The foundation of expertise and creative innovation at The Rybar Group begins with our people. Multidisciplinary in composition, they collectively hold over 150 years of hands-on management in the healthcare financial, reimbursement and payment, provider and payor experience.
RICHARD S. REID, MPA, FHFMA, CHFP, CPA
President and CEO
Rick has over thirty years of expertise in the healthcare financial and reimbursement service areas. He has worked in a variety of roles in hospital finance departments, including ten years as a CFO for Acute Care and Rural hospitals. Additionally, he has consulted for multiple national healthcare consulting firms and worked for a healthcare payor. Rick prides himself on providing the high level of service that is synonymous with The Rybar Group. Rick’s expertise covers a wide range of strategic initiatives centered on the complexities of reimbursement and payment for all provider types; including specialization in ensuring rural health providers are optimizing their opportunities. Rick has a strong understanding of both present and future reimbursement and payment issues and proactively develops strategies to ensure providers are optimizing their opportunities. He offers an in-depth knowledge of accounting, budgeting, reimbursement and revenue cycle functions, including Medicare and Medicaid Cost Reporting, Third-Party Reimbursement, Contractual Modeling, Corporate Compliance, Strategic Planning, Financial Analysis, Budgeting, Decision Support and Payor Reimbursement Systems. His experience includes:
- Cost report improvements for numerous hospitals, one resulting in annual rural health clinic reimbursement improvements of approximately $500,000 and another that increased Medicaid reimbursement of over $1.3 million annually for a behavioral health hospital.
- Key role in identifying and implementing operational improvements for a rural hospital, resulting in increased reimbursement and reduced costs of over a combined total of $1.6 million in a six-month time period.
- Implementing 340b pharmacy programs at rural hospitals, with one resulting in increased reimbursement of over $700,000 and reduced drug expense of over $1 million annually.
- Worked with a community hospital in developing processes to improve net reimbursement, taking advantage of State programs designed for District Hospitals. Annual reimbursement impact over $2.5 million.
- Successfully merged a new physician practice into the hospital and moved procedures from the office to the hospital resulting in $400,000 of additional reimbursement.
- Working with rural providers to ensure that they qualify for all potential Medicare and Medicaid reimbursement, including all Medicaid supplemental reimbursement opportunities.
- Revised the Medicaid application process flow to ensure capture of all potential Medicaid patients at a large urban hospital. Estimated annual increase of $40 million.
- Revised an urban hospital’s contractual model, bringing over $6 million in additional reimbursement and revised prior cost reports, resulting in an additional $8 million in reimbursement.
Rick received his Bachelors in Accounting and his Masters in Public Administration from Western Michigan University. He is an active member of the Michigan Great Lakes Chapter of the Healthcare Financial Management Association, recently having served as the Chapter President and as a member of the Board. In addition, he is a member of the Michigan Association of Certified Public Accountants. Rick’s work was acknowledged when he became the recipient of the 2013 North Bay CFO of the Year Award for his work in Northern California.
Director, Revenue Cycle
As the Director of Revenue Cycle, Julie draws upon her extensive experience acquired while working in executive-level positions at academic medical centers, integrated health systems, children’s hospitals and with hospital-owned medical groups. She brings over ten years of results-driven leadership experience and a high level of technical knowledge to our clients.
With a focus in revenue cycle management including coding, billing, compliance, reimbursement and vendor management, Julie has helped to enhance provider financial performance, resulting in improved reimbursement and increased physician compensation while maintaining compliant practices. She has a special interest in process improvement, project management and operational optimization, regularly providing guidance as to best practices and methods that support processes leading to optimal revenue.
Julie’s past experiences includes:
- Overseeing the front- and back-end revenue cycle functions for a multi-hospital health system.
- Served as the project manager for a multi-departmental improvement opportunity that reduced billing turnaround from 150 days to 40 days.
- Practice assessments of large specialty practices to evaluate and optimize operational efficiency as well as revenue optimization.
- Evaluation of physician contracts for optimal reimbursement.
- Assistance throughout third-party audits to ensure providers have the resources needed to support documentation, coding and billing.
- Identified revenue opportunities for a facility-based urgent care center leading to an additional $1 million in annual charges.
- Decreased coding backlog for a large integrated care delivery system by 70% utilizing Lean methodologies for production.
