Why Pinnacle Health Care Advisors? ROI.
Our primary objective at Pinnacle Healthcare Advisors is to design and implement sustainable improvements that will result in a return on investment (ROI) for our clients. We founded Pinnacle with the belief that your people are at the core of everything you do and that developing them is the most important aspect of driving sustainable improvements in financial performance.
Mission
Elevate our clients’ revenue cycle performance through technology optimization and people development
Vision
Re-define what organizations can expect from a consulting firm
Values
Act with integrity, professional respect for all individuals, internal and client transparency, personal accountability, teamwork driven, open to innovation and customization
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Leadership Team
Todd Hakala
Principal
25+ years leading revenue cycle transformation efforts that have contributed to millions of dollars in net revenue enhancement and improved customer service.
Meet Todd Hakala
Todd has over 25 years of experience assisting healthcare providers with identifying and implementing operational and revenue cycle improvements that have contributed to millions of dollars in savings and net revenue enhancements as well as improved quality and customer service. Over the past several years, Todd has led numerous revenue cycle transformation efforts in a variety of provider settings across the country.
Todd has deep technical expertise in all areas of the revenue cycle, and he also has experience in implementing labor, non-labor, clinical utilization, and patient throughput improvements. Prior to cofounding Pinnacle, Todd was a project leader at Huron Consulting Group and Novia Strategies, Inc., and he also served in various finance and operations roles at healthcare providers in Minnesota. Representative examples of Todd’s experience include:
- Led an end-to-end revenue cycle transformation effort at a 200-provider multispecialty medical group; key metrics improvements included an 85% reduction in aged Pre AR, a 50% reduction in the denial write-off rate, a 17-day AR reduction, and a 2% collection rate improvementProvided interim leadership for a central business office and had responsibility for over $80 million of monthly cash collections; also identified and led numerous performance improvement initiatives to increase cash flow, net revenue, and productivity
- Led a revenue cycle engagement at a community hospital in North Carolina that resulted in $6 million of annual income statement improvement
Led a revenue cycle engagement at a level-1 trauma center that resulted in $14.6 million of annual net revenue benefit and $5.7 million of one-time balance sheet improvement - Directed a revenue cycle engagement at multi-hospital system in that resulted in $23 million of annual net revenue benefit and $13 million of one-time balance sheet improvement
- Served as a process improvement director for a health system in Minnesota where he was responsible for managing a labor productivity system and leading operational, clinical, and revenue cycle improvement initiatives
Todd’s Approach to Consulting
Todd is passionate about leveraging data to drive opportunity identification and prioritization and developing strategies and tactical plans to achieve sustainable results. He appreciates the importance of collaborating with leaders and staff members to develop solutions that work for each organization he partners with.
Certifications & Professional Memberships
- Healthcare Financial Management Association
Education
- Master of Healthcare Administration, University of Minnesota
- Bachelor of Arts in Health Information Management, College of St. Scholastica
Andrew Jacobsen
Principal
Nearly 20 years of experience driving revenue cycle transformation through end-to-end consulting engagements and interim leadership.
Meet Andrew Jacobsen
Andrew has approximately 20 years of experience assisting hospitals and health systems with identifying and implementing revenue cycle enhancements that have led to significant improvements in net revenue, cash flow, and key revenue cycle metric performance. Over the past several years, Andrew has been responsible for overseeing revenue cycle process improvement engagements at community hospitals, tertiary medical centers, and multi-hospital systems across the country.
