Medicare Revenue Manager at Presbyterian Healthcare Services
Albuquerque, New Mexico Area
- Current
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- Medicare Revenue Manager at Presbyterian Healthcare Services
- Past
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- Medicare Operations Manager at Presbyterian Healthcare Services
- I/S Medicare Service Manager at Presbyterian Healthcare Services
- Manager, Financial Planning at Presbyterian Healthcare Services
- Manager, Financial Systems and Quality Control at Lovelace Sandia Health System
- Manager, Financial Planning at Presbyterian Healthcare Services
- Education
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- Arizona State University
- Connections
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24
connections
- Industry
- Hospital & Health Care
Jennifer Lewis’s Experience
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Medicare Revenue Manager
Presbyterian Healthcare Services
(Non-Profit; Hospital & Health Care industry)
September 2008 — Present (1 year 5 months)
Ensures the Medicare program receives the appropriate amount of Medicare reimbursement for members enrolled in Medicare Managed Care Products, including the development, implementation and oversight of a department that will be responsible for Medicare revenue optimization through the analysis of medical and pharmacy claims, prospective and retrospective review data and related functional activities to support unit and enterprise goals. Responsible for the strategic planning, development and standardization of Medicare Reimbursement processes and responsibilities throughout multiple business units and departments. Works closely with both health plan operations, Presbyterian Medical Group and other state-wide contracted providers to develop processes to ensure that coding of diagnoses is complete and accurate. Promoted to position.
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Medicare Operations Manager
Presbyterian Healthcare Services
(Non-Profit; Hospital & Health Care industry)
August 2007 — September 2008 (1 year 2 months)
Ensures operational compliance with Centers for Medicare & Medicaid Services (CMS) regulations. Project lead for annual CMS Medicare bid filing process. Project lead for annual benefit configuration process with I/S, ensuring ID card and Facets configuration is correct and compliant with plan bid. Interpreted CMS regulations, developed projects plans, and established work groups to implement new or revised regulations. Reviewed marketing and member materials to ensure compliance with CMS and Presbyterian marketing guidelines. Prepared Annual Notice of Change (ANOC) Medicare member materials and applied clear understanding of Medicare requirements and solid editing skills to ensure materials were compliant. Responsible for Plan to Plan (P2P) payment, tracking, and reconciliation. Promoted to position.
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I/S Medicare Service Manager
Presbyterian Healthcare Services
(Non-Profit; Hospital & Health Care industry)
September 2005 — August 2007 (2 years )
Liaison for all Medicare-related issues between I/S and business units in cross-functional departments: Medicare Administration, Pharmacy, Medicare Enrollment, and I/S. Successfully managed Facets conversion activities and interfaces to Market Prominence and Medicare Part D implementation in first 3 months in position. Worked directly with Vice President of PHP Medicare Program and independently with business areas to provide technical support for applications, business analysis and project leadership for Medicare product. Managed monthly production process for the Part D Explanation of Benefit (EOB) letters, Prescription Drug Event (PDE) file submission, Coordination of Benefits (COB) reporting, encounter submission (RAPS), Medication Therapy Management (MTM) letters and reporting. Organized and led cross-functional teams to analyze and solve business issues relating to CMS compliance and PHP’s pharmacy vendor, SXC.
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Manager, Financial Planning
Presbyterian Healthcare Services
(Non-Profit; Hospital & Health Care industry)
February 2004 — September 2005 (1 year 8 months)
System administrator for the Eclipsys Sunrise Decision Support Manager system (TSI). Refined the annual system update and net revenue budgeting processes for efficiency. Developed new audits and automated reject posting to improve system data accuracy. Budgeted $340M annual gross and $178M net revenues for 5 regional hospitals. Supervised staff of three analysts and served as point of contact for users encountering system issues. Educated, trained and empowered TSI users to extract data, relieving staff of reporting duties. Communicated system changes to Finance and other appropriate hospital departments. Provided financial, clinical and statistical reporting to senior leadership and hospital operations staff. Provided support for annual strategic planning cycle regarding baseline data and integration of individual business unit initiatives.
Managed relationship with software vendor, Eclipsys. Facilitated allocation of $75M capital budget for major and minor capital. Coordinated five-year capital and financial plans for eight hospitals, health plan and physician group. Developed hospital capitated payer reporting and analyzed direct/indirect costs of inpatient and outpatient encounters. Provided adhoc financial, clinical and statistical reporting to senior leadership and hospital operations staff. Provided support for annual strategic planning cycle using Kaufman Hall ENUFF software. -
Manager, Financial Systems and Quality Control
Lovelace Sandia Health System
(Public Company; Hospital & Health Care industry)
December 2002 — February 2004 (1 year 3 months)
Finance Team Lead for IDX system conversion to Cerner and implementation of CyberView data repository. Team Lead for asset management conversion from Best to Lawson fixed assets, developing the conversion process and preparing conversion files for 8K+ assets. Coordinated Oracle general ledger system conversion to Lawson, mapping account and cost center structures to parent company standards, assessing departmental reporting needs and verifying historical data loads. Directed pharmacy audit quality control function, supervising one analyst. Provided monthly IDX, Medics, Cash, Payroll and banking interfaces to Lawson. Developed and automated Daily Operations Productivity Reporting.
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Manager, Financial Planning
Presbyterian Healthcare Services
(Non-Profit; Hospital & Health Care industry)
April 1999 — December 2002 (3 years 9 months)
System administrator for the Eclipsys Sunrise Decision Support Manager system (TSI). Refined the annual system update and net revenue budgeting processes for efficiency. Developed new audits and automated reject posting to improve system data accuracy. Budgeted $340M annual gross and $178M net revenues for 5 regional hospitals. Supervised staff of three analysts and served as point of contact for users encountering system issues. Educated, trained and empowered TSI users to extract data, relieving staff of reporting duties. Communicated system changes to Finance and other appropriate hospital departments. Provided financial, clinical and statistical reporting to senior leadership and hospital operations staff. Provided support for annual strategic planning cycle regarding baseline data and integration of individual business unit initiatives.
Managed relationship with software vendor, Eclipsys. Provided support for annual strategic planning cycle using Kaufman Hall ENUFF software.
Jennifer Lewis’s Education
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Arizona State University
Bachelors Degree , Finance , 1985 — 1991
- Activities and Societies:
- Alpha Kappi Psi business fraternity
Additional Information
Jennifer Lewis’s Groups:
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Alpha Kappa Psi -
W. P. Carey School of Business at Arizona State University -
Medicare Advantage Healthplan Colleagues -
The Business of Medicare Advantage Forum -
Medicare Risk Adjustment -
Risk Adjusted Rev Mgt
Jennifer Lewis’s Contact Settings
Interested In:
- career opportunities
- job inquiries
- expertise requests
- reference requests
- getting back in touch
