PROFESSIONAL DESIGNATIONS and CERTIFICATION
* Certified Public Accountant (CPA) * Certified Information Systems Auditor (CISA)
INDUSTRY EXPERIENCE
* Healthcare * Retail * Higher Education * Real Estate * Financial Consulting Services
AREAS OF SPECIALIZATION
* Systems Analysis * Data Audits/ Analysis * Internal Controls over Healthcare/Managed Care Practices * Database Design and Maintenance * Accounting System Implementation and Audit * Process Improvement/ Redesign * General Ledger Administration * Financial Report Writing * Financial Modeling/ Analysis * Contract Cost Management
SYSTEMS/SOFTWARE EXPERTISE
* CODA Accounting System * Infinium * Deltek * SAP * Quickbooks * Peachtree * PeopleSoft * Oracle * Meditech * Audit Command Language (ACL) * MS Access/Excel * MS SQL * SPSS
RECENT PROJECTS
$1.5 Billion Healthcare Company
Problem:
The Managed Care department could not keep track of problems and solutions regarding medical claims. Employees could not determine whether a problem had been resolved and what solution was reached.
Solution:
* Performed a problem assessment * Met with director and employees to discuss the problem and alternative solutions * Designed an Intelligent Database Management System (IDBMS) to record problems, solutions reached, and other details * The IDBMS became the data depository for medical claims issues and solutions * The IDBMS was used as an expert system to help employees learn about how a problem was solved when faced with a similar problem
Problem:
How to design and execute an audit to identify and recover overpayments of medical and pharmacy claims submitted by Payors.
Solution:
* Prepared an audit plan to recognize invalid claims, based on Current Procedural Terminology (CPT) and Chargemaster legitimate lists, Membership and In-Net-Work Provider lists, and contracted fee schedules. * Reconciled electronic claims data with settlement reports, based on business rules and contract stipulations. * Verified that health services were performed or referred by an In-Net-Work Primary Care Physician (PCP), and were medically necessary. * Ensured that claims were submitted for legitimate members (patients) on Membership list. * Verified that charges were appropriate, customary and usual with contracted fee schedules. * Queried claims data for duplicates and for incomplete claims records. * The execution of the audit plan resulted in recovering over $6million from Health Maintenance Organizations (HMOs) and improved claims submission and reimbursement processes.
$800 Million Auto Parts Retail Public Company
Problem:
The company had over 200 auto parts retail stores spread throughout the country, and was a member of a group owned by a Fortune 500 company. Business license fees, real estate taxes, and personal property taxes were consistently paid late by the company and resulted in penalties.
Solution:
* Designed a system to record and trigger due dates using Microsoft Access. * Accurately monitored, accrued, and reported business license fees, real estate taxes, and personal property taxes. * Conveyed tax due dates and payment amounts to Parent Company Tax Accountant. * Set up monthly automated apportionment for the corresponding accounts and designed triggers in MS Access to monitor apportionment set-ups and terminations. * Reconciled business license fees, real estate taxes, and personal property taxes accounts in GL with MS Access reports. * Designed a system to record tax information for new stores and to terminate postings and payments for closed stores. * The system resulted in timely payments and reduced penalties for past-due fees and taxes by over 95%, and reduced the time for tracking and settling by over 50%.
TESTIMONIALS
UMMHC
“This CPA was responsible for streamlining and automating our monthly financial reporting of Managed Care Contracts. Using his knowledge and experience in business process engineering, report writing, and accounting information systems, this prolific professional was able to save this company over 0.20 Full-Time Employee (FTE) hours per month and a reduction in printing costs of over 90%.” – Divisional Director, Managed Care Finance, UMMHC.
Trak Auto Corporation
“This former G/L Systems Accountant was instrumental in ensuring a smooth operation of our accounting department after the sudden departure of our Controller, Assistant Controller and G/L Systems Administrator, who were the only employees who could do report writing and G/L systems administration tasks. This energetic individual performed the tasks of an Assistant Controller and some System Administration tasks that earned him the name “right-hand man” of the new controller. Not only did his efforts enable us to be ahead of schedule in preparing for an acquisition, we saved the cost of hiring a CODA Systems Administrator and an Assistant Controller; an annual savings of approximately $250,000.” – Former Controller, Trak Auto.
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