviewed vendor applications for real-time adjudication of insurance benefits and allowances, and recommended the most comprehensive and comprehensive, and scalable solution.

Consultant with a firm whose specialty includes the following areas: compliance with federal and state laws and regulations, Accreditation ( URAC, NCQA, JCAHO), Quality Improvement, Patient Safety, Consumer privacy, and security (including HIPAA), employee training and development, liability insurance, Litigation, Integrating traditional medicine with complementary and alternative medicine.

Advisor and Consultant to financial banking investment firms on all areas of expertise in the healthcare industry with revenue cycle management. Advisor to a consulting firm specializing in EMR, EHR, e-prescribing, coding, billing, and patient portals. Assessments of physician practices were completed with recommendations implemented.

Expert was most recently the Chief Healthcare Informatics Officer at Hewlett Packard, bridging medicine's clinical and business perspectives in creating an analytics platform. Before HP, Expert’s career encompassed working for acute and ambulatory hospitals, Health Plans, and IPAs. Some entities she gained valuable experience at were Tenet, Humana, Emory Clinic, Blue Shield of California, Blue Cross Blue Shield of Georgia, Independent Health, and Cirrus Health. Expert’s knowledge of the healthcare ecosystem and expertise in healthcare data provides an innate ability to discern where problems exist. Exemplifies Expert’s expertise in performing Healthcare Analytics at the retrospective, real-time, predictive, and prescriptive realms. She has been responsible for creating clinical practice protocols and physician profiling report cards, negotiating national managed care contracts from all perspectives; both fee for service and shared risk methodologies, and presenting the holistic view of a patient incorporating data from Electronic Medical Records, Claims, Ancillary services, etc. to create a longitudinal analysis.

Expert has created a startup in the Revenue Cycle and Clinical Informatics space, incorporating Patient Scheduling, Eligibility Check, Transcription/Dictation, Billing, Coding & Claim Processing with 2 million edits determining payment, denial, or pending status by health plans nationally. She has extensive expertise with operational and financial perspectives encompassing negotiation, implementation, and analysis of national managed care contracts and supply chain GPO contracts from the payer, physician, and hospital perspectives. She has created Joint Venture projects encompassing Ambulatory Surgical Centers, Surgical Hospitals, and Medical Office Buildings. Additionally, Expert is well versed in the Hospital Based Physician arena encompassing Hospitalists, Emergency rooms, Anesthesiologists, Pathologists, etc., by creating physician networks and managed care divisions for these entities.

Education

Year Degree Subject Institution
Year: 2014 Degree: M.S Subject: Epidemiology Institution: SUNY Buffalo, School of Medicine
Year: 2000 Degree: Bachelor of Arts Subject: Political Science Institution: State University of New York- Buffalo

