Alex is a Managing Director in Protiviti’s Healthcare and Life Sciences practice and has more than 20 years of professional experience providing operational, financial, and regulatory compliance and internal audit services to the healthcare industry. Alex leads Protiviti’s healthcare practice in the Western Region and serves in a national leadership role with the firm’s healthcare compliance solution.
Prior to entering consulting, Alex worked for a large multi-regional healthcare system and was responsible for integrating Managed Care HMO protocols with Federally regulated Medicare guidelines for Health Care delivery. Alex directs numerous internal audit outsourcing and co-sourcing engagements and is a frequent speaker on internal audit, compliance, and revenue improvement initiatives.
Major Projects 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.
- 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.
- Experience leading insurance providers with compliance efforts regarding Model Audit Rule (MAR) and Own Risk and Solvency Assessment (ORSA) including readiness assessments, project scoping, process documentation and controls effectiveness testing.
- Led Affordable Care Act (ACA) gap assessments, due diligence reviews for hospital/physician practice acquisitions, Medicare and Medicaid claims payment negotiations, policy and procedure implementation and benefits design and redesign. Experience with medical coding, third party payors 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).
Areas of Expertise
- Internal Audit
- Revenue Cycle
- Regulatory Compliance
- Healthcare and Life Sciences
- University of Minnesota - Master of Healthcare Administration
- Brigham Young University - Bachelor of Arts
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)