Beth Anderson-Lenkey
New Salem
Summary
Results-driven professional with extensive experience in revenue cycle management and healthcare analytics. Proven track record in developing programs that streamline operations, reduce readmissions, and enhance patient care outcomes.
Overview
29
29
years of professional experience
1
1
Certification
Work History
RN Revenue Cycle Specialist- Analyst/ Inpatient /Operations Manager
WVU Hospital Uniontown
Uniontown
07.2024 - Current
- Review clinical documentation appropriateness for primary DRG for high-risk cases.
- Analyze process of the revenue cycle for gaps
- Apply CMS CPT, ICD-10, and Local Medicare Policy guidelines.
- Prepared data analytics for senior leadership, highlighting potential and current revenue losses across multiple hospital departments.
- Collaboration with CDI, Appeals Management and Utilization review.
- Developed Physician Advisor Program to enhance clinical documentation and support revenue integrity.
- Managed denial claims process, ensuring timely resolution and minimizing revenue impact.
- Program development to reduce denials.
Director of Patient Care Management and Social Wor
WVU Hospital Uniontown
Uniontown
03.2021 - 07.2024
- Led training for staff on transitioning to Epic and Carport Health platforms to enhance user proficiency.
- Redesigned utilization review and transitional care teams to enhance efficiency.
- Implemented initiatives for social determinants of health to improve community healthcare equity.
- Managed patients in emergency department with social and behavioral health needs.
- Aligned discharge planning processes with federal regulations and resource utilization.
- Streamlined ER admission process to accurately capture care levels and improve patient flow.
- Established command center to optimize patient transitions and expedite transportation.
- Developed strategies for readmission reduction, contributing to improved hospital outcomes.
Director of Medicine Services
Mon Health Care Morgantown
Morgantown
02.2020 - 02.2021
- Delivered strategic feedback to leaders and directors on performance-related goals, enhancing alignment with organizational objectives.
- Managed budget planning and resource allocation for departmental projects, ensuring optimal use of financial resources to support initiatives.
- Established performance metrics to monitor progress towards strategic goals in healthcare delivery.
- Directed the organization's daily operations, ensuring compliance with applicable laws and regulations.
- Promoted collaboration between teams by establishing open communication channels, fostering a culture of teamwork and shared objectives.
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Developed policies and procedures to ensure compliance with corporate standards.
- Collaborated with senior leadership to set long-term objectives for the company.
- Engaged in federal, state, and local surveys and inspections to support compliance.
- Established systems for assessing quality of care and health services.
- Maintained affiliations with primary care providers to ensure patient continuity.
- Developed relationships with key referral sources and healthcare organizations.
- Implemented clinical practices for COVID-19 patients effectively.
Director Care Management, Transitions of Care, Den
Fairmont Region Medical System
Fairmont
07.2018 - 02.2020
- Identified clinical documentation errors and led educational sessions for physicians to enhance compliance.
- Decreased Part B rebilling by 24% within three months.
- Reengineered utilization review process, reducing denials by 75%.
- Implemented physician education sessions to ensure alignment with CMS regulations and improve documentation accuracy.
- Increased capture of higher case weighted payment through strategic initiatives.
- Established internal physician advisory program to provide ongoing support and education, fostering continuous improvement in clinical practices.
- Integrated telehealth services into home health agency, achieving zero readmissions in three months.
- Enhanced HCAHPS scoring for transitions of care from 20th to 60th percentile within three months.
Interim AVP Care Management for System Wide Servic
University of Texas Medical Branch
Galveston
09.2016 - 03.2018
- Developed business plan for undocumented and unfunded patients to self-administer IV antibiotics within their own home. Currently developing the plan for implementation in FY 18.
- The redesign of RN Care Management program resulted in UTMB ranking among the top twenty academic medical centers (AMC) in 2017, placing ninth from the previous year of seventy-six. The redesign of RN CM led UTMB to receive efficiency scores, moved from 98th place out of 102 to 27th place out of 107 and the efficiency scores moved from 47th place out of 102 to 14th out of 107. UTMB is now a 5-star academic health center.