Andrew has vast technical expertise and leadership experience in all areas of the revenue cycle including patient access, health information management, patient financial services, and vendor management. Prior to joining Pinnacle, Andrew was a project manager at a large healthcare consulting firm where he oversaw revenue cycle transformation projects and contributed to methodology development. Representative examples of Andrew’s experience include:
- Led the buildout of a redesigned revenue cycle organization structure and established core metric and accountability measures for critical revenue cycle functions while acting as the interim VP of Revenue Cycle at a west coast based health system on the Cerner platform
- Co-led a comprehensive revenue cycle engagement at a hospital in North Carolina that resulted in $6 million of annual income statement and significant key metric improvement
- Served as the interim Patient Financial Services Director at a multi-hospital system in Georgia, where he led a business office redesign project including implementation of Epic health information system, design/implementation of an accounts receivable coverage strategy, unbilled/billed AR reductions, implementation of metric reporting, and re-implementation of revenue cycle vendors
- Led the Utilization Management portion of an IP authorization reduction project with a west coast health system resulting in a 30% drop in IP auth denials
- Managed the patient access portion of an engagement at a multi-hospital system in Minnesota which included implementing a new pre-registration unit, improved eligibility / authorization / financial counseling workflows and reporting, and enhanced point of service (POS) cash collections, resulting in a 30% decrease in patient access related denials and significantly improved Medicaid conversions and POS cash collections
- Managed the revenue cycle portion of an Epic health information system design, install, and conversion project in Oregon which included developing best practice revenue cycle workflows and reporting
- Led the patient access and patient accounting portions of a revenue cycle transformation project at a health system in Hawaii which resulted in reduced days in AR, increased POS cash collections, and improved cash flow
Andrew’s Approach to Consulting
Andrew’s educational background in Psychology at UC San Diego, with their institutional focus on education and public service, positions him uniquely to navigate the intricacies of organizational transformation in the highly complex healthcare revenue cycle environment.
Andrew is a problem solver and a developer of people, and he drives positive change by building strong, open relationships at the individual level and across the organization.
Certifications & Professional Memberships
- Healthcare Financial Management Association
Education
- Bachelor of Arts in Psychology and History, University of California at San Diego
Brian Felland
Principal
18+ years of experience providing technical, functional, and leadership expertise in all areas of revenue cycle operations.
Meet Brian Felland
Brian has over 18 years of experience assisting healthcare providers with strategic revenue cycle optimization and transformation resulting in sustained increases in functional and financial performance. Over the past 2 years, Brian has been providing Revenue cycle support for 2 health systems focusing on operational, technical, and analytic integration and stabilization.
Brian has strong technical, functional, and leadership expertise in all areas of revenue cycle operations and has experience working in community hospitals as well as large multi-facility organizations. Prior to joining Pinnacle, Brian was a solutions advancement leader and project manager at Huron Consulting Group. Representative examples of Brian’s experience include:
- Provided interim leadership for a multi-facility patient accounting office in Georgia during a system conversion
Provided interim leadership for a large, multi-facility patient accounting office in Illinois during a system conversion and business office consolidation engagement - Developed and supported implementation and training of enhanced technical, reporting, and functional best practice methodologies over the span of 9 client revenue cycle implementations
- Led the patient access, denial management, and vendor management portions of a revenue cycle engagement in North Carolina with a focus on patient access technology optimization and design
- Managed the patient access, patient financial services, vendor management, and charge capture portions of a comprehensive revenue cycle engagement at a community hospital in Washington that resulted in $3.5 million of annual recurring income statement benefit
- Provided billing office and patient access analytic and workflow support for two multi-facility organizations
Brian’s Approach to Consulting
Brian invests in his clients with his hands-on and collaborative approach. He works with his teams to establish and sustain the most optimal solutions to meet each individual client’s need.
Certifications & Professional Memberships
- Healthcare Financial Management Association
Education
- Bachelor of Science in Molecular Biology, University of California at San Diego
- Bachelor of Arts in Economics, University of California at San Diego
Jim Martin
Principal
30+ years of experience implementing sustainable operational improvement, benefiting his clients with significant net revenue, process, and cost enhancement.
Meet Jim Martin
Jim has over 30 years of experience working with healthcare providers identifying and resolving their most pressing operational challenges. His primary focus and passion throughout his career has been implementing sustainable revenue cycle solutions. These efforts have resulted in millions of dollars of benefits in the form of both net revenue enhancement and cost improvement for his clients.
Jim has led numerous comprehensive improvement engagements with broad scope including revenue cycle, labor optimization, and expense management associated with supplies, purchased services, and clinical utilization. Prior to joining Pinnacle, Jim was a Managing Director and consulting leader for Huron Consulting Group, Wellspring Partners, and Arthur Andersen. Representative examples of Jim’s experience include:
- Served as the primary client service and relationship manager for numerous comprehensive performance improvement and revenue cycle engagements for large integrated delivery networks, academic medical centers, and large and mid-sized community hospitals. These projects consistently delivered tangible benefit resulting in 3% – 5% net revenue improvement and 5% -10% cost improvement.