- Partner with physician executives to lead documentation improvement efforts for multiple hospitals and clinics.
- Served as project manager for multiple large-scale implementations including EMRs and the conversion to ICD-10.
- Provides expert testimony on behalf of physicians related to coding and compliance matters.
Julie is a highly requested speaker among professional associations for audiences of both providers and their staff. She has presented at numerous state and regional-level meetings.
Julie graduated from Ferris State University with a bachelor’s degree in healthcare management and earned a master’s degree from Central Michigan University in healthcare administration. She maintains the Registered Health Information Administrator (RHIA), Certified Coding Specialist-Physician Based (CCS-P) and Certified Coding Specialist (CCS) credentials from the American Health Information Management Association. She’s also a member of the Medical Group Management Association (MGMA).
Director of Reimbursement
As Director of our Reimbursement team, Jesse has over ten years of healthcare regulatory reimbursement and payment experience. Through his work for one of the Medicare Administrative Contractors (MAC), Jesse offers experience with financial and governmental reimbursement audits for healthcare organizations and government entities. This knowledge provides our clients with a current understanding as to what the auditors are requesting and how providers can work to optimize their reimbursement while meeting the regulatory requirements.
During his work at the MAC, Jesse conducted extensive audits of the Medicare cost reports, ensuring Medicare reimbursement was fairly stated by reconciling reported amounts to external documentation and investigating any detected variances. His ability to maintain open communication and manage multiple projects at one time ensures clients’ needs are met and led to the development of strong working relationships with provider clients.
Since joining The Rybar Group, Jesse has been instrumental in assisting our clients in identifying revenue opportunities through analysis of their cost reports and through the application of regulatory opportunities. Additionally, he is a key member of our COVID-19 team, remaining on top of the continually changing regulations and requirements and assisting our clients in obtaining the various relief funds available and in preparing for the related required reporting and single audits.
Jesse received his Bachelor of Science in Accounting from Central Michigan University. He is a member of the Florida Association of Certified Public Accountants and a member of the Michigan Great Lakes Chapter of Healthcare Financial Management Association.
Steve Sprague, CHFP, CPA
Director, Volume Decrease Adjustment
As the Director of our Volume Decrease Adjustment team, Steve offers our clients over ten years of healthcare regulatory reimbursement and payment experience. This includes work as a Senior Payer Strategy Analyst for one of the nation’s largest not-for-profit health systems.
Steve has assisted numerous rural hospitals in ensuring that they benefited from the special reimbursement opportunities available through their designation. This includes the successful completion of Volume Decrease Adjustment requests for Sole Community and Medicare Dependent Hospitals, up to and including Provider Reimbursement Review Board (PRRB) hearings, and analysis and conversions for Rural Health Clinics and hospital departments seeking Provider-Based status. His innovative problem-solving capabilities and the ability to link business strategies to successful outcomes is invaluable as he supports clients through the appeal process.
Through the years, Steve has worked with a variety of Medicare Administrative Contractors to optimize reimbursement for a range of healthcare providers. He has been deeply involved in several cost report preparations and optimizations engagements and has analyzed cost report structures, statistical allocations, and data to ensure proper reimbursement for facilities in multiple states. His work included interim, short-year, and full-year cost report review and preparation. He has assisted with local and national commercial contract negotiations including modeling proposed payer contract changes for hospitals, ambulatory surgical centers, ancillary services, and physician services; performing risk assessments of various negotiation strategies; and preparing presentations for senior leadership. He has also performed system-wide analysis of the potential impact of payer policy changes.
Prior to joining The Rybar Group, Steve spent a number of years working in financial analyst positions across multiple markets. During this time, he has developed an expertise in all facets of accounting, including corporate budgeting, financial reconciliations, and financial reporting. His experience includes multiple years as a Corporate Controller for a national business strategy organization.
Steve holds a Masters of Accounting degree from the University of Michigan and is a current member of the Great Lakes Michigan Chapter of Healthcare Financial Management Association.