- $5.6 Mil. saved, RN Case Management service restructuring which resulted in decreased length of stay from 5.9 to 3.9, FY 17
- Average nine hundred days saved each month, FY17.
- Retained $4.5 Mil through restructuring Community Health Program (CHP), Care Transitions, and Community Health Worker services, decreasing unplanned readmissions from 15.9% to 11.9%, FY 17.
- Projected $6 Mil. retained from Utilization Review restructure and newly designed Physician Advisory services within the Health System
- Created and implemented Physician Advisory Program to enhance care coordination and decision-making.
- Developed and implemented policies and procedures.
- Created an infrastructure of centralized Utilization Management functions.
- Implemented training modules to standardize Care Management practices across the system.
- Re-institute the Utilization Review Committee
- Updated the Utilization Review Plan to current CMS Regulations
- Educated the system on state/federal laws and regulations.
- Implemented programs for Population Health Management
- Disease Management trending and program evaluation
- Implemented UR RN within patient access/ surgical scheduling.
- Implemented an UR RN within emergency services.
- Created Population Health Management programs within UTMB downstream providers.
- Instituted Cardiac Care – Heart Care Program /Heart Failure to Home
- Decreased ALOS from 5.9 to 4.1 within 6 months
- Developed IT data system to track and analyze avoidable delay metrics in patient care.
- Implemented Observation Task Force, Physician Advisor Lead
- Instituted Physician Advisor Appeals and Denials process.
- Created Downstream Provider Symposium, “Partnership for Patients”
- LTACH integration within the ICU
- Payment structure, Contracts Tiered for unfunded, Post-Acute Care
- Implemented High Risk complex rounding with MD service.
- Institute daily Patient Care Rounds within the individual patient care units.
- Integrated “Transitions of Care Team” within the hospital setting
- Realigned Observation billing process
- Initiated “Extended Recovery” process to appropriately manage and bill.
- Participated with governance of State grants for “Community” alignment for patients.
- Governance Team member for eliminating variances in physician practices.
- Built data analytics for capturing KPI.
Director Care Management –Resource Center /Appeal
Allegheny Health Network Systems
Pittsburgh
12.2014 - 08.2016
- Redesigned care management department at Allegheny General Hospital, managing one manager, two senior leads, 40 RNs, 18 social workers, and 20 resource staff to improve operational efficiency.
- Piloted redesigns at main campus, integrating across health care system.
- Implemented triage model, reporting 14,000 days avoided and $8.3 million saved within four months.
- Decreased average length of stay from 6.5 to 4.99 days.
- Integrated post-acute care services, achieving full capture of DME, 89% of health care at home, and 56% of hospice services to enhance patient support.
- Established transitional care liaisons for COPD, CHF, and diabetes management to reduce readmissions below 8%.
- Redesigned utilization review process to align with revenue cycle, improving communication and operational alignment.
- Facilitated weekly internal meetings with payers to develop transitional care plans.
Executive Director Case Management/Clinical Documentation Specialist
Weirton Medical Center
Weirton
07.2014 - 12.2014
- Reengineered clinical process for level of care assignment to ensure timely and accurate patient classification.
- Developed billing and registration process that increased revenue through precise care level assignments.
- Educated staff on CMS two-midnight rule, enhancing compliance and understanding.
- Redeveloped processes for CMS liability limits by initiating observation letters and non-coverage notifications.
- Implemented CMS 42 CFR 482.30 with second-level utilization reviews and regulatory documentation.
- Facilitated monthly executive meetings to educate physicians on CMS transmittals and practice regulations.
- Improved clinical documentation process with ICD-10-specific query forms, boosting accuracy.
- Created focus group to identify and implement performance improvements in physician documentation, ensuring consistency.
Transitional Leader Case Management - HealthLinx C
University of Virginia Medical Center
Charlottesville
06.2013 - 07.2014
- Re-developed Case Management to follow Medicare regulations under 42 CFR Conditions of Participation . Building Case Management from the ground up.
- Established collaborative processes with revenue cycle, patient financial services, and case management, enhancing overall workflow efficiency.
- Created pathways for clinical and financial services to provide best practices, by redeveloping the Clinical Documentation Specialist role for improved physician documentation, DRG assignment.
- Implemented compliance regulation for Quality and Finance I.e., Hospital Issuance of Notification of Non-Coverage, developing policies and procedures.
- Conducted educational sessions for Case Management Certification, boosting staff knowledge and skills in case management best practices.
- Guided senior leadership and on Outcome Driven Deliverables such as decreasing lengths of stay, decreasing readmissions, capturing physician documentation for the two midnight stay, implementing part B rebilling procedures.
- Integrated the Transfer Center into a Case Management Model to capture the correct patient population for best practices.
- Integrated Case Management IT systems with a Tele Track patient tracking system, enabling identification of 30-day readmissions, pending discharges, and length of stay alerts.
- Within three weeks we identified critical broken process within the revenue cycle and implemented strategies to reduce current losses. Estimated $2.8 million with one case.
Director of Patient Care Management
Uniontown Hospital
Uniontown
10.2010 - 10.2013
- Created DRG Validation position under the Clinical Documentation Specialist and raised the CMI from 1.20 to 1.39 within three months.
- Implemented services to review Traditional Medicare Surgical cases for hip and knee replacement and within 1 month decreased per payment denials from seven per month to zero with savings to the hospital of $250,000 in 1 month.
- Increased the response rate of physician queries from 72% to 95% resulting in additional financial gains of $300,000+ per month.
- Reduced all-cause readmissions from 19% to 7% per month within one year and decreased same-cause readmissions from 14% to 2.5% by implementing Transitions of Care Coach.
- Renovated patient assessment tool to align with Joint Commission standards for discharge planning, enhancing compliance and care transition.
- Reduced costs for physician advisory services by 30%, resulting in monthly savings of over $40,000 without an increase in denial rates.
- Participated in Highmark Blue Cross initiative for reducing readmissions, contributing to hospital's $100,000 funding for improved patient outcomes.
- Contributed to Highmark Blue Cross initiative, securing up to $100,000 for reduced readmissions and supporting community assessment projections tool implementation.
Outcomes Manager for Case Management
West Virginia University Hospital
Morgantown
07.2005 - 10.2010
- Cost savings of up to $50,000+ per patient case through implementing the Halo Team to review outlier cases to decrease costs; team included the CFO, VP of Professional Service, Director of Billing, and Director of Case Management.
- Decreased average LOS of medical patients by two days through implementation of the Huddle Project, enhancing patient flow and resource utilization.
- Developed staff education that led to additional FTEs for clinical preceptors in Case Management; this program trained staff in the basic principles of Case Management
- Developed the Medical Access Referral (MAR) line to assist the medical physician with direct admission and the placement of patients in the correct level of care increasing direct admits by thirty per day and over $5,000 per inpatient day.
- Saved over $100,000 within the first month by initiating a new Pre-Acute RN Case Manager position to capture the patient assigned for Surgery on an inpatient or outpatient basis.
- Completed staff development for nurses, social workers, and non-professional services through performance reviews, education, hiring, budget planning, and quality management.
Case Management Professional/ Access Manager for a
Monongalia General Hospital
Morgantown
07.2003 - 07.2005
- Increased the hospital’s Press Ganey Patient Satisfaction scores to the highest level in the hospital’s history from 30% to 98%.
- Decreased wait times to 15 minutes through redesign of the pre-admit process for patients requiring pre-admission testing, labs, imaging, etc.
- Eliminated lost charts and untimely filing in the billing cycle through a re-design of the scanning operations of outpatient charts for billing and work with technical department.
- Saved approximately $300,000 for a new system and ensured the captures of the billing process to recoup up to an estimated $100,000 loss per month through removal of the scanning process from the registration area into Medical Records
- Removal of scanning process also led to a decrease in wait times for registration by adding the FTE back into the registration process and customer service line.
- Restored FTE to registration, improving customer service and reducing overall wait times.
Clinical Care Coordinator
West Virginia University Hospital
Morgantown
07.2003 - 08.2004
- Educated physician groups on level of care assignment and revenue cycle roles, enhancing understanding and compliance.
