VP · Director · Strategic Leader
Thirty years transforming how health systems capture, manage, and optimize revenue. I specialize in the space where clinical operations meet financial performance — and I've built the AI-assisted denial triage framework that closes the gap between ambition and execution.
I've spent three decades at the intersection of healthcare operations and financial performance — leading revenue cycle transformations for hospitals, health systems, and multi-site physician groups across the country.
My expertise runs deep in Epic Resolute, managed care contracting, denials management, and AR optimization. I've built and rebuilt RCM functions from the ground up, integrated systems through mergers and acquisitions, and led teams through the industry's most significant technology transitions.
Today, I'm focused on a critical inflection point: health systems are writing AI into every RCM job description — but few can clearly articulate what they need AI to actually do. That's the conversation I'm driving.
End-to-end RCM strategy, team development, and operational transformation at VP and Director level across acute and ambulatory settings.
Deep platform expertise across build, implementation, optimization, and post-live support — including charge capture, billing, and AR workflows.
Systematic denial prevention and management frameworks that reduce write-offs and accelerate cash flow at scale.
Payor strategy, contract negotiation, and reimbursement analysis that align clinical volume with financial outcomes.
There's a growing disconnect between how hospitals are writing AI into RCM job descriptions and the operational reality on the ground. Leaders are asking for "AI-powered" workflows — but when pressed, most can't articulate the specific use case, the process being automated, or how success will be measured.
This isn't a technology problem. It's a leadership problem. And it's creating a dangerous gap between expectation and execution.
Most denial management programs are built to appeal. The best ones are built to prevent. The difference is upstream clinical and coding alignment.
A platform is only as strong as the workflow behind it. Resolute exposes gaps — it doesn't resolve them. Here's what that means at go-live.
Health systems are struggling to hire strong RCM leaders. The shortage is real, but the bigger issue is how we've defined the role for the next decade.
Contract management is table stakes. What separates the best health systems is how they leverage data to drive payor conversations before renewal season.
I've designed a multi-phase, AI-assisted triage and routing framework for denial management — built on structured 835 ERA data and CARC-based classification logic that most health systems already have available but aren't fully leveraging.
Phase 1 addresses the three systemic failures that plague RCM teams at scale: manual triage that breaks under volume, no priority logic separating a $500 denial from a $500,000 one, and 835 data sitting idle while appeal decisions are made by gut.
The framework is designed to deliver immediate operational value using data you already have — no new infrastructure required. Additional workflow modules can be built on demand as Phase 2 contract data integration and professional claims workstreams activate.
Acute care facility claims. UB-04 institutional billing. Three-layer triage model using 835 ERA CARC codes to classify, prioritize, route, and score every denied claim for appeal probability — automatically.
Payer contract data layer unlocks automated timely filing logic, payer-specific appeal routing, and underpayment detection by comparing contract rates against 835 paid amounts.
CMS-1500 triage adapted for physician and specialist billing — deployed across eClinicalWorks, Athena Health, GE Centricity/IDX, and mid-market PM systems via API or HL7 interface.
The triage architecture is modular. New claim types, payer-specific logic, coding edits, and underpayment recovery workflows can be layered on top of the same foundational infrastructure.
Every denied claim is tiered by total billed amount — not denied amount. Write-off zone under $100. Supervisor queue $100–$20K. Manager queue $20K–$100K. Director mandatory review above $100K. Dollar tier determines reviewer level before any other logic fires.
Claim is matched to its payer. Any claim requiring contract-specific logic is tagged with a Phase 2 dependency flag — surfacing it to the human reviewer with a structured instruction set so nothing falls through without a deliberate decision.
The 835 ERA CARC code classifies the denial type and drives appeal pathway logic. AI assigns an appeal probability score — High, Medium, Low, or Non-Appealable — built from 9+ months of historical 835 win-rate data. Not hardcoded assumptions. Real data.
Runs on 835 ERA data, payer master, and clearinghouse logs — assets every health system already maintains. No new infrastructure required to activate Phase 1.
AI classifies, routes, and generates instructions. Humans make final decisions. Every write-off, appeal, and escalation is documented with timestamp, reviewer identity, and rationale — HIPAA-compliant by design.
The triage logic is a platform, not a one-time build. New claim types, payer rules, coding edit checks, and underpayment recovery modules can be activated on demand as the organization's needs evolve.
For cleared appealable claims, the workflow auto-populates appeal letters using patient demographics, 835 data, DRG and revenue codes, and CARC-specific letter templates — with payer portal, fax, or PDF output.
Led full-cycle Epic Resolute implementation across a multi-hospital health system — encompassing charge capture redesign, billing workflow optimization, and post-live AR stabilization. Achieved go-live on schedule with measurable reduction in days in AR within 90 days.
Platform: Epic Resolute · Scope: EnterpriseRebuilt a denials management function for a multi-site physician group, shifting from reactive appeal processing to proactive upstream prevention. Established denial trending, root cause workflows, and cross-functional accountability with coding and clinical documentation teams.
Result: Sustained reduction in denial write-off rateLed renegotiation of a major commercial payor contract leveraging utilization data and outcome benchmarks. Repositioned the health system's negotiating posture and established a reimbursement monitoring infrastructure that surfaced underpayments systematically.
Impact: Improved reimbursement yield per encounterDirected revenue cycle integration for an acquired ambulatory network — harmonizing billing platforms, credentialing pipelines, and payor enrollment across multiple locations. Maintained collections continuity through transition while standardizing operations onto the parent system's infrastructure.
Platform: ResQ RCM · Scope: Ambulatory NetworkWhether you're leading a health system through transformation, building an RCM leadership team, or navigating the AI-to-operations gap — I'd welcome the conversation.