Caroline is Protiviti’s Healthcare Revenue Cycle Practice Leader. She has extensive professional consulting and industry experience in the healthcare industry. Caroline works with various healthcare provider organizations including hospitals, health systems, home care, physician specialty groups and clinics, free-standing ambulatory care providers, payers, private equity groups, and investors. Prior to joining Protiviti, Caroline led the development and client delivery of revenue integrity consulting services for CohnReznick LLP, Grant Thornton LLP and Navigant Consulting, Inc.. Caroline has experience serving in industry roles such as Corporate Compliance Officer and Director of Revenue Integrity for integrated health systems. She is a recognized industry speaker and author in the areas of revenue integrity, revenue cycle transformation, regulatory compliance, electronic health record design, implementation and optimization, and data analytics.
- Directed multiple revenue cycle assessment, performance improvement and transformation engagements for hospital systems, physician groups, urgent care, freestanding emergency centers, and home care providers. Engagements focused on all aspects of the revenue cycle from patient access through final payment, including scheduling, registration, documentation, coding, charge capture, billing, denials management, payment posting and collections. Key activities included identifying and implementing process and systems improvements to improve the timeliness, efficiency and efficacy of the revenue cycle across interdependent stakeholders to improve charge capture accuracy, reduce late charges, denials and accounts receivable days, optimize payer contracts, and increase net revenue.
- Directed numerous assessments and transformation activities of revenue integrity programs for hospital systems and large physician groups. Key activities included defining the program scope and objectives, right-sizing staffing structures, aligning skill sets to client needs, collaboration with Internal Audit and Compliance, policy, procedure and workplan development; formalizing audit, monitoring and reporting methods, and dashboard development.
- Directed many electronic health record (e.g. Epic, Cerner, Meditech) implementation and optimization engagements for hospital systems. Assisted in the design, build, testing, implementation and post go-live optimization activities to best leverage staff and technology to improve the identification, capture and billing of chargeable items, services and procedures. Key activities included legacy mapping, charge description master and charge capture simplification; facility charge calculator design, rational pricing strategy, workqueue consolidation, customized charge and claim edit rules; policy and procedure development; training development, and post-implementation performance monitoring.
- Directed various buy and sell-side due diligence reviews of provider billing, coding and compliance. Reviews focused on the provider’s ability to effectively manage the revenue cycle, meet regulatory requirements for documentation, coding and billing compliance; optimize reimbursement under existing payer contracts, and the ability to scale with considerations for staffing and technology.
Areas of Expertise
- Revenue Cycle Operations
- Revenue Integrity Program Design
- Regulatory Compliance
- Compliance Effectiveness
- Transformation and Integration
- Transactions and Turnaround
- Data Mining/Analytics
- Internal Audit
- System Optimization
- Physician Groups / Specialties
- Home Care
- Ambulatory Care
- Payers / Medicare Advantage
- Master in Business Administration
- Master of Science Management in Healthcare Administration
- Bachelor of Science, Corporate Health
Professional Memberships and Certifications
- National Association of Healthcare Revenue Integrity, Advisory Board
- Healthcare Financial Management Association
- Association of Healthcare Internal Auditors
- American Association of Healthcare Administrative Management