- Provided overall project leadership for several distressed hospital systems. Responsible directly to the board and turnaround committee for establishing and implementing detailed plans for reorganization and operational improvement. Worked closely with internal and external stakeholders including banks, bond holders, and rating agencies during recovery process.
- Worked with the senior leadership of a regional integrated delivery network to establish their own internal process improvement infrastructure. Included establishing a leadership decision making process that identified, evaluated, and prioritized performance improvement opportunities and a project management office that managed and executed prioritized opportunities across the enterprise. The sustainable infrastructure coordinated, in an integrated way, all performance improvement activities and resources, both internal and external, to achieve desired performance outcomes and became the primary process for managing projects across the enterprise.
Jim’s Approach to Transformation
Jim is passionate about collaborating with clients to solve complex business problems. He takes time to understand the challenge considering the perspective of all the key stakeholders including both leaders and staff. He has found throughout his career that oftentimes the solutions to problems reside within the organization and simply need to be elevated, nurtured, and resourced properly to achieve the desired outcomes.
Certifications & Professional Memberships
- American College of Healthcare Executives
- Healthcare Financial Management Association
Education
- Master of Business Administration, Finance and Health Organization Management, Texas Tech University
- Bachelor of Arts, Political Science, Texas Tech University
Nick Fortman
Senior Director of Business Intelligence
Experienced in back-end revenue cycle management improvement, EHR optimization, and system implementations.
Meet Nick Fortman
Nick is a versatile and adaptable professional who has extensive experience managing healthcare revenue cycle projects and developing teams to deliver customized solutions. He leverages his technical experience to help clients better leverage the available tools and technologies to improve operational performance and reporting transparency. Nick has recently focused on implementation of Revenue Cycle tools driving operations in billing, follow-up, denials, underpayments, vendor management, and contract management.
Experience
Nick has spent his entire 15-year career as a revenue cycle performance improvement consultant with a focus on blending operational processes with technical solutions. In addition to Nick’s revenue cycle background, he is an expert in system implementations, analytics, report standardization, tool configuration, and validation. Representative examples of Nick’s experience include:
- Managed the implementation of a contract management system and underpayment optimization at a $9B health system with 20+ facilities
- Managed the implementation of a large-scale Revenue Cycle workflow implementation at five main locations of a $13B health system
- Developed workflow improvement plans, report sets, and risk mitigation strategies to support a large-scale health system during an EHR conversion and business office consolidation
- Spearheaded a hospital and physician revenue cycle optimization and software implementation engagement at a 400-bed health system, increasing recurring cash by $19M annually, 45% over projected goal by improving authorization rates, redirecting collection efforts, and denial prevention
- Planned and executed a project to redesign and implement denials workflows which resulted in reducing over $10M in AR backlogs by addressing pre-billing root cause issues, improving documentation, and establishing metrics to drive accountability
- Managed HIS optimization project for an academic medical center, reducing workload by over $49M during the project period and producing over $12M in annual benefit by addressing workflow redundancies, providing clear metrics, and establishing a structure to track and maintain progress
- Provided design, configuration, and delivery support of specialized revenue cycle management work-drivers and reporting suites across multiple simultaneous clients
Nick’s Approach to Consulting
Nick’s key to success is in breaking problems down into detailed components to build understanding before implementing lasting and sustainable solutions. He uses thorough documentation and confirmation analyses to ensure solutions are customized to address the root issues in a sustainable manner.
Certifications & Professional Memberships
- Healthcare Financial Management Association
Education
- Bachelor of Science Degrees: Finance, Decision Sciences, and Management Information Systems, Miami University
Kevin Blanchard
Senior Director
16+ years of experience guiding clients through front-end to back-end revenue cycle improvements and Epic HB go-live and post-live optimizations.
Meet Kevin Blanchard
Kevin has over 16 years of experience collaborating with healthcare organizations to drive enhanced revenue cycle performance. He has been responsible for leading patient access re-design efforts, accounts receivable reduction initiatives, and Epic electronic health record optimization engagements that have led to sustained improvements in net revenue, cash flow, automation, productivity, and reporting transparency.