- Initiated development of access RN case manager position to enhance patient support.
- Launched medical access referral line to streamline patient coordination.
- Streamlined services between patient access and registration, ensuring accurate surgical procedure billing.
- Reduced average length of stay from three days to 1.5 days, achieving cost savings of up to $2,000 per case.
- Integrated case management services for emergency department and observation unit, improving care for up to thirty patients daily.
- Developed efficient workflows to enhance patient registration processes and ensure billing accuracy.
- Facilitated collaboration between departments to optimize operational efficiency in patient care.
Emergency Department RN /Pediatric RN
Uniontown Hospital and WVUH
Uniontown
07.1997 - 06.2003
- Assisted in emergency procedures, providing life-saving interventions.
- Administered medications and monitored patient responses to ensure optimal outcomes in critical care settings.
- Collaborated with interdisciplinary teams to develop and implement effective patient care plans.
- Conducted assessments to identify patient needs and coordinate appropriate services.
- Educated patients and families on health management and discharge instructions to promote understanding and adherence post-discharge.
- Documented patient progress in electronic medical records to maintain accurate and comprehensive care history.
- Advocated for patients' rights, ensuring adherence to ethical nursing practices.
- Trained new nurses on protocols, safety standards, and best practices in care delivery.
Education
MBA - Business Administration
West Virginia University
Morgantown, WV06-2003
Bachelor of Science - Nursing
Waynesburg College
Waynesburg, PA 07-1997
Skills
- Revenue cycle management
- Utilization review
- Clinical documentation
- Healthcare analytics
- Clinical care management
- Care coordination
- Value-based care strategies
- Data analysis
- Integration, Cerner, Meditech, Epic, Sorian, Midas
- EMR systems
- OR and ER experience
- Coordinating referrals
- Patient care planning
- Patient relations
- Resource allocation
- Process improvement
- Team leadership
- Staff training
- Effective communication
Conflict resolution
Integration, Cerner, Meditech, Epic, Sorian, Midas
Accomplishments
Pre-Hospital Registered Nurse –PHRN
Preceptor Training Case Management
Mastering Medical Necessity
West Virginia Leadership
Certification
- National Board for Case Management - Accredited Case Manager- ACM
Custom Section 1
PROFESSIONAL AFFILIATIONS, HONORS, PUBLICATIONS_____________________________________________________________________________
American Case Management Association- Board Member
Sigma Theta Tau International Honor Society of Nursing member since 1995
American College of Healthcare Executive -Member
Publish Author, Childre4ns Book/Rythmic Reading
Timeline
RN Revenue Cycle Specialist- Analyst/ Inpatient /Operations Manager
WVU Hospital Uniontown
07.2024 - Current
Director of Patient Care Management and Social Wor
WVU Hospital Uniontown
03.2021 - 07.2024
Director of Medicine Services
Mon Health Care Morgantown
02.2020 - 02.2021
Director Care Management, Transitions of Care, Den
Fairmont Region Medical System
07.2018 - 02.2020
Interim AVP Care Management for System Wide Servic
University of Texas Medical Branch
09.2016 - 03.2018
Director Care Management –Resource Center /Appeal
Allegheny Health Network Systems
12.2014 - 08.2016
Executive Director Case Management/Clinical Documentation Specialist
Weirton Medical Center
07.2014 - 12.2014
Transitional Leader Case Management - HealthLinx C
University of Virginia Medical Center
06.2013 - 07.2014
Director of Patient Care Management
Uniontown Hospital
10.2010 - 10.2013
Outcomes Manager for Case Management
West Virginia University Hospital
07.2005 - 10.2010
Case Management Professional/ Access Manager for a
Monongalia General Hospital
07.2003 - 07.2005
Clinical Care Coordinator
West Virginia University Hospital
07.2003 - 08.2004
Emergency Department RN /Pediatric RN
Uniontown Hospital and WVUH
07.1997 - 06.2003
MBA - Business Administration
West Virginia University
Bachelor of Science - Nursing
Waynesburg College