The document provides a resume for Robert Whipple seeking a senior-level position in healthcare management. It summarizes his experience in revenue cycle management, case management, clinical documentation, and hospital operations. It also lists his areas of expertise, software proficiencies, management experience at various healthcare organizations, and credentials.

1. ROBERT WHIPPLE
RNC, BSN, CCM, CCSP
PHONE: 781-595-4833
EMAIL: BWWHIPPY@GMAIL.COM
I AM SEEKING A SENIOR-LEVEL POSITION IN HEALTHCARE MANAGEMENT UTILIZING MY EXPERIENCE IN THE REVENUE CYCLE
MANAGEMENT INCLUDING CASE MANAGEMENT, HIM & CODING, PATIENT ACCOUNTING, REVENUE MANAGEMENT, HOSPITAL
OPERATIONS, AND CLINICAL DOCUMENTATION.
HIGHLY SKILLED IN THE FOLLOWING AREAS:
• RAC AUDIT ASSESSMENTS FOR HOSPITAL READINESS, AND SOLUTIONS FOR RAC COMPLIANCE 50 % OVERTURN DENIAL
RATE
• AS A SEASONED INDUSTRY EXPERT. MANAGED LARGE PERFORMANCE IMPROVEMENT PROJECTS AND SPECIALIZES IN
OPERATIONAL REENGINEERING WITH A FOCUS ON BUSINESS AND PROCESS REDESIGN WITHIN INDIVIDUAL HOSPITALS
INCLUDING, PATIENT ACCESS, CASE MANAGEMENT, HIM, AND PATIENT FINANCIAL SERVICES
• UNIQUE COMBINATION OF A CLINICAL BACKGROUND COUPLED WITH EXCEPTIONAL BUSINESS/FINANCIAL MANAGEMENT
CAPABILITIES, AND A PROVEN TRACK RECORD IN FORMULATING STRATEGIC SOLUTIONS FOR OPERATIONAL CHALLENGES
THAT INVOLVE REVENUE CYCLE MANAGEMENT, CASE MANAGEMENT, PATIENT ACCESS, MEDICAL CODING/BILLING, AND
CASE MANAGEMENT.
• QUICK STUDY WITH PROVEN LEADERSHIP TALENT, WHILE BUILDING TEAMWORK AMONG CROSS-FUNCTIONAL
PERSONNEL.
• IN-DEPTH COMPREHENSION OF ALL AREAS OF COMPLIANCE AND STATE & FEDERAL CONTRACTING REGULATIONS.
OUTSTANDING PRESENTATION, COMMUNICATION, INTERPERSONAL, AND RELATIONSHIP BUILDING SKILLS.
• PROFICIENT WITH THE FOLLOWING: MS PROJECT MANAGEMENT, MS WORD, EXCEL, POWER POINT, ACCESS, MS
PUBLISHER-VISIO, OUTLOOK, AND PRIMAVERA.
• COMMAND OF MULTIPLE HOSPITAL SOFTWARE SYSTEMS. IDX, ECLIPSYS INC AM/PFM CONFIGURATION 1, 2,
SUNRISE CLINICAL MANAGER, CONFIGURATION 1, 2, REGISTRATION CONFIGURATION 1, SCHEDULING
CONFIGURATION 1, 2. AS WELL AS MEDI-TECH, SIEMENS ENVISION, AND OTHER HOSPITAL SYSTEMS.
• COMPREHENSIVE UNDERSTANDING OF MEDITECH AND INTERQUAL ( CERME)
• STARTED A DENIAL MANAGEMENT SYSTEM WHICH TRACK, AND APPEAL ALL MEDICAL NECESSITY DENIALS
EXPERIENCE
HARRINGTON HEALTHCARE SYSTEM, SOUTHBRIDGE, MA JUNE 2010 TO OCTOBER 2015
DIRECTOR OF CARE MANAGEMENT
• DIRECTOR OF CARE MANAGEMENT AND SOCIAL SERVICES MANAGING A STAFF OF TEN CARE MANAGERS AND THREE
SOCIAL WORKERS

