Healthcare Management Consultant Resume

Ralph Brighthall, Jr.
71 West Greeley Drive, Maplewood, NJ 07040
201-761-5555 Home § 201-761-5556 Fax §

Management Consulting / Contract Management – Healthcare Industry
Risk Management § Internal Audit § Project Management § Managed Care Contracts
Well-qualified legal consultant / process analyst with J.D. and M.P.H. (Health Policy & Management) degrees. Six
years’ experience in Big Five Consulting, government healthcare agency, and medical practice management.
Proven project management skills (purpose, scope, approach, deliverables, and timelines). Expertise in:
ü Process Improvement ü Contract & Management Services ü Strategic Business Planning
ü Operations Management ü Cost Reduction & Avoidance ü Operational Benchmarking
ü Financial Forecasting ü Financial Analysis & Reporting ü Accounting Systems
Integrated and standardized operating and administrative systems (Healthcare and IT) to deliver sustainable cost
reductions. Team leader who performs at a high level of productivity and fosters a participative environment.
Mastery of accounting (MediSoft), legal (Lexis / Nexis, Westlaw), and healthcare (MedLine) software.

OFFICES OF RALPH BRIGHTHALL, M.D., P.A., Irvington, NJ 1999-present
Practice Manager
Brought on board to turnaround and revitalize the financial situation in a medical practice challenged with rising
overhead costs and declining revenues in a managed care environment.
§ Pioneered a series of standards, policies and systems to more efficiently manage physician compensation,
billing and collections, third-party reimbursements (including managed care contracts), accounting, financial
analysis, and reporting. Incorporated the flexibility required to respond to emerging growth needs.
§ Negotiated and managed favorable provider-services contracts with HMO, PPO, and other provider
networks, and created opportunities for negotiated lump sum payments on problematic payers’ accounts.
§ Transitioned legacy accounts receivable system to a new automated billing system (MediSoft), enabling the
proactive management of provider contracts and reimbursements, as well as informed contract renewals.
§ Results: Improved claims processing turnaround time by 50%, reduced claim rejection rate to less than
10%, realized operating cost reductions of 33%, and increased net revenue collections by 25%.

SANDERS CONSULTING, LLP, Raleigh, NC 1997–1999
Lead, Contract Management Team, TeleSouth-Alliance (1998-1999)
Earned fast-track move to team leadership role. Led 5-member project management team in support of new
business function delivery (long-term, risk-sharing IT outsourcing) across client alliance. Interfaced with
executive management in Sanders’ first contract management endeavor worth $2.28 billion over 10 years.
§ Assembled cross-functional team through proactive recruitment and staff development process, which
improved dispute resolution response time by 20%, and enhanced client relationship management.
§ Key player in interpreting 2500-page contract (only attorney on-site), providing legal counsel in
collaboration with contract manager, outside counsel, and Quality, Legal, and Commercial Department.
Served as Internal Audit Coordinator to meet regulatory standards of client’s independent auditors.
§ Instrumental in negotiating multi-million dollar vendor master services agreements, and 53 subcontractor
work orders (worth $40K to $5 million each). Designed and administered multiple contract deliverables
matrices to track overlapping, complex details and ensure contract compliance.
§ Results: Established a framework of proven policies and procedures for contract management teams in
future outsourcing engagements. Delivered on-target future performance forecasts, uncovered contractual
issues of significant financial exposure, and reduced outside counsel bills by 35% within the first year.

Contractual Metrics Lead, Metrics Reporting Team, TeleSouth-Alliance (1997-1998)
Tapped to lead contractual metrics component for the team charged with: identifying the operational strengths
and weaknesses of the newly formed TeleSouth-Alliance, as well as the potential financial impact.
§ Deployed metrics reporting and operational benchmarking for process improvement of outsourced IT
functions. Subject matter expert on contractual metrics, critical services, and designated service levels.
§ Established framework for collection, analysis, and reporting of key performance indicators, as well as
monitoring critical-services performance levels daily. Collaborated with in-field contacts and senior
management in root cause analysis and action plan creation for all critical-service failures and near misses.
§ Results: Automated and improved reporting and forecasting, implemented an early warning system to
prevent critical-service failures, and facilitated hands-on change management for process improvement.
Process Analyst, Receivables Process Management Team, East Coast Laboratories (1997)
Challenged to redesign the key functions of the accounts receivable pipeline of a laboratory services company
(the nation’s largest biomedical reference laboratory) in a mergers and acquisitions (M&A) situation.
§ Developed best practices benchmarking through on-site inspection of clinical- and medical-billing
environments. Distilled key performance indicators for all functions and developed monitoring methods.
§ Improved front-end, in field capture of patient, third-party, and client-physician billing information, which
decreased the number of days needed to generate a bill by 69% (from 45 to 14). Initiated workflow and
process re-engineering, cutting accounts receivable days by 50%, while increasing revenue collection by 30%.
§ Results: Stemmed the flow of money into Unidentified Cash. Eliminated $2 million backlog of unidentified,
third-party payment postings to patient accounts through improved exceptions processing, which in turn
significantly enhanced customer service through properly credited payments from insurance companies.
Law and Health Policy Analyst
Recruited to investigate the key factors involved in a 30% price increase of domestic childhood immunizations.
§ Conducted extensive legal and health policy research, analyzed industry economics and extant corporate
financial information, and interviewed corporate executives and subject matter experts critical of the
industry’s pricing policies.
§ Proposed reforms designed to lower the price of childhood vaccine products: increased government
regulation (as in a public utility), and an industry-government partnership, as well as projected outcomes.
§ Enabled federal assessment of the antitrust situation within the domestic childhood vaccine industry, and
created a legal framework for workable industry regulations and reforms, along with anticipated outcomes.
§ Results: Independently drafted an advisory opinion for use by the U.S. Department of Justice, which has
formed the basis for industry reform of national vaccine pharmaceutical manufacturing and pricing policies

M.P.H., Health Policy & Management, Carolina State University, Raleigh, NC-1996
J.D., Pennsylvania State University, Philadelphia, PA-1993
A.B., Political Science, Seton Hall University, South Orange, NJ-1990

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