Expert Details

Expert in Substance Use Disorders, Healthcare, Call Center Operations, Compliance, Quality Improvement, Strategic Planning, and Mail Order, Medical Supplies, and HME

Expert ID: 724726 Florida, USA

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Expert is a National Healthcare Executive with demonstrated success in delivering top and bottom line growth for multiple healthcare verticals. He is recognized as a subject matter expert in RCM/Billing, Procurement, Contracting, Operations, Compliance, Payer Enrollment, Medicare, Medicaid, and Healthcare. He has served as an SME in this capacity in private organizations and entrepreneurial companies alike with a passion for solving complex business issues using data-driven analytics and team building. A well-known leader, Expert has consistently demonstrated a track record of building and leading high-performance organizations that deliver strong business results.

Expert has an extensive background as a subject matter expert in HME and SUD RCM/Payer healthcare operations, clinical protocols, payer management, enrollment, compliance – strategic planning, revenue cycle management, (RCM), medical billing/reimbursement, regulatory - accreditation, Medicare/Medicaid – contract negotiation - wellness, administration and executive strategic planning. He just completed a project in which he worked with senior management as their Sr. Vice President – RCM/Payer – Contracting - Compliance Administrator that manages 12 healthcare SUD Centers in 3 States.

Expert uses a side by side work ethic with colleagues and in a recent engagement managed a project that included building from architect plans to opening, a new 40 bed medical Detox Center. Managing the Coastal Detox project included design modification, permitting, Procurement contracts - payer enrollment, billing – RCM Software design, licensing for DCF, Joint Commission, policy implementation, Staff Recruitment, working with the State Board of Pharmacy, DEA, SAMHSA, and numerous other regulatory agencies in order to gain their certificate of occupancy for their inpatient medical treatment center which had its open house in the later part of March 2016.

Expert is the former CEO of a healthcare industry solutions company. He has been an active consultant with Medicare/Medicaid Payer Remittance and RCM - Compliance technology solutions for the healthcare industry, with a focus on reducing and managing the costs of healthcare administration and continuous best practice improvements.

Expert's was Co-Founder and Chief Executive/Compliance Officer of the healthcare industry solutions company. As such, he played an instrumental role in the development and launch of our national cloud based Private Payer and Medicare Part B RCM Payer ERA Compliance – Denial management product, MRN Manager©. Also, developed unique products for the Billing RCM Markets, Wellness, Medical Supply - HME/DME, Physician Markets. These products included, but were not limited to the acquisition and re-engineering of their consumer healthcare MedFlash© electronic Personal Health Manager Wellness Marketing benefit platform.

Additionally, Expert served as a Vice President New Business for Liberty Medical, a national Medicare mail order diabetic marketing company from 1997 to 1999, with revenues in excess of $100M, (PLMD) and was their New Business & Contract – Procurement and Compliance RCM/Regulatory Officer for two years. Areas of expertise are; operations, public speaking, marketing, fundraising for startups, administrative – strategic planning, medical billing & auditing, compliance, call center development, medical – healthcare staff and business planning, medical fulfillment and strategic - turnaround business consulting. Also a Registered Respiratory Therapist and served in the US Navy, now a Disabled Veteran.

As an SME, Expert has worked with an executive management team that manages and operates recovery - SUD facilities in AZ, CA and FL States with revenues in excess of $700M. Expert role included working with a team of subject matter experts that provide all the necessary operational, marketing and management services to sustain the daily operations of these organizations. Expert's role was to work with the team on projects as needed throughout the many areas of the organization. During his engagement, Expert reengineered their national enrollment Operation/Payer – RCM processes.

Expert's next project was to rebuild TMC’s Medical Records – HIM department(s). He developed their National Payer Matrix, Contracting, Joint Commission Accreditation, QA, educational - clinical – compliance staff peer review processes and KPI reporting. Expert served as their primary executive for all SIU Payer Audits – Enrollment Payer Contract Negotiations and worked directly with Audit Executive Committee, RCM and General Counsel to ensure compliance and ensuring the company goals were accomplished.

Expert also utilized his skills as SME to assist in the development and growth of a new recovery - SUD Company - Coastal Detox. He worked side by side with the investors and owners to implement the infrastructure for their operating policies, DCF and Joint Commission Accreditation.

