Alex is a Managing Director in Protiviti’s Phoenix office and has more than 15 years professional experience providing operational, financial, and regulatory consulting and internal audit services to the healthcare industry. He leads Protiviti’s healthcare practice in the western region as well as a national leadership role in the firm’s compliance solution.
Prior to entering consulting, he worked for a large multi-regional healthcare system and was responsible for integrating Managed Care HMO protocols with Federally regulated Medicare guidelines for healthcare delivery. He directs numerous internal audit outsourcing and co-sourcing engagements and is a frequent speaker on internal audit, compliance, and revenue improvement initiatives.
Representative Engagements Include
- Directed multiple internal audit functions for acute and long-term care hospital systems, surgery center ventures, hospital management companies, and health insurance plans, which included performing a variety of control and business improvement projects. Reviews included enterprise risk assessments, clinical and revenue operations assessments, financial statement audits, vendor and payer contract compliance reviews, clinical trials and IRB compliance audits, accounts payable/materials management control reviews, electronic health record and patient accounting implementation/operational reviews payroll, and various IT general control reviews
- Directed numerous regulatory compliance assessment and process improvement projects, including those related to HIPAA / HITECH, CMS Medicare Managed Care rules, Stark laws, physician contracting and property leasing, clinical coding, government reimbursement, OIG compliance agreement requirements, etc. Process improvement initiatives included standardization, contract management, data abstraction, policies and procedures, controls, reporting, etc.
- Directed numerous provider revenue cycle improvement and transformation initiatives across access, charge capture, billing, collections, and denials management functions. Key activities included identifying and implementing process and system improvements across patient care, finance, and revenue departments and achieving significant benefits in net revenue and sustainable cash, cash collected as a percentage of revenue, and accounts receivable days reduction
- Responsible for integrating Managed Care HMO protocols with federally regulated Medicare guidelines for healthcare delivery. Medicare and Medicaid claims payment negotiations, policy and procedure implementation and benefits design and redesign. Experience with medical coding, third party payers and claims adjudication
- Actively participated in and managed an Independent Review Organization (IRO) compliance engagement to provide findings regarding whether client policies, procedures and operations comply with the terms of the client’s federally mandated Corporate Integrity Agreement (CIA)
- Master of Healthcare Administration, University of Minnesota
- Bachelor of Arts, Brigham Young University
Professional Memberships & Certifications
- Certified Healthcare Compliance Professional (CHC)
- Accreditation in Quality Assessment and Validation
- Health Care Compliance Association (HCCA)
- Healthcare Financial Management Association (HFMA)
- Association of Healthcare Internal Auditors (AHIA)
- Institute of Internal Auditors (IIA)