2. • REDUCED LOS TO 3.2 DAYS. WE HAVE THE LOWEST LENGTH OF STAY IN THE US WITH ALL HOSPITALS WHO USE
CRIMSON DATA-PHYSICIAN SERVICES
• REDUCED COPD ADMISSIONS BY 40% SAVING THE HOSPITAL $166,000
• WE INSTITUTED A SUCCESSFUL LEAN INIATIVE FOR FY 2014. I AM A CERTIFIED LEAN FACILITATOR
• THE HEALTHCARE ADVISORY BOARD CREATED A CASE STUDY OF HOW WE REDUCED COPD READMISSIONS BY 40%
WITHOUT RAISING THE LOS. THE ADVISORY BOARD IS SHOWING THIS CASE STUDY ON A NATIONAL LEVEL.
• DESIGNED AND IMPLEMENTED AN ED CARE MANAGEMENT MODEL 2013 YTD WE HAVE BEEN ABOUT TO DIVERT 78
ADMISSIONS TO SNF’S REHAB OR HOME WITH SERVICES INSTEAD OF ADMITTING THESE PATIENT WHO MOST LIKELY
WOULD HAVE BEEN DENIED
• WE IMPROVED COMPLIENCE FOR THE MEDICARE IM FROM 22% IN FY 2012 TO 98% COMPLIANCE IN FY 2013 YTD
• DESIGNED AND IMPLEMENTED A NEW CARE MANAGEMENT SYSTEM THAT DELIVERS CARE THROUGHOUT THE
HEALTHCARE CONTINUUOM, INCLUDING HARRINGTON PHYSICIAN SERVICES IN THE COMMUNITY
• REDUCED OBSERVATION DISCHARGES TO 12% OF ADMISSIONS
• DESIGNED AND IMPLEMENTED A DENIAL MANAGEMENT PROGRAM.
• REDUCED ONE & TWO DAY INAPPROPRIATE INPATIENT ADMISSIONS BY 65%
• REDUCED AVOIDABLE DAYS FROM 206 FOR FY 2012 AND NOW 78 FROM FY 2013 YTD
• IMPLEMENTED SYSTEMS TO REDUCE DENIALS FOR MEDICAL NECESSITY. OUR DENIAL RATE FOR FY 2013 WAS LESS
THAN 1% OF TOTAL GROSS REVENUE
• HEAD THE IMPLEMENTATION OF MCKESSON ENHANCED VERSION OF INTERQUAL. CERME
• BUILT A DENIAL MANAGEMENT SYSTEM THAT RECOVERED AND APPEAL ALL MEDICAL NECESSITY DENIALS
NORTHEAST HEALTH SYSTEM / BEVERLY HOSPITAL, BEVERLY, MA DEC 2008 TO JUNE 2010
MANAGER OF REVENUE ENHANCEMENT
• Responsible for enhancing emergency department revenue by designing, creating, implementing and
evaluating new systems to improve documentation, coding, billing and accounts receivable structures,
charge master, and clinical documentation practices.
• Responsible for revenue enhancement strategies that include educating and advising physicians, other
licensed independent practitioners, nurses, coders, case managers, and billing and coding staff on best
practice methods to maximize outpatient clinical service revenue in the Emergency Department.
• Responded to retrospective requests for clinical information required for reimbursement and
retrospective denials from third party payers. Member of the Emergency Department Nursing Leadership
Team along with Nurse Managers, Trauma Program Manager, and Clinical Nurse Specialist.
ATLANTIC HEALTHCARE SOLUTIONS, SCITUATE, MA 2005 TO 2014 (PART TIME)

3. OWNER, CONSULTING FIRM
PROVIDING CONSULTING IN THE FOLLOWING SERVICES:
• LONG TERM CARE REIMBURSEMENT/RUG ANALYSIS
• REVENUE CYCLE MANAGEMENT
• THROUGH-PUT
• CLINICAL RESOURCE MANAGEMENT
• DENIAL MANAGEMENT
• AR MANAGEMENT
• TELEPHONIC TRIAGE
ACS HEALTHCARE SOLUTIONS, DEARBORN, MI 2005 TO 2008
SENIOR MANAGEMENT CONSULTANT
• PROVIDE INTERIM LEADERSHIP FOR CASE MANAGEMENT & ACCESS MANAGEMENT
• DELIVER HEALTHCARE SERVICES THAT DRIVE CLINICAL TRANSFORMATION AND FINANCIAL IMPROVEMENTS FOR CLIENTS
OF THIS LEADING PROVIDER OF HOSPITAL CONSULTING SERVICES TO THE HEALTHCARE INDUSTRY.
• IMPROVE CLINICAL DOCUMENTATION TO IMPROVE CODING ACCURACY AND REIMBURSEMENT, AND TO IMPROVE
MORTALITY INDICATOR PERCENTAGES.
• MANAGE A SECTION OF WORK FROM SIMPLE TO COMPLEX. UNDERSTAND THE SCOPE OF THE TOTAL PROJECT. DESIGN
AN APPROACH. DETERMINE THE RESOURCES NEEDED TO COMPLETE THE PROJECT. SELECT METHODOLOGY AND
COMPLETE THE WORK. DEVELOP THE RECOMMENDATIONS, INTEGRATE WITH THE PROJECT AND MANAGE THE CLIENT
INTERFACE.
• EXPERIENCED WITH MULTIPLE SOFTWARE SYSTEM INSTALLATIONS INCLUDING SIEMENS, ENVISION PATIENT
ACCOUNTING, PRIMAVERA, MEDI-TECH, AND ECLIPSYS, MS4 SOFTCOPY FOR ADVANCED CLINICAL REPORTING, AND
MULTIPLE BUSINESS OFFICE SCRUBBERS FOR CLEAN CLAIMS INITIATIVES. RESPONSIBLE FOR THE FOLLOWING SUITES:
AR/ADT, MIRA, SYNGO, TRANSCRIPTION, PAYROLL, HIM & CODING, ANCILLARY SERVICES, RADIOLOGY,
APPOINTMENT SCHEDULING, UB04, REPORT WRITER, ORDER ENTRY
• LOWERED GMLOS BY AN AVERAGE OF 1.5 DAYS
• REDUCED AVOIDABLE DAYS BY AN AVERAGE OF 80%
• GENERATED $1,800,000 IN INCREMENTAL CASH FOR MY LAST CLIENT, AND I DID IT WITHIN FOUR MONTHS
• INCREASED CASE MIX INDEX BY AN AVERAGE OF .3
• REDUCED AR DAYS FROM 73 TO 54
• AVERAGED A 1% TO 1.5 % REVENUE INCREASE FOR CLIENTS
• DESIGNED AND IMPLEMENTED A “DISEASE STATE CASE MANAGEMENT MODEL”
• TRAINED PHYSICIANS AND PHYSICIAN OFFICE STAFF BEST PRACTICE CLINICAL DOCUMENTATION