Kevin has extensive experience developing methodologies and implementing solutions to enhance Epic revenue cycle functionality related to reporting, metric management, work queue (WQ) prioritization, and account flow. Prior to joining Pinnacle, Kevin was a project manager at Navigant Consulting, Inc. and Huron Consulting Group where he oversaw revenue cycle transformation projects and Epic revenue cycle implementations. Representative examples of Kevin’s experience include:
- Led the development and implementation of a comprehensive Epic HB WQ re-design to reduce overlap and WQ black holes, increase reporting transparency, and improve WQ stratification for billing, follow-up, denials/variance, self-pay, and credits. Outcomes included a net reduction of 600+ WQs and the identification and resolution of 15K+ accounts that were failing to qualify for staff WQs.
- Managed a remittance code (RMC) audit to ensure logic was designed in a way that accurately identified and routed denials within Epic to drive transparent reporting and accountability. This was coupled with a denial WQ re-design effort focused on WQ consolidation and black hole reduction. Finally, denial-specific Watch List metrics were developed to trend denial #/$ by owning area within Radar Dashboards.
- Led the Epic Candidate for Bill (CFB) go-live risk mitigation committee including the development of the CFB management team, achieving 3.4 days in CFB within 60 days of the Epic go-live.
- Co-developed methodology and functionality tied to Simple Visit Coding and MinDay (suspense days) reduction to increase automation and free up capacity in HIM
- Led the creation of a newly insourced self-pay unit at an Epic provider which included the development of scripting, account stratification, and low dollar write-off policies
- Implemented scheduling workflows to improve abandonment rates resulting in an abandonment rate of 2.3%. Developed metrics and dashboards to drive performance.
- Implemented custom metrics directly into Epic dashboards related to unworked denials, uncoded populations and vendor aging to drive transparency and accountability across the revenue cycle
Kevin’s Approach to Consulting
Kevin collaborates with hospitals to develop methodologies and solutions that increase reporting transparency, improve workflows, and reduce denials. Kevin understands the revenue cycle workflow and can work with teams to develop methodologies and tools to increase efficiency and improve outcomes. Kevin prides himself on his ability to connect and partner with various levels of management to work towards a desired outcome throughout an engagement.
Certifications & Professional Memberships
- Healthcare Financial Management Association – Credentialed as a Certified Revenue Cycle Representative
- Certified in Epic Resolute Hospital Billing
Education
- Bachelor of Business Administration, University of Colorado at Boulder
Leon Chang
Senior Director
More than 15 years’ experience in healthcare management and consulting with a focus on margin improvement.
Meet Leon Chang
Leon, who is also fluent in Mandarin Chinese (Putonghua), has approximately 17 years of experience in management and consulting with an emphasis on margin improvement. He has helped acute care and medical group clients overcome issues ranging from uncompensated care and avoidable losses to charge integrity and reimbursement optimization.
Leon has led complex engagements of multiple disciplines providing transformative value to clients. He has led large teams and coordinated the delivery of revenue, cost, throughput, network integrity, and value-based care initiatives. Prior to joining Pinnacle, Leon held leadership roles at Berkeley Research Group, The Claro Group, and Huron Consulting Group. Representative examples of Leon’s experience include:
- Transformed the centralized scheduling center for a 134-clinic health system leading to reduction in abandonment rate from 12% to 6% on 19,500 calls offered and fourfold acceleration in referral appointment scheduling on 3,500 consultation referrals received per week
- Led a team of 25+ consultants that resulted in an assessment opportunity of $33M and integrated delivery of $20M in income statement benefit at a $500M-net tertiary care hospital
- Implemented a denials management program that resulted in a 70% decrease in access-related payment denials and a $400,000 reduction in access-related insurance write-offs at a $310M-net community hospital
- Redesigned the billing and collection functions of a divisional business office that led to a rise of 26 days cash on hand in 5 months
- Built a point-of-service cash collection program that increased cash receipts from zero to 0.5% of net patient service revenue (NPSR) in 6 months at a $140M-net community hospital
- Oversaw the design, partner selection, and rollout of an enterprise-wide financial eligibility program that resulted in an additional $2.4M in annual cash receipts at a 174-bed, 27-clinic health system
- Designed and deployed automated service capture solutions that consistently led to revenue enhancement of 1.0% of NPSR at small to large provider organizations
- Held leadership positions in Berkeley Research Group’s innovation initiatives, including revenue cycle applied analytics and automation
Leon’s Approach to Consulting
Leon’s affinity for medicine, finance, and data motivates him to work beyond silos and take a theory-informed, evidence-based, and insight-driven approach to problem solving. His background in engineering allows him to evaluate situations analytically, and his collaborative interactions with front-line staff to executives ensure optimal and sustainable outcomes.