Work History

Years Employer Title Department
Years: 2010 to 2014 Employer: Hewlett Packard Title: Chief Healthcare Informatics Officer Department:
Responsibilities:
• Report to several VPs, Developed framework of healthcare analytics platform which encompassed quality improvement, outcomes analysis, patient safety, operational analytics, clinical informatics, physician performance, and regulatory compliance monitoring for health plans, hospitals and physicians. This model was based on the IDOL 10 platform utilizing Vertica and Autonomy which would incorporate structured and unstructured data from disparate sources of data from the entire continuum of care.
• Manage team of developers, engineers, analysts and clinical personnel for creation of healthcare analytics platform for payers and providers
• Create Use Cases, Proofs of Concept (POC) utilizing Autonomy; CHF predictive models for readmissions, Claims integrity including Fraud and Abuse, Clinical Analytics and Financial Performance Measures, Variation of Clinical Practice protocols, Electronic Medical Record search, & Longitudinal Healthcare record encompassing SNOMED CT, LOINC, ICD-9, ICD-10
• Advisor on Company Wide Task Force designated by HP’s CEO for Healthcare Analytics, M&A, Market Trends, and Company positioning in Healthcare
• Health Care Expert for RFIs/RFPs, Board of Advisor Meetings, Customer Presentations, etc throughout the company with SLED, ES, EB, IPG, PSG, PPS, EG
• Healthcare Expert/Speaker for Company on aggregating disparate data from Health Plans, Hospitals; both acute and ambulatory, ancillary services, pharmacy, etc in order to create ACOs, PCMHs
• Develop market-based pricing schedules for healthcare analytics product modules
• Build Business Case and White Papers for healthcare analytics product for Payer and Provider Marketplace
• Wrote Script for HIMSS conference; HP Booth Tour encompassing products Pan HP
• Engage Physician Leaders, CMIOs, CMOs to participate in development of solutions that evaluate clinical outcomes, and clinical decisions support tools
• Created ACO assessment encompassing domains of capability; patient/population management, care delivery & coordination, risk management
Years Employer Title Department
Years: 2008 to Present Employer: Undisclosed Title: Healthcare Transformation Leader Department:
Responsibilities:
• Provided Thought Leadership for a Global Information and Technology Services Company in the Healthcare Industry
• Provided analysis, use cases, etc for Hospital of the Future 2027 in the Clinical Care arena
• Provided Hospitals, Health Systems and Physician Practices optimization in the revenue cycle management realm for a Fortune 500 company
• Advised Private Equity & Venture Capital Firm to provide consulting and advisory services in connection with evaluation of possible acquisitions with businesses related to the healthcare information technology industry
• Advised management team at corporation providing nursing, hospital staffing and temporary staffing services to hospitals. This corporation provides a unique insight for the development of automated staffing solutions for both per diem and traveling staff. With the insight and expertise provided, automated staffing solutions saved time, increased productivity and decreased costs associated with procuring and scheduling temporary healthcare staff. All of the staffing processes were designed to meet or exceed JCAHO requirements for document production and retention.
• Managed the development of physician practices associated with a physician foundation/hospital system that provides primary and specialty medical care, research and education. The Physician Foundation and medical groups comprise more than 120 employed physicians and 175 providers.
• Negotiated hospital and physician contracts for an 11 physician Hematology/Oncology Group Practice with eight clinics and eight hospitals. Audited external billing and collection services.
• Advisor to consulting firm who specializes in EMR, EHR, e-prescribing, coding, billing and patient portals. Assessments of physician practices were completed with recommendations implemented.
• Consultant with firm whose specialty includes the following areas: compliance with federal and state laws and regulations, Accreditation (URAC, NCQA, JCAHO), Quality Improvement, Patient Safety, Consumer privacy and security (including HIPAA), employee training and development, liability insurance, Litigation, Integrating traditional medicine with complementary and alternative medicine.
• Advisor for global health care provider network which is designed to foster cooperation and collaboration with providers located all over the world.
• Advisor for ASP model start-up, whose business included a HIPAA/HL7 and PCI compliant processing tool which verifies a patient’s insurance coverage, accurately calculates out-of-pocket costs, and processes payments in one system and at the time of service.
• For 50 physician primary practice with 10 sites, audited visit coding and reimbursement including recommendations for improving visit revenue, coding and collections and reviewed vendor applications that allow for real-time adjudication of insurance benefits and allowances and recommended most comprehensive and scalable solution.
Years Employer Title Department
Years: 2007 to 2008 Employer: Blue Shield of California Title: Director, Business Architecture Department:
Responsibilities:
Reported to VP, Developed business framework which established core elements of a large scale IT systems implementation to increase competitive advantage for Blue Shield of California. Re-engineered core business processes in Health Services Division in order to modernize the technology.