4. • MANAGE A PROJECT, WHICH INCLUDES MANAGING THE EXECUTIVE RELATIONSHIP, ORGANIZING THE TEAM,
STRUCTURING THE WORK PLAN, COMPLETING THE WORK, INTRODUCING THE WORK TO THE CLIENT AND DEVELOPING
THE IMPLICATIONS FOR THE CLIENT.
• TURNAROUND LEADERSHIP – SENIOR MEMBER OF A 12-PERSON TEAM THAT ORCHESTRATED THE SUCCESSFUL
TURNAROUND OF A 750-BED HOSPITAL. SERVED AS THE INTERIM DIRECTOR OF CLINICAL RESOURCE MANAGEMENT.
ACTIVELY PARTICIPATED IN THE ASSESSMENT PHASE OF THE TURNAROUND, AND CONTRIBUTED TO
DEVELOPING/IMPLEMENTING A MANAGEMENT ACTION PLAN.
• DESIGNED AND IMPLEMENTED A PRIMARY CASE MANAGEMENT MODEL/DISEASE MANAGEMENT
HEALTHCARE CONSULTING BENEFITS REVIEW, MAUMEE, AND OH 2004 TO 2005
DIRECTOR OF CLINICAL OPERATIONS
• MANAGED A STAFF OF RN’S AND I WAS RESPONSIBLE FOR THEIR TRAINING
• PROVIDE LEADERSHIP TO A TEAM OF RN’S, MANAGE THEIR DAY-TO-DAY PERFORMANCE, AND IMPLEMENT QUALITY
MEASURES TO IMPROVE THE QUALITY OF WORK;
• LEAD BUSINESS DEVELOPMENT, PRESENTATION, AND PROPOSALS TOWARDS A SUCCESSFUL CLOSE OF BUSINESS
• INTERACT WITH OUR CLIENTS REGARDING CLINICAL ISSUES AND BE THE RESIDENT EXPERT ON OUR CLINICAL PROGRAMS
AND PROCESSES;
• CONDUCT TRAINING OF CLINICAL STAFF ON AN ON-GOING BASIS FOR BOTH INTERNAL EMPLOYEES AND EXTERNAL.
• MANAGE PROJECTS WITHIN THE ESTABLISHED SCOPE, SCHEDULE, AND BUDGET WHILE MEETING OR SURPASSING
COMPANY STANDARDS OF QUALITY.
BOSTON MEDICAL CENTER, BOSTON, MA 1999 – 2004
MANAGER OF PAYMENT VERIFICATION
• This position is responsible for the ongoing implementation and reengineering solutions for BMC
healthcare operations (Patient Access, Medical Records, Patient Financial Services, Clinical Care Areas, and
Ancillary Areas). This position will work with clients (departments of BMC). Will utilize formal process
improvement/redesign methodology to evaluate, analyze, develop process redesign, planning, training
and implementation as well as offer ongoing support and measurement of key healthcare operations at
BMC. This position will be responsible for executing the Performance Improvement Department's
program.
• BROUGHT IN TO EVALUATE AND REENGINEER REVENUE CHARGE CAPTURE PROCESSES TO OPTIMIZE REIMBURSEMENT
AND MINIMIZE REVENUE LOSSES DUE TO CLAIM DENIALS, OVER USE OF OBSERVATION AND UNDER BILLING. PARTNERED
WITH COO AND SENIOR MANAGERS TO DEVELOP AND IMPLEMENT NEW REVENUE MANAGEMENT POLICIES,
PROCEDURES AND TOOLS. RETAINED FULL TIME TO PROVIDE STRATEGIC DIRECTION FOR PAYMENT RECOVERY
OPERATIONS. MANAGED CLAIMS APPEAL PROCESS AND NEGOTIATED COST EFFECTIVE RATES WITH PAYERS.
• LED DEVELOPMENT AND ROLLOUT OF A DENIAL MANAGEMENT SYSTEM AND AN UNDERPAYMENT REVIEW SYSTEM
THAT GENERATED OVER $7 MILLION IN ANNUAL REVENUES.