For Leon, the definition of a successful transformation is both an enjoyable process and the desired outcome.
Certifications & Professional Memberships
- Healthcare Financial Management Association
Education
- Bachelor of Science in Biomedical Engineering and Economics, Northwestern University
Vickie Bridge
Director
25+ years of experience working in and with healthcare organizations to enhance their clinical documentation and revenue integrity processes.
Meet Vickie Bridge
Vickie has over 25 years of experience working for and consulting with healthcare organizations to drive sustained improvements in net revenue and quality. She is skilled in overall revenue cycle management with expertise in clinical documentation, case management, and charge capture improvement which also positively impacts data quality and patient outcomes.
Vickie has an extensive background with several unique knowledge sets in the areas of traditional health information management (HIM), revenue integrity, utilization review, and quality management. Over the course of her career, she has gained deep experience in completing patient chart and claim reviews, analyzing data, developing educational materials, guiding work plan execution, and implementing on-going monitoring to sustain outcomes. Prior to joining Pinnacle, Vickie was a Project Manager at BRG | Prism and Huron Consulting Group, and she has also served in leadership roles at healthcare organizations. Representative examples of Vickie’s experience include:
- Achieved $3.2M annual net revenue increase for a community-based hospital by enhancing emergency department (ED) clinical documentation and charging structure
- Developed Medicare Annual Wellness Visit program enhancements resulting in a $714K increase in annual net revenue
- Drove $2.4M annual net revenue increase for a community-based hospital by improving clinical documentation, charge capture, and charge structure within the ED, perioperative services, endoscopy, and cardiac cath lab
- Increased annual net revenue for a regional medical center by $4.1M by improving clinical documentation and charge capture processes for outpatient infusion therapy, recovery room, and ED supplies
- Served in HIM, utilization review, quality, physician practice, and patient accounting leadership roles at several healthcare organizations in Indiana
Vickie’s Approach to Consulting
Vickie builds solid client relationships across all levels of the organization to better understand the client’s mission, methodologies, strategies, and culture. She works in collaboration with clients to identify revenue cycle and clinical opportunities. For each opportunity, Vickie confirms the current state, identifies barriers, and develops an actionable future state to establish the ideal sustainable solution to meet the client’s need.
Certifications & Professional Memberships
- Registered Health Information Administrator (RHIA)
- Lean Six Sigma Green Belt
- American Health Information Management Association
- Indiana Association for Healthcare Quality
Education
- Master of Business Administration, Indiana Wesleyan University
- Bachelor of Science, Indiana University School of Medicine
Veronica Molares
Director
Over 16 years of experience in healthcare developing strategic solutions resulting in sustained improvements to overall revenue cycle productivity and efficiency.
Meet Veronica Molares
Veronica has over 16 years of experience working with healthcare organizations to develop strategic solutions to improve overall revenue cycle performance. She has managed multiple Epic revenue cycle installations from a build perspective to produce efficient and enhanced workflows. Veronica bridges the gap between operations and IT by working on both teams to ensure quality outcomes.
Veronica has extensive experience successfully implementing multiple financial systems, enhancing revenue integrity, and identifying technology improvement opportunities. Before joining the Pinnacle team, Veronica worked in various revenue cycle roles in IT and operations for large and complex healthcare organizations. Representative examples of Veronica’s experience include:
- Served as Patient Financial Services Director at a tertiary medical center in Georgia and had responsibly for the overall operational performance and strategic direction of the business office for multiple acute and critical access hospitals
- Led IT and operational revenue cycle teams in deploying new Epic installations from kick-off through build completion and go-live support
- Led Epic stabilization and optimization project under the revenue integrity department by refining revenue capture with clinical and ancillary departments and collaborating with IT and revenue integrity team members on solution design and execution
- Served as Epic Resolute Hospital Billing & Claims Lead in both Single Billing Office (SBO) and non-SBO environments
- Spearheaded build and optimization of Epic revenue routing, revenue integrity and Revenue Guardian for three hospitals, hospice, and two long term care facilities
- Developed and managed Epic change control policy and change advisory board during implementation and Go Live
Veronica’s Approach to Consulting
Veronica believes there is a balance between innovative technological capabilities and the human element that can impact the success of revenue cycle. She thrives in environments that desire to increase the integration between the two areas for long-term solutions. Veronica has a passion for process improvements and building relationships across teams that result in an increase in productivity and system efficiency.
Certifications & Professional Memberships
- Certified in Epic Resolute Hospital Billing SBO
- Certified in Epic Claims
- Certified in Epic Resolute Electronic Remittance
- Proficient in Epic Charge Router
- Epic Data Courier / Data Migration and Financial Assistance Modules
- Lean Six Sigma Yellow Belt
Education
- MBA, Saint Leo University
- B.S. Health Science, University of Florida
Ryan Hutten
Director
Experience partnering with healthcare systems to develop tailored solutions in back-end revenue cycle to increase revenue and productivity.
Meet Ryan Hutton
Ryan has over 11 years of experience in healthcare and multiple Epic revenue cycle certifications. He has a unique blend of clinical and revenue cycle operations and Epic applications experience and utilizes his expertise to provide holistic solutions to his clients.
Ryan started his career as a radiologic technologist and transitioned into the Epic world as a clinical and then revenue cycle build analyst. Ryan has deep expertise in charge generation optimization, Epic technical build, and revenue cycle workflows. Prior to joining Pinnacle, Ryan was a Managing Consultant at Guidehouse (formerly Navigant), and he also served as an Epic analyst at 2 healthcare systems. Representative examples of Ryan’s experience include:
- Managed the design and implementation of Epic Revenue Guardian (RG) edits for multiple clients
- Created and deployed detailed workplans for all RG ancillary build including workqueue (WQ) structure, DNB configuration, Epic Radar Dashboards, and benefit tracking reporting utilizing Epic extracts
- Served as the lead HB/PB implementation analyst for new facilities, departments, and community connect affiliates
- Developed internal Revenue Cycle Readiness Program for new affiliate go-lives
- Led build design, testing, and post live troubleshooting workgroups
- Led team responsible for creation and optimization of workflows to increase business office efficiency and productivity
- Managed oversight team in deployment of automated system letters, business office smart phrases, account WQ routing, and write-offs
- Managed conversion of Meditech to Epic for self-pay and customer service workflows for multi facility healthcare system
Ryan’s Approach to Consulting
Ryan partners with healthcare systems to design solutions and workflows that increase revenue and user productivity. Ryan has clinical experience as a former Radiologic Technologist and understands that revenue cycle begins during patient care. He leverages this along with his extensive technical background in back-end revenue cycle processes to produce proven results. Ryan enjoys connecting with his clients to understand their objectives and tailors the solutions to fit the need and achieve the best possible outcomes.
Certifications & Professional Memberships
- Epic Resolute Hospital Billing Administrator
- Epic Resolute Professional Billing Administrator
- Epic Resolute SBO Administrator
- Epic HIM – Coding Administrator
- Epic Cogito Administrator
- RT(R) – Radiologic Technologist Registered
Education
- Associate of Science, Rock Valley College
Marci Mollman
Director
Bringing people, processes, and technology together to drive operational change and growth.
Meet Marci Mollman
Marci has 17+ years of experience helping hospitals and health systems achieve operational and technology improvements within patient access and the overall revenue cycle. She is goal oriented and has a demonstrated record of building relationships, motivating change, managing projects from concept to completion, and coaching associates to success.