Director of Client Relations and Business Development
As The Rybar Group’s Director of Client Relations and Business Development, Claudine’s primary role is to work as the business liaison of the organization, focusing on the success, satisfaction and growth of our clients. Over the past thirty years, she has developed an in-depth knowledge of the healthcare industry, having worked in various operational and administrative roles within the hospital, clinical office, pharmaceutical distribution and consulting settings. This knowledge is an important component as Claudine works to foster and develop relationships with our clients and vendors while providing exceptional client services.
Over the years, Claudine has helped shape the strategic direction of a number of organizations. This includes working with several non-profits and for-profits through restructure and change, developing strategies to ensure stability while creating a new framework and plan for growth. She has proven experience in directing business efforts, working to align resources and services to meet the needs of organizations and to lay the groundwork for future growth and stability.
Having worked in a multitude of client service and operational practice areas, Claudine areas of expertise include: Business Operations and Management, Project Management, Strategic Relations, Sales and Marketing, Product Development and Launch, Recruitment and Retention, Contract Analysis, Negotiations and Performance, Purchasing, Strategic Planning and Business Strategies Development.
Claudine graduated with a Bachelor of Arts degree in Communications from Michigan State University, with a minor in Animal Science and Pre-Veterinary Medicine. She is a regular speaker at regional and national conferences, focusing on both technical and soft-skill related topics. She currently serves on the board of directors for a number of non-profit organizations.
Rural Healthcare Reimbursement Manager
As the Manager of our Rural Healthcare Division, Caren offers our clients over twenty-five years of Critical Access Hospital (CAH) and other Rural Hospital financial, accounting, revenue cycle and reimbursement experience. She has worked in a variety of roles in the finance departments of CAHs, including multiple years as a Chief Financial Officer. Caren’s prior provider experience and hands-on knowledge of the issues impacting rural hospitals allows her to identify both present and future reimbursement and payment opportunities.
Caren’s broad experience has included ensuring that providers optimize their payments under their CAH and rural designations. Areas of focus have included financial, reimbursement, cash flow analysis, pro-forma scenarios, accounting, general ledger, financial statements, contractual allowance, contract management and negotiations, operational efficiency, and revenue cycle analysis. Caren brings these areas of focus to effectively assist our clients. Her accomplishments include:
- Successful application submission and conversion of a hospital to CAH status, as well as numerous clinics to Rural Health Clinic status.
- Lead multiple CAH cost report review engagements that resulted in increased Medicare reimbursement of over 1 million dollars. CAH engagements ranged from solo facilities to system owned CAHs.
- Negotiation and coordination of payer contracts, including those for a new retail pharmacy and CAH Medicare Managed Care contracts resulting in additional reimbursement.
- Assisted several health systems to implement strategies for optimizing the opportunities of their rural hospitals.
- Worked for several Rural Health Clinics to obtain improved Medicaid and Medicaid HMO reimbursement, resulting in over 2 million dollars in additional revenue.
- Assisted clients in implementing a line of credit to provide for a steadier and predictable cash flow.
- As CFO for a CAH, consistently established a culture related to overall financial performance and worked as a leader to sustain a fully operational community hospital.
- Lead cross functional teams focused on various initiatives including the reduction of lost revenue, risk management, internal policies, risk of claims and other revenue cycle related areas.
- Lead role in the implementation of a new financial system while enhancing processes to increase charge capture, reduce claim errors and improve accuracy. Experience with a number of financial and EHR systems, including Dairyland/Healthland, Rollins, Tech Time/MedWorxs, HMS, Epic, athena and CPSI
Caren is a highly requested speaker for board level presentations and among professional associations. She has presented at numerous state and regional-level meetings.
Caren earned a Bachelor of Business Administration degree from Saginaw Valley State University, majoring in Finance. She is a member of the Michigan Great Lakes Chapter of Healthcare Financial Management Association and has achieved the status of Certified Healthcare Financial Professional. In addition, she completed the World Class Customer Service with Innovation course through Dale Carnegie.
Manager, Hospital Revenue Cycle
Tim offers our clients over thirty years of healthcare finance and reimbursement experience. From his work with national healthcare consulting firms and his years
Medicaid Reimbursement Manager
Revenue Cycle Consultant
As a consultant on the Revenue Cycle team, Sue offers a range of expertise in the area of professional service coding, billing, auditing, and education. She has spent the past fourteen years working in a variety of settings and her experience includes working with a multitude of specialties. Having worked in all aspects of professional coding and billing, Sue provides a critical eye and mind to projects.