5. • PROVIDED HANDS ON ASSISTANCE TO HIM, CODING STAFF AND DRG VALIDATION TO SIMPLIFY BILLING/CODING
PROCESS WHILE MAINTAINING COMPLIANCE.
• FORMULATED NEW PROCESS FOR THE MANAGEMENT OF OBSERVATION. THIS NEW PROCESS WAS RESPONSIBLE FOR
INCREASING REVENUE BY 7 MILLION PER YEAR
WINCHESTER HOSPITAL, WINCHESTER, MA 1995 TO 1999
DIRECTOR OF CASE MANAGEMENT
• PROVIDED OVERSIGHT FOR CASE MANAGEMENT FUNCTIONS INCLUDING ADMISSION REVIEW, REIMBURSEMENT,
UTILIZATION REVIEW, AND DISCHARGE PLANNING. FORMULATED RESOURCE REDUCTION STRATEGIES TO CAPITALIZE ON
FACILITY BEST PRACTICES. IDENTIFIED OPPORTUNITIES FOR IMPROVEMENT AND ENSURED APPROPRIATE CHANNELING TO
EFFECT CHANGE. PROVIDED LEADERSHIP AND GUIDANCE TO A STAFF OF 10 CASE MANAGERS.
• WROTE THE CONTINUUM OF CARE MANUAL FOR THE JCAHO SURVEY.
• DEVELOPED A DISEASE STATE CASE MANAGEMENT MODEL.
UNLIMITED SUCCESS, STONEHAM, MA 1994 TO 2006 (PART TIME PER-DIEM)
HEALTHCARE CONSULTANT
PERFORMED TELEPHONIC REVIEW AFTER HOURS FOR BCBS
• CONDUCTED MULTIPLE ON-SITE MEDICAL CASE MANAGEMENT PROJECTS FOR HEALTH INSURANCE PROVIDERS AND
SEVERAL BOSTON AREA HOSPITALS. MAJOR CLIENTS INCLUDED BLUE CROSS, TUFTS HEALTH PLAN AND HARVARD
PILGRIM HEALTHCARE. COORDINATED REPATRIATION OF PATIENTS AND CLOSELY MONITORED PROVISION OF CARE TO
ACHIEVE MAXIMUM MEDICAL IMPROVEMENT (MMI), PERMANENT PARTIAL IMPAIRMENT RATING (PPI) AND RETURN
TO WORK (RTW). SCOPE OF RESPONSIBILITY INCLUDED UTILIZATION REVIEW, DISCHARGE PLANNING, QUALITY
ASSURANCE, DRG VALIDATION AND CHARGE AUDITING. EXECUTED PER DIEM CODING AND DRG VALIDATION TASKS.
• PERFORMED NURSING DUTIES( MEDICAL SURGICAL), INCLUDING PATIENT CARE, FULL & PART-TIME ASSIGNMENTS
PRIOR EXPERIENCE:
ADVANCED RAPIDLY THROUGH A SERIES OF INCREASINGLY RESPONSIBLE LEADERSHIP POSITIONS IN NURSING WITH THE VA
HOSPITAL (LOS ANGELES, CA) AND JOHN’S HOPKINS HOSPITAL, (BALTIMORE, MD). INCLUDING A 50% INVESTMENT WITH A
FRIEND IN AN AUDIO-VISUAL STUDIO
EDUCATION & CREDENTIALS
• BACHELOR’S DEGREE– CASTLETON STATE COLLEGE, CASTLETON, VT
• REGISTERED NURSE, STATE OF MASSACHUSETTS, LICENSE NO. 207651
PROFESSIONAL AFFILIATIONS
• CERTIFIED MEDICAL CODING SPECIALIST (CCSP)

6. • HFMA
• CASE MANAGEMENT SOCIETY OF AMERICA

7. • HFMA
• CASE MANAGEMENT SOCIETY OF AMERICA