Expert transitioned the company from outside billing services to an in-house billing department with Payer Enrollment, RCM and KPI internal controls to ensure compliance across the billing and clinical spectrums of care. This included updating and implemented their in-house cloud based staff training programs and HR – policies, reducing staff turnover through training and education.

Expert has spent the last 20 years in business development, management and performance-based scenarios. Some of his expertise includes, but is not limited to; new business start ups, team building, process
engineering, audits/compliance, quality review and operational management. Expert has spent many years in managing operational centers and is well versed in creating foundations for new enterprises/startups in order to achieve and exceed his client’s objectives.

Expert has an extensive background in HME/SUD executive management, operations, supply chain contracting – procurement, marketing, medical billing – reimbursement, healthcare wellness, telemedicine, business administration and strategic planning.

He served as the Co-Founder of a healthcare industry solutions company specializing in end-to-end Business Process Outsourcing (BPO) solutions for the healthcare industry, with a focus on reducing and managing the cost of operations and business receivables.

He was part of a team that developed unique products for B2B and B2C markets including the development and launch of our national cloud based Private Payer and Medicare Part B RCM Payer ERA Compliance – Denial management product, MRN Manager©. He also developed unique products for the Billing RCM Markets, Wellness, Medical Supply - HME/DME, Physician Markets. In addition to RCM – Billing we offered MedFlash, the electronic Personal Health Manager Benefit platform. The MedFLash is an easy-to-use Personal Health and Lifestyle Manager that is accessible using a powerful web portal suite which is a proven wellness consumer – patient retention program with thousands of members nationwide. He developed the company's telemedicine program and was instrumental in launching USA Medical Monitoring an emergency response company, specializing in PERS, Personal Emergency Response. The combination of these two products had never been offered to the consumer in an affordable - easy you use program. He and his partner pioneered the MedFlash national I.C.E. Marketing Program combined with Telemedicine.

Expert served for six years as a consultant specializing in Medicare Home Medical Equipment, HME Accreditation. As an ACHC Surveyor, he ensured that Medical Supply - HME and related businesses had implemented - developed comprehensive healthcare accreditation policies, education, standards and programs.

Expert's responsibilities included, but were not limited to; an impartial third-party peer reviewer in the evaluation of their operations, Medicare compliance - patient care services. He specialized in a systematic approach for their regulatory and operational patient care, equipment programs, Medicare – Medicaid chart review and data analysis using best practice education for business operations and evidence-based health care data analysis & evaluation for operational improvement reporting mechanisms; including program reviews and results which were used to accredit the entities for State programs, Private Payers and government and Centers for Medicare and Medicaid (CMS) approval.

Expert was engaged as an SME to work with a Medical Supply Company investor to facilitate a three-way merger with three healthcare HME companies in Kansas City, Kansas that were in need of compliance oversight working with OIG, federal and State regulatory agencies related to allegations of violations in lead generation for their payer billing practices, medical call center and national pharmacy. Expert's role was to assist with the facilitation of the merger with a Canadian Pharmaceutical Public Company and the Government in order to help settle the case. The project lasted ~ 12 months and ended in a successful merger of the assets of the three U.S. Companies being acquired by the Canadian VC Group.

Expert was COO of Liberator Medical Supply for 8 years. He utilized his skills in healthcare SME to assist in the development and growth of this new Medicare Mail Order Medical Supply - HME Company. Expert worked side by side with the owner to implement the infrastructure for their marketing, RCM, call center, mail order fulfillment program, operating policies and senior healthcare and mobility product – market development. This also includes assisting the owner and management team to ensure Medicare – Medicaid Payer regulatory compliance. As their COO, he was responsible for their Payer billing and RCM management, compliance and billing, purchasing – supply contracts staff training, regulatory audits. Additional projects included updating and implemented their web base HME product portal.

Expert joined Liberty Medical as their Vice President of New Business Contracts and Medicare/Medicaid Corporate Compliance. His role included, but was not limited to, implementing their PI call center program, in-house training for call center agents, working with senior management on new business verticals.

Additional management projects included, working with their Customer Service Team, Managed Care Contracts, Product- Supply Contracts, RCM/Billing and Collections Managers and was instrumental in development and collaboration of their document acquisitions – Payer Insurance Verification and Doctor Order programs and processes. Expert was their initial Company Compliance Officer in 1998 and developed innovative reporting programs as the company was in an untoward growth period in which revenues increased from $20-$100M in less than 12 months.