Sue’s extensive knowledge of the coding and billing process offers a valuable balance of revenue and compliance expertise, including hands-on experience with billing operations and denial management. She has a special strength in surgery and obstetric-related specialties including general OB, maternal fetal medicine, urogynecology and gynecologic oncology. Her experience includes:
- Perform assessments focused on improved provider financial performance, resulting in improved reimbursement while maintaining compliant practices.
- Evaluation of low-paid claims to identify missed revenue opportunities.
- Complete audits of professional documentation and coding for providers in a variety of settings including large medical groups, independent physician practices and health systems.
- Provide education related to regulatory requirements and reimbursement opportunities for providers and their staff.
- Review of policies and procedures for validity, accuracy, efficiency, and compliance with any applicable rules and/or regulations.
- Assisted with multi-department process improvement projects to compliantly improve revenue for multiple specialties.
- Worked with a variety of electronic medical record and administrative systems, including Epic, 3M Encoder and Vitalware.
In addition to the Certified Professional Coder (CPC) credential, Sue is also a Certified Obstetrics Gynecology Coder (COBGC). She is an active member of the American Academy of Professional Coders (AAPC).
Revenue Cycle Consultant
As an instrumental member of The Rybar Group’s Revenue Cycle service line, Jim offers our clients over thirty years of financial healthcare experience. His extensive knowledge of the third-party payor reimbursement systems is continually in high demand.
Jim is recognized as an expert in the hospital reimbursement community on Blue Cross Blue Shield of Michigan, the underlying claims data, and how it impacts payment and the settlement process. He utilizes this expertise to analyze claims data for hospitals of various sizes, from Peer Group 5 hospitals to multiple hospital health systems. With a focus on the technical aspects of commercial payer reimbursement, Jim works to position clients to identify both present and future opportunities. He specializes in claims related third-party payer audits, working with facilities to ensure correct payments. In the past 5 years, Jim has recovered over $15.0 M in additional reimbursement for hospitals from Blue Cross Blue Shield of Michigan settlement reviews. Using 835 files, Jim has developed a Payment Validation process which assists hospitals in understanding their current cash position with the payer, in validating their contractual model and in identifying claims that are receiving less than optimal reimbursement.
Prior to joining The Rybar Group, Jim worked numerous years at Blue Cross, focused on ensuring that projects such as e-Prescribing, e-Registration, and e-Enrollment complied with applicable laws such as HIPAA Privacy and Security, Medicare, and other regulations. He analyzed claims data for data integrity issues and compliance with regulations to ensure proper reimbursement and used data mining to validate and test third-party settlements to ensure compliance with contracts.
In addition to being a CPA, Jim is a Certified Information Assurance Professional with Trainer endorsement and was among the first people in the country to pass the BS7799 (now ISO 27001) Lead Auditor exam. He has served as a university instructor, teaching both graduate and undergraduate level courses. Jim is a member of the Healthcare Financial Management Association.
Jim holds a Master of Science Degree from the University of Detroit Mercy in Computer Information Systems specializing in management of software development.
Revenue Cycle Consultant
As a Consultant in the Revenue Cycle department, Clair offers the clients of The Rybar Group a range of expertise in the area of professional service coding, auditing, and education. She has spent over seven years working in several settings, and her experience includes working with a multitude of specialties and a robust residency program. Clair’s experience with the various aspects of professional
coding allows her to assist clients in developing solutions that yield measurable results.
Having worked as a medical auditor and educator, Clair has assisted a multi-specialty practice and hospital-based physician group in an array of payer reimbursement-related needs. Through her activities she has developed an extensive knowledge of the coding, offering a valuable balance of revenue and compliance expertise. Clair’s experience includes:
- Perform assessments focused on optimizing documentation compliance, resulting in improved coding and reimbursement.
- Identify missed charges and coding opportunities which increased revenue opportunities for various providers.
- Utilize benchmark data to identify documentation and coding trends, leading to the development of needed education and revised processes.
- Assist with the completion of payer audit based corrective action plans.
- Development of practice workflows, refining reporting and charge capture processes for hospital services.
- Creation of educational materials to provide diagnosis and procedure coding education to a variety of medical learners.
