Caroline Znaniec, MBA, MS-HCA, CRIP, CRCR

Experience

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  Peninsula Regional Medical Center

  Sept 1996 - Nov 1998

  Physician Billing Representative

  Responsible for clean claims submission for primary care physician offices, claim followup and payment posting.

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  Halpern Eye Care

  Nov 1998 - Feb 2000

  Business Operations Manager/AR

  Oversaw the charge capture, compliance, billing and A/R for a multi-site medical optometry practice and eyewear retail sales. Created a billing compliance program, reports for A/R tracking and analysis and reduced overall A/R by 30%.

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  KPMG US

  Jan 2000 - Jan 2002

  Senior Consultant-National CDM Practice

  Participated in large charge master standardization projects, charge capture analyses, charge master maintenance, APC readiness, and Maryland HSCRC RVU optimization engagements. Performed daily tasks including, analysis, report writing, preparation for client meetings, determination of budgets, and research. Client base included nationally recognized health systems, academic hospitals, and community-based hospitals throughout the East Coast, as well as nationally known software development companies. Show less

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  Children's National Medical Center

  Jan 2000 - Jan 2000

  Clinical Operations Manager

  Supervised the daily operations of the Departments of Orthopaedics and Otorhinolaryngology. Responsibilities included the management of support staff (10), patient flow, medical records, cash handling, appointment scheduling, charge entry, and compliance standards for twelve teaching physicians. Participated in practice operations committees, concept groups, and provided computer training as a super user of HBOC STAR.

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  Anne Arundel Medical Center

  Jan 2002 - Jan 2003

  Lead Billing Compliance Auditor

  Responsible for daily maintenance of the hospital chargemaster. Initiated the development and maintenance of internal auditing procedures for clinical departments, including charge selection, entry, and reconciliation. Assisted the Research Integrity and Compliance Officer as needed for clinical trial approval and guidance regarding reimbursement and registration processes. Assisted the Director of Reimbursement and Chief Financial Officer in approval and development of new service lines, ensuring services met payer requirements for proper documentation and coding. Show less

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  ANNE ARUNDEL HEALTH SYSTEM, INC.

  Jan 2003 - Jan 2006

  Corporate Billing Compliance Officer/Chief HIPAA Officer

  Oversaw the daily operations of the compliance program for the health system including acute care hospital, home infusion services, clinical trials program, freestanding radiology centers, and physician billing operations. Acute care hospital was under a corporate integrity agreement and required additional reporting/training to the Board and OIG, as well as the development of a comprehensive compliance program. Active participant in CMS' Compliance Effectiveness Pilot Program where the developed program at AAMC was positively referenced in its effectiveness from CMS. HCCA speaker on compliance effectiveness 2006 in conjunction with CMS.“Framework of a Compliance Program”, Baltimore, MD, Maryland HIMA, April 2006. Joint presentation with Medicare's Department of Program Integrity.“CMS Compliance Effectiveness Pilot: The Participant’s Perspective”, Las Vegas, NV, HCCA Annual Institute, April 2006. Show less

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  Navigant

  Apr 2006 - Jun 2011

  Charge Integrity Services Lead including OP-CDI

  Performed and managed engagements under the services of CDM and Charge Integrity to include billing compliance analyses, charge capture, implementation, audits and education. Service line leader for outpatient clinical documentation improvement service line creation, including sales/marketing, approach, assessment logic, implementation tools, etc. Client base included large physician groups, larger hospitals in and outside of Maryland including large academic health systems. Supported other service lines including disputes and investigation, and payer strategy. Show less

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  Grant Thornton LLP

  Jul 2011 - Sept 2013

  Revenue Integrity Lead - Health Care Advisory Services

  Revenue Integrity Services national lead. Services include but not limited to, charge description master (CDM) reviews for structure, integrity and optimization, coding and documentation quality, clinical interface integrity assessments and implementation planning and design support, billing and compliance due diligence reviews, litigation support, revenue integrity compliance consulting, data mining and benchmarking analysis for opportunities in process improvement. Collaborate with our other service leads including restructuring, valuation, acquisition, managed care contracting, healthcare technology, governmental services, and internal audit. Responsible for the creation and maintenance of client relationships, business development of revenue integrity services, mentoring and development of advisory staff, engagement management and performance.Sample projects:- Brookdale Hospital Restructuring - providing revenue integrity improvements to increase net revenue- SUNY Update EPIC Implementation Assistance - improving process for the identification, capture and reporting of services to increase net revenue; particular emphasis in supply chain, pharmacy and emergency services- Johns Hopkins Health Care - providing review and oversight of audit activities related to the reporting of HCCs by physician clinics for the Medicaid payer program Show less

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  Central Casting House of Cards

  Jul 2012 - Jul 2012

  Background Talent (Non Union) - for fun

  Political Aid - House of Cards; NetFlix series 2013 First Season - episode 7

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  Luna Healthcare Advisors LLC

  Sept 2013 - Mar 2020

  Principal Owner

  Luna Healthcare Advisors LLC focuses on healthcare provider integrity consulting. Our core services address healthcare documentation, coding and billing operations, efficiencies and compliance. Additional services expand into other hot areas such as pricing transparency, transaction due diligence, compliance program effectiveness, financial and operational efficiencies, and electronic health record (EHR) assessment, design, interface testing, implementation and optimization assistance. Through a network of experienced advisors, clients can be connected to the expertise of advisors with at least 15 years of industry, professional consulting or combined experience. Our advisors provide professional subject matter expertise and advisory services to Big 4, large consulting groups, large nationally recognized best in KLAS software vendors and direct healthcare clients. Prior strategic partners have included KPMG, Grant Thornton, RSM, Provident Management Consulting, Berkeley Research Group, Pinnacle Healthcare Advisors, CohnReznick, Tatum, Alvarez & Marsal, Mazars, Craneware, BasisCode Compliance and Healthcare Compliance Associates. www.lunahealthcareadvisors.com Show less

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  Craneware

  Jan 2016 - Feb 2017

  Revenue Integrity Consultant (subcontractor)

  Craneware is the leading provider of solutions that improve financial performance for healthcare organizations. As a Revenue Integrity Consultant, I am privileged to work with the hospitals and healthcare organizations that have chosen to partner with Craneware to get their best value from our powerful solutions. Through a variety of engagements and projects, I help those who work in the Revenue Cycle to establish and maintain processes around their CDM and claims that improve organizational efficiency, minimize compliance risk, and increase financial performance. Show less

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  Hcpro - National Association of Healthcare Revenue Integrity

  Jan 2019 - now

  Advisory Board Member
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  CohnReznick LLP

  Mar 2020 - Jan 2022

  Managing Director, Healthcare Advisory Lead, Strategy & Innovation

  CohnReznick LLP is a national professional services firm headquartered in New York, NY. It is the eleventh largest public accounting firm in the United States based on aggregated 2017 revenues. The Healthcare Industry Practice provides advisory, assurance and tax services. CohnReznick’s Healthcare Advisory practice helps clients optimize their operations to meet today’s challenges and achieve game-changing results from defining moments throughout the lifecycle of their business. Drawing on our broad perspective, market connectedness, and transformation and innovation experience, our team helps senior healthcare leaders navigate the industry’s ever-changing landscape.OUR PERSPECTIVE ON HEALTHCARE:- We understand the importance of integrating clinical and financial processes so that they collectively deliver high-quality patient outcomes and efficient care and help maximize value.- We see the success of your revenue cycle as the sum of all stakeholder efforts and organization wide processes to provide an interdependent strategy that optimizes revenue.- We know the complexities of the healthcare industry and assist organizations in mitigating risks as they strive to uncover and pursue opportunities for sustained improvement.- We understand that improving your organization’s financial health in a way that aligns with your needs and strategic outlook requires the capability to analyze complex data sets, the expertise to recognize Improvement opportunities, and the ability to strategize and collaborate, and we can support you in those areas.- We appreciate that technology transformation can drive improved patient outcomes and enhanced operations, but comes with inherent execution, integration, and interoperability risk. Show less

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  Protiviti

  Jan 2022 - now

  Managing Director, Healthcare Business Performance Improvement, Provider Operations Solutions Leader

  Protiviti (www.protiviti.com) is a global consulting firm that delivers deep expertise, objective insights, a tailored approach and unparalleled collaboration to help leaders confidently face the future. Protiviti and our independent and locally owned Member Firms provide clients with consulting and managed solutions in finance, technology, operations, data, analytics, governance, risk and internal audit through our network of more than 85 offices in over 25 countries. Named to the Fortune 100 Best Companies to Work For® list, Protiviti has served more than 60 percent of Fortune 1000 and 35 percent of Fortune Global 500 companies. The firm also works with smaller, growing companies, including those looking to go public, as well as with government agencies. Protiviti is a wholly owned subsidiary of Robert Half (NYSE: RHI). Founded in 1948, Robert Half is a member of the S&P 500 index. Show less

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  HFMA Maryland

  Jun 2022 - now

  Chair, Social Media
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  AAHAM - The American Association of Healthcare Administrative Management

  Mar 2023 - now

  Member, National Certification Committee (CRIP)