Marci has experience in all facets of revenue cycle but is most passionate about the patient access realm. She has spent considerable time implementing changes to make the people, processes, and technology in this space better. Prior to joining Pinnacle, she directed teams and projects that led to achieving goals and best practice metrics. Examples of Marci’s experience include:
- Served as Patient Access Director where she successfully integrated 5 new registration areas during her tenure, including standing up a call center
- Achieved multiple KPI increases in both a director and consultant capacity: Increased registration quality, achieved the highest tier for associate engagement, increased POS collections, and reduced denials and claim edits
- Led 10+ successful implementations of new software and/or modules within the EMR and acted as a liaison between analysts and operations
- Redesigned training programs and created new material for patient access at 8 different facilities
- Built out standardized financial modeling approaches for AI automations
- Responsible for project management and leadership of multiple verticals in both operational and technical capacities
Marci’s Approach to Consulting
Marci is passionate about bringing people, processes, and technology together to drive operational change and growth. She appreciates any opportunity to collaborate with stakeholders to make an impact and work towards sustainable solutions.
Certifications & Professional Memberships
- Certified in Epic Cadence, ADT/Prelude, Grand Central and Hospital Readiness
- Healthcare Financial Management Association – Certified Healthcare Financial Professional (CHFP)
- Certified Health Access Manager (CHAM)
Education
- Master of Business Administration, University of the Southwest
- Bachelor of Science in Education & Business Administration, Black Hills State University
Ehson Afshar
Director
13+ years of consulting experience developing strategic and tailored revenue cycle solutions to drive bottom line cash improvement.
Meet Ehson Afshar
Ehson has over 13 years of experience supporting hospitals across the entire range of the revenue cycle, from patient access to business office operations. He has demonstrated continued success in building strong relationships, driving operational improvements, and implementing technology changes to improve the bottom line.
Ehson has led projects to drive net revenue recovery including denials reduction, AR aging reduction, workflow tools implementation, and front-end financial clearance. Ehson has expertise across the full revenue cycle with a specialization in denials prevention and management. Prior to joining Pinnacle, Ehson led project teams with a focus on implementing leading practice operations and surpassing key performance metric goals. Representative examples of Ehson’s experience include:
- Installed comprehensive denials prevention program that resulted in 3% lower denial rate, translating to $3M annualized revenue lift. Collaborated with 40+ leaders across four facilities to identify denial trends and implement corrective initiatives
- Spearheaded creation of centralized denials team including hiring, training, and work driver / tool development. Resulted in increased appeal collections and decreased write-offs (0.2% reduction in write-off rate)
- Directed initiatives to reduce AR agings, decreasing AR over 90 days by 6% through persistent escalation of root cause issues with problematic payers and accelerated account resolution
- Led 8 outpatient medical necessity initiatives to drive $3M in annualized benefit, partnering with 5 directors across an academic health system
- Centralized and redesigned financial clearance processes at a multi-hospital system, increasing clearance rate from under 60% to over 90%
Ehson’s Approach to Consulting
Ehson passionately believes in utilizing technology and data to identify and prioritize the top issues facing hospital systems. He strives to understand these issues by analyzing and interacting with all levels of the organization, from front-line staff to executives. He uses objective knowledge from data and subjective data from surveying the organization to develop customized solutions from the ground up that impact the bottom line.
Certifications & Professional Memberships
- Healthcare Financial Management Association – Certified Revenue Cycle Representative (CRCR)
Education
- Bachelor of Arts in Economics & Mathematics, Vanderbilt University
Yuri Karev
Manager
Experienced in supporting hospitals and health systems improve their approach to revenue cycle, both through technological optimizations and targeted coaching.
Meet Yuri Karev
Yuri has several years of experience in supporting hospitals and health systems improve their approach to revenue cycle, both through technological optimizations and targeted coaching. Recently, Yuri has been responsible for mitigating denials and write-offs within the Service Delivery (middle Revenue Cycle) space, leading to several million dollars in additional net revenue.