Expert has 5 years of experience with ACHC CMS/Medicare Audits specializing in Medicare Part B HME Industry. He has audited over 100 locations across the Country which include; HME, Pharmacy/Retail, Hospice, Nursing Home - Assisted Living Facilities. Expert has worked as a lead consultant with KBK consulting for 3 years specializing in corporate compliance and quality improvement review, training and auditing. He also works with management of healthcare company's to review their operations for due diligence - Acquisition and reorganization. Expert has 15 years of expertize as a call center expert and has worked with 200+ seat medical and general call centers to assist with compliance, training and new product development. Expert has 20 years of healthcare executive management experience, specializing in operational strategic planning and healthcare compliance. Expert has consulted on numerous Substance Use Disorder Startups form inception to accreditation -fully operating status.

Expert may consult nationally and internationally, and is also local to the following cities: Miami, Florida - Hialeah, Florida - Orlando, Florida - Fort Lauderdale, Florida - Hollywood, Florida - Pembroke Pines, Florida - Port Saint Lucie, Florida - Miami Beach, Florida - West Palm Beach, Florida - Palm Bay, Florida

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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 Responsibilities
Years: 2005 to Present Employer: Undisclosed Title: President & CEO Department: Responsibilities: As Founder and former Chief Executive for a healthcare industry solutions company, Expert has an extensive background in HME/SUD executive management, operations, supply chain contracting – procurement, marketing, medical billing – reimbursement, healthcare wellness, telemedicine, business administration and strategic planning.
The solutions company specialized in end-to-end Business Process Outsourcing (BPO) solutions for the healthcare industry, with a focus on reducing and managing the cost of operations and business receivables.

Expert was part of a team that developed unique products for B2B and B2C markets including the development and launch of their national cloud-based Private Payer and Medicare Part B RCM Payer ERA Compliance – Denial management product, MRN Manager©. He also developed unique products for the Billing RCM Markets, Wellness, Medical Supply - HME/DME, Physician Markets. In addition to RCM – Billing, the firm offered MedFlash, the electronic Personal Health Manager Benefit platform. The MedFLash is an easy to use Personal Health and Lifestyle Manager that is accessible using a powerful web portal suite which is a proven wellness consumer – patient retention program with thousands of members nationwide. He developed the telemedicine program and was instrumental in launching USA Medical Monitoring an emergency response company, specializing in PERS, Personal Emergency Response. The combination of these two products had never been offered to the consumer in an affordable - easy-to-use program. Expert co-pioneered company's national I.C.E. Marketing Program combined with Telemedicine.
Years: 2016 to 2017 Employer: Treatment Management Company Title: Sr VP Administration Department: Responsibilities: Expert worked with an executive management team that manages and operates recovery - SUD facilities in AZ, CA and FL States with revenues in excess of $700M. He is part of a team of subject matter experts that provide all the necessary operational, marketing and management services to sustain the daily operations of these organizations. His role is to work with the team on projects as needed throughout the many areas of the organization. During his engagement, he reengineered their national enrollment Operation/Payer – RCM processes. His next project – task was rebuilding TMC’s Medical Records – HIM department(s). Developed their National Payer Matrix, Contracting, Joint Commission Accreditation, QA, educational - clinical – compliance staff peer review processes and KPI reporting. Served as their primary executive for all SIU Payer Audits – Enrollment Payer Contract Negotiations and worked directly with Audit Executive Committee, RCM and General Counsel to ensure compliance and ensuring the company goals were accomplished.
Years: 2014 to 2016 Employer: Coastal Detox Title: COO Department: Responsibilities: Expert leveraged his skills as SME to assist in the development and growth of a new recovery - SUD Company. He worked side by side with the investors and owners to implement the infrastructure for their operating policies, DCF and Joint Commission Accreditation.

Expert transitioned the company from outside billing services to an in-house billing department with Payer Enrollment, RCM and KPI internal controls to ensure compliance across the billing and clinical spectrums of care. This included updating and implemented their in-house cloud based staff training programs and HR – policies, reducing staff turnover through training and education.

Expert's final project was to work with the owners in building from architect plans to opening their new 40-bed medical detox center, Coastal Detox which included design modification, permitting, licensing for DCF, Joint Commission, policy implementation, Staff Recruitment, working with the State Board of Pharmacy, DEA, SAMHSA, and numerous other regulatory agencies in order to gain their certificate of occupancy for their inpatient medical treatment center which had its open house in the later part of March 2016.

