Protiviti Contact

Protiviti Contact

Don Billingsley

Director

Professional Experience

Don is a founding member and Protiviti’s US Revenue Cycle Practice Lead. He has extensive experience working with numerous healthcare providers assessing and improving their operational, financial, and compliance processes. Prior to joining Protiviti, Don worked as a revenue cycle consultant at Arthur Andersen and held a position as a care manager and compliance auditor for one of the largest diversified specialty healthcare management organizations. Don is a key leader in Protiviti’s Healthcare Practice and a frequent speaker on revenue improvement initiatives.

Major Projects

  • Led numerous charge capture process improvement reviews. Key procedures included identifying process deficiencies across multiple clinical departments, developing charge capture consistency standards and improvement plans, providing educational seminars, implementing controls, and assessing processes and procedures for adding, updating, and communicating changes to the charge description master table to capture all relevant charges timely, accurately, and completely.
  • Led multiple denials tracking resolution and patient access/revenue cycle re-engineering reviews for major multi-hospital healthcare organizations. Key procedures included comprehensive data analysis, sampling and statistical extrapolation, and operational and systems reviews throughout multiple entities and departments to identify business process and/or system improvement opportunities within existing operations that, when implemented, would lead to enhanced profitability and cash flow through a reduction of denied claims.
  • Led multiple reviews of medical management practices to evaluate the sufficiency of utilization review and medical necessity practices implemented to ensure payer authorizations are obtained for continued care and compliance with other insurance requirements is achieved.
  • Led multiple electronic health record (EHR) pre-implementation reviews evaluating control design effectiveness and readiness evaluation for the planned state of processes supporting patient access, order and results management, charge capture, charge description master maintenance, and health information management while also considering key revenue cycle operational feasibility upon implementation.
  • Led multiple electronic health record post-implementation reviews evaluating the utilization of the EHR, including key application controls, CPOE usage, issue resolution, and progress toward value realization to verify intended business needs were met and verifying supporting information technology processes were effectively implemented, including user access provisioning, computer workstation deployment, data processing and inbound/outbound interface integrity, and downtime procedures.
  • Led multiple internal audit and internal control reviews, including enterprise risk assessments, clinical and revenue cycle operations assessments, compliance program effectiveness reviews, personnel pay practices, patient safety quality and management assessments, quality data abstraction audits, IRB and clinical trials reviews, joint venture baseline assessment third-party vendor and insurance payer contract compliance reviews, accounts payable/materials management controls reviews, electronic health record and patient accounting implementation/operational reviews (Epic, Cerner, and Siemens).

Areas of Expertise

  • Revenue Cycle
  • Compliance
  • Internal Audit

Industry Experience

  • Healthcare

Education

  • Master of Science in Human Resources
  • Bachelors of Science in Communications

Professional Memberships & Certifications

  • Healthcare Financial Management Association (HFMA)
  • Health Care Compliance Association (HCCA)
  • Association of Healthcare Internal Auditors (AHIA)
  • Institute of Internal Auditors (IIA)