• Reported to VP, Developed business framework which established core elements of a large scale IT systems implementation to increase competitive advantage for Blue Shield of California. Re-engineered core business processes in Health Services Division in order to modernize the technology.
• Act as change management driver for the operational redesign and business process engineering for the Health Services Division, partnered with leadership and key stakeholders to implement a cost efficient usable future state operating model
• Collaborated with the technical, configuration and program management office functions to deliver a new end to end design for each major process in the Health Services Division of the organization, with Trizetto/Facets technology. Led business process modeling and requirements efforts.
Years Employer Title Department
Years: 2004 to 2006 Employer: Cirrus Health Title: VP, Physician Solutions Department:
Responsibilities:
• Reported to CEO and Chairman of the Board, Created de novo as well as existing/joint venture projects involving Ambulatory Surgical Centers, Surgical Hospitals and Medical Office Buildings. Built a technological infrastructure providing a solution for the facilities and their respective physicians; bringing unique perspective of healthcare to medical real estate.
• Created national managed care network strategy negotiating contracts with payers throughout the United States, adding affiliate sites as they were executed, Implemented corporate strategic Supply Chain/GPO contracts.
• Created a unique and innovative market research product for each community which would outline the current suppliers of healthcare, the demand of healthcare that is required, and provide an output as to whether the building or parcel of land is a viable option. Physician partnerships and practice optimization would close the project.
• Created technological infrastructure with McKesson software as compared with current vendor of Advantix.
Years Employer Title Department
Years: 2003 to 2003 Employer: Sun Capital Healthcare, Inc Title: Senior VP, Chief Compliance Officer Department:
Responsibilities:
Reported to Chairman and CEO, Legitimized and provided due diligence on the $50 million portfolio of collateral purchased from health care providers, and created extensive checks and balances from invoice to payment for this factoring entity.
Years Employer Title Department
Years: 2001 to 2002 Employer: Phyamerica Physician Services of Florida Title: Director of Managed Care Department:
Responsibilities:
• Reported to President, Created managed care division of national physician owned company providing emergency medicine practice management services
• Negotiated contracts and managed billings and collections representing five states and 2,000 physicians specializing in emergency medicine, internal medicine, family practice, pediatrics, hospitalists and anesthesiologists.
• Increased average contracted rate of reimbursement 300%, increased collections rate from 30% of billed charges to 80% of billed charges.
• Developed extensive database of over 450 managed care contracts, encompassing fee schedules billed, fee schedules per contract, plan collections, percentage of collections vs. contracted rate, and potential contracts and potential revenue as compared to current revenue.
Years Employer Title Department
Years: 2000 to 2001 Employer: Med on Web Title: Chief Operating Officer Department:
Responsibilities:
• Reported to Board of Directors, Created nation’s first electronic administrative service organization designed to provide physicians a single place to outsource all of their practice administrative processes which included all revenue cycle management functions on an ASP model including patient scheduling, eligibility verification, medical transcription, billing/coding clinical edits and claims processing, data warehousing, claims collection and payment, banking and financial services, connectivity, regulatory compliance management and practice management advisory services.
• Created technological infrastructure with McKesson
Years Employer Title Department
Years: 1998 to 2000 Employer: Indpendent Health HMO Title: Assistant Director Department: Physician Management and Credentialing
Responsibilities:
• Reported to Chief Medical Officer, Implemented a comprehensive management program for providers. This included profiling, implementing new models of health care delivery, credentialing and developing a cross-functional approach in all initiatives.
• Developed audit techniques, statistical profiles, health care policies and procedures. Implemented and monitored provider contracts.
• Managed and facilitated specialty physicians to function as an advisory source for the office of the medical director.
• Formulated plans with the medical director in strategies to reach benchmarks. Prepared and presented statistical reports for each physician, delineated “Best Practice” physicians by using benchmarks, costs and quality measures. Generated physician profile report cards.
Years Employer Title Department
Years: 1997 to 1998 Employer: The Emory Clinic, Inc. Title: Project Manager, Practice Services Department:
Responsibilities:
• Reported to President, Conducted quantitative and qualitative analyses by physician specialty including radiology, pain management, anesthesiology and neurology. Oversaw Epic and IDX software implementation with patient areas.
Years Employer Title Department
Years: 1994 to 1996 Employer: Blue Cross Blue Shield of Georgia, Quality Care Providers, Inc. Title: Medical Delivery Consultant Department:
Responsibilities:
• Reported to Senior V.P., Collaborated with physicians to develop a managed care financing and delivery system in response to health care reform. Created solutions to the problems of access, cost, and quality in the health care system.
• Developed economic analyses; premium dollars, capitation, discounted fee, relative value systems.
• Implemented practice development services through the following avenues: Fee Schedule Analysis, Contract Review, Managed Care Plan Review, General Problem Identification, Plan Performance Review, Contract Negotiations, Practice Management Assistance, Joint Venture Opportunities, Continuing Medical Education, and Practice Enhancements.
• Spearheaded Medical Educational Series for physicians, devised 45 practice protocol guidelines, developed audit review tool, medical record standards and physician satisfaction survey in accordance with NCQA guidelines and OSHA.
• Initiated electronic connectivity with 500 primary care physicians; practice protocols/medical record.
• Implemented physician profiling capabilities utilizing epidemiological methods, comparative data on physician practice patterns, assessing dimensions of cost, utilization of services, and quality of care, increased primary care physician profile and patient care management scores by 80% as a result of intervention.
• Utilized as consultant resource for physician offices, maximize efficiency, physician practice management.
• Spearheaded primary care and specialty care physicians’ credentialing, centralized functions utilizing NPDB, streamlined provider networks.
• Directed Corporate medical policy and procedure committee instituted 450 policies; Disease Management and Operational Initiatives.
• Administered quality of care protocols, adherence of preventive health standards; HEDIS; immunization, mammography, cholesterol screenings, initiated disease specific management compliance.
Years Employer Title Department
Years: 1991 to 1994 Employer: Tenet Health System, Palm Medical Group IPA Title: Executive Director Department:
Responsibilities:
• Reported to three Hospital CEOs and Physician Board of Directors, Directed and administered all day to day non-medical business aspects of the IPA’s medical practice including administrative management, provider network maintenance/member services, payer contracts, utilization review, quality assurance, claims administration, financial management.
• Increased market base of third party payers, directed administrative support with physicians.
• Negotiated agreements with non-hospital ancillary service providers, and developed participating provider network.
• Administered plan member eligibility verification, compensation, distribution and utilization review management.

Government Experience

Years Agency Role Description
Years: to Present Agency: Role: Description: In Government, Expert has worked at the County, State, and Federal levels. Additionally, Expert completed a Master's thesis at the Veterans Administration Medical Center.

Career Accomplishments

Professional Appointments
Board of Directors, eWellness Healthcare Corporation
AHIP IT Working Group
Steinberg Leadership Institute Graduate, Anti-Defamation League
Member, Women Business Leaders of the U.S. Health Care Industry Foundation
Member, Leadership Council Graduate, American Israel Political Action Committee
Awards / Recognition
- Recipient of Scholarship, Harvard School of Public Health’s Program for Executives in Managed Care
- Healthcare Executive Public Policy Institute, The Shaping of Public Policy in Washington
- Hospitals: “HMO ownership pays off for systems that stick with it”

Additional Experience

Other Relevant Experience
Prior Experience:
- Humana Health Care Plans, Administrator, Florida, 75,000 Lives
- Florida Medical Center, Director of Materials Management, 459 Bed Hospital

Fields of Expertise

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