Upon completion of both projects, Expert returned to hisconsulting practice and joined Treatment Management Company.
Years: 2007 to 2015 Employer: Connectyx Holdings (CTYX) Title: Chief Executive Officer Department: Responsibilities: As founder and former Chief Executive for this healthcare industry solutions company, Expert utilized his skills in launching their national cloud based Private Payer and Medicare Part B RCM Payer ERA Compliance – AR product, MRN Manager©. He also worked on projects that included healthcare operations, marketing, medical billing - reimbursement – elder care healthcare wellness - telemedicine, business administration and executive strategic planning - development. He served as the President and CEO of the public holdings company for for 8 years. The company specializes in end-to-end Business Process Outsourcing (BPO) solutions for the healthcare industry, with a focus on reducing and managing the costs of healthcare administration and continuous business process improvements in multiple healthcare verticals.
Years: 2008 to 2014 Employer: Accreditation Commission for Healthcarees Title: Surveyor Department: Responsibilities: Expert served as a consultant specializing in Medicare Home Medical Equipment, HME Accreditation. As an ACHC Surveyor, he ensured that Medical Supply - HME and related businesses had implemented - developed comprehensive healthcare accreditation policies, education, standards & programs.

Expert's responsibilities included, but were not limited to; an impartial third-party peer reviewer in the evaluation of their operations, Medicare compliance - patient care services. He specialized in a systematic approach for their regulatory and operational patient care, equipment programs, Medicare – Medicaid chart review and data analysis using best practice education for business operations and evidence-based health care data analysis and evaluation for operational improvement reporting mechanisms; including program reviews and results which were used to accredit the entities for State programs, Private Payers and government and Centers for Medicare and Medicaid (CMS) approval.
Years: 2011 to 2014 Employer: KBK Consulting Title: Consultant Department: Regulatory Compliance Responsibilities: He joined a colleague and served as an independent HME Medicare compliance – PI consultant specializing in working with owners of Medical and Respiratory Care, HME and Mail Order Medical Equipment Companies. As an SME, Expert's role with KBK was to ensure that their clients were prepared for HME Regulatory Medicare Accreditation. As a KBK senior consultant, Expert ensured that HME and related clients had implemented - developed comprehensive and realistic healthcare PI and accreditation operating policies, standards and programs. In some instances, this included managing these processes as their in-house compliance – regulatory consultant. As a compliance regulatory operations consultant, he served KBK clients as an impartial third-party peer reviewer in the evaluation of their operations, compliance - patient care services.
Years: 1998 to 2007 Employer: Liberator Medical Title: COO Department: Responsibilities: Expert utilized his skills as a healthcare SME to assist in the development and growth of this new Medicare Mail Order Medical Supply - HME Company. He worked side by side with the owner to implement the infrastructure for their marketing, RCM, call center, mail order fulfillment program, operating policies and senior healthcare & mobility product – market development. This also includes assisting the owner and management team to ensure Medicare – Medicaid Payer regulatory compliance. As their COO, Expert was responsible for their Payer billing and RCM management, compliance and billing, purchasing – supply contracts staff training, regulatory audits. Additional projects included updating and implemented their web base HME product portal. Other responsibilities included working directly with industry manufacturers to negotiate long term contracts which included rebates and shared marketing programs. As their COO, I collaborated with the CFO and Owner to create long term models for market forecasts and budgets related to the HME mail order business markets.
Years: 1997 to 1998 Employer: Liberty Medical Title: Vice President New Business - Compliance Officer Department: Responsibilities: Expert joined the company as their Vice President of New Business Contracts and Medicare/Medicaid Corporate Compliance. His role included, but was not limited to, implementing their PI call center program, in-house training for call center agents, working with senior management on new business verticals.

Additional management projects included, working with their Customer Service Team, Managed Care Contracts, Product- Supply Contracts, RCM/Billing and Collections Managers and was instrumental in development and collaboration of their document acquisitions – Payer Insurance Verification and Doctor Order programs and processes. As the Company Compliance Officer, Expert developed innovative reporting programs as the company was in an untoward growth period in which revenues increased from $20-$100M in less than 12 months.

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

Fields of Expertise

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