Yuri has worked across all areas of the revenue cycle, from ensuring a patient is appropriately pre-registered to actively appealing a denial. Prior to joining Pinnacle, Yuri worked as an associate at Alvarez & Marsal and Huron Consulting Group. Some examples of Yuri’s project work include:
- Developed & implemented metrics within the Care Management Revenue Cycle (CMRC) which included an Inpatient Authorization Approval rate, a Payer Response Rate for authorizations, and Escalations by Issue Type which identified encounters that were likely to receive denials for level of care
- Outlined & improved processes for Peer-to-Peers, Escalations, and Concurrent Denials through collaborative sessions with CMRC Leaders and employees, which have streamlined efficiency and provided more reporting opportunities
- Ran daily reports within both Cerner and Panther which allowed for improved communication between on-site leaders & the remote team for timely escalations, and improved outcomes by identifying at-risk encounters that were missing Authorization
- Stood-up a central billing office which led to overseeing vendor strategy, AR follow-up, and UCR standardization by state for a 20+ office dental organization
- Created 30+ policies and procedures ranging from consent forms to posting guidelines for an oral specialty organization
- Assessed opportunity areas and implemented quick hit strategies such as zero-dollar charge workflows to improve a joint venture targeting patient lifestyles
- Performed a pro forma review for a joint venture involving urgent cares to identify the impact that COVID and E&M changes had on expected vs actual performance
- Led denial prevention efforts for a $10BN+ hospital system which resulted in a $12MN annualized reduction of timely denials
- Oversaw front-end tool sustainability with patient access manager which led to urgent due diligence complete rates rising from 45 to 93%
- Managed roll-out of a revamped ambulatory denial strategy for engaging disparate clinic leaders in the system denial process
Yuri’s Approach to Consulting
Yuri believes that organizations should be empowered to use data to identify opportunities and streamline communication to create tactical plans and achieve sustainable results. He understands the importance of collaborating with leaders and staff to develop unique, long-term solutions that work for each place he partners with.
Education
Bachelor of Arts in Economics, University of North Carolina at Chapel Hill
Andrew Tyus
Manager
10+ years of experience implementing sustainable revenue cycle improvement for his clients including leveraging emerging technologies and partnership strategies such as robotic process automation (RPA), artificial intelligence (AI), advanced digital capabilities and outsourcing.
Meet Andrew Tyus
Andrew has over 10 years of experience assisting healthcare organizations achieve their strategic and operational goals through revenue cycle improvement. With a focus on people, process, and technology optimization, Andrew has successfully led numerous revenue cycle solution implementations for critical access, community-based, and academic hospitals. Some examples include:
- Led several successful digital transformation implementations in the areas of patient access and financial services. These efforts targeted patient engagement as well as reducing repetitive back-office tasks by leveraging digital assets and RPA technology.
- Led denials management program for $5B net patient service revenue (NPSR) health systems resulting in material cash flow and net revenue improvements
- Re-designed business office workflow resulting in increased productivity, improved employee satisfaction, and improved cash collections
- Improved operational metrics and efficiencies by optimizing revenue cycle processes and leveraging previously under-utilized technology investments. Results included achieving previous un-realized ROI on these technology investments and a material improvement in cash collections, reduced denials, and net revenue improvement
- Implemented a consolidated business office for 3 critical access hospitals to achieve efficiencies in staffing and an overall reduction in the cost-to-collect across the network
- Performed complex analyses including cost-to-collect for critical access hospitals resulting in the development of an improvement plan that ultimately enhanced collection activities and reduced cost -to-collect
Andrew’s Approach to Transformation
Andrew has a passion for understanding the client business challenges, doing the research, collaborating with client colleagues, and leveraging technologies all in the spirit of achieving the client’s desired outcomes.
Certifications & Professional Memberships
- National Association of Health Services Executives
- Healthcare Financial Management Association
Education
- Master of Business Administration, Michigan State University
- Bachelor of Arts in Psychology, Michigan State University
Liz Hendricks
Operations Manager
13+ years’ experience supporting business operations.
Meet Liz Hendricks
Liz has over 10 years of experience supporting the operations of healthcare consulting companies. With SPHR certification, Liz’s area of specialty is Human Resources. Liz works to identify opportunities for increased efficiencies and decreased costs while maintaining quality and compliance.
Certifications & Professional Memberships
- Society for Human Resource Management
- Society for Industrial Organizational Psychology
- PHR – Professional in Human Resources Certification
- SPHR – Senior Professional in Human Resources Certification
Education
- Master of Arts in Industrial Organizational Psychology, Central Michigan University
- Bachelor of Arts in Psychology, Capital University