- Perform data verification to confirm the accuracy of EMR reports, ensuring that they accurately reflect physician and APP services
- Complete audits of professional documentation and coding for providers in a variety of settings including large medical groups and resident physician practices.
- Provide individual and group education related to regulatory requirements and reimbursement opportunities for providers and their staff.
- Collaborate with cross functional teams to successfully implement new services across the organization.
- Worked with a variety of electronic medical record and administrative systems, including Cerner PowerChart, Allscripts EHR, and Allscripts PM.
- Coordinating and communicating with patients related to surgical services and associate follow-up.
In addition to the Certified Professional Coder (CPC) credential, Clair is also a Certified Professional Medical Auditor (CPMA) and a Certified Obstetrics Gynecology Coder (COBGC). She is an active member of the American Academy of Professional Coders (AAPC).
DEB KENNEY, CPC, CPMA
Revenue Cycle Consultant
As a Consultant in the Revenue Cycle department, Deb brings over twenty years of healthcare industry experience with specialization in revenue cycle management, coding, billing, compliance and auditing. Through her work with numerous medical centers, physician groups, hospitals and national healthcare consulting firms, Deb is able to assist clients in implementing sustainable solutions related to optimizing revenue and workflows, establishing and maintaining reporting methodologies and ensuring compliance.
Deb’s experience includes work as the Director of Revenue Management for a multi-location Federally Qualified Health Center that provided primary care and Integrated Behavioral Health services. As a consultant, Deb has assisted several multi-specialty practices and hospital-based physician groups in an array of payer reimbursement-related needs. Through her activities she has developed an expertise in risk and compliance, medical records management, multi-specialty physician coding, chart auditing, medical billing and payer contracting.
Having intimate firsthand knowledge of practice operations, management and consulting with a variety of clients allows Deb to provide the best possible service. Her ability to maintain open communication and manage multiple projects at one time ensures clients’ needs are met. Examples of how Deb has assisted providers includes:
- Assessment of revenue cycle activities, determining best practices and redesign opportunities with a focus on the optimal capture of revenue and compliance. Includes an assessment from front desk to patient collections for a growing practice, resulting in reduction in days outstanding from 35 to 28 on average.
- Implemented workflow & process improvements in HIM, resulting in scanning accuracy to an average of 98% audit scores for team members.
- Established team-based referral coordination to improve provider-to-referral specialist communication.
- Streamlined payer credentialing decreasing risk to revenue due to payer enrollment delays.
- Provided external billing audits for a large medical billing company, which allowed them to market to quality-driven clients, ensuring them compliance and the highest quality revenue management services.
- Successfully managed full revenue cycle responsibilities for multiple physician clients and specialties with over $36M annual collections in a management services organization, managing teams of 20 or more staff members.
- Identifying missed charges and coding opportunities which increased revenue opportunities for various providers.
Deb has experience with HHS, CMS and Medicaid program guidelines and policies. She has worked with a variety of EHR and coding systems, including NextGen, Optum, 3M Encoder and Ingenix.
Deb is an active member of the American Academy of Professional Coders (AAPC), National Alliance of Medical Auditing Specialists (NAMAS), and the Medical Group Management Association (MGMA).
As a Certified Public Accountant, Eric started his career in Public Accounting working as a senior level accounting professional, focusing in the areas of tax and healthcare across multiple markets. During this time, he developed an expertise in all facets of accounting, including financial reconciliations and financial reporting.
Eric has worked with a variety of Medicare Administrative Contractors to optimize reimbursement for a range of Healthcare providers including hospitals, nursing facilities, home health agencies, Federally Qualified Health Centers, and Rural Health providers. Other engagements included Contractual Reviews for a large University Medical Center, Medicaid optimization for regional healthcare systems spanning two-states, Medicaid cost report preparations for various states, and Medicare cost report preparations and optimizations.
Currently Eric serves as a Reimbursement Consultant on our Provider Reimbursement team, working with hospitals of various designations, Skilled Nursing Facilities, Federally Qualified Health Centers and Rural Health providers to assist them in optimizing their reimbursement and payment opportunities. His focus includes work with contractual reviews, preparation of various cost reports, cost report strategies and governmental and third-party appeals and reopens.
Eric holds a Bachelor of Science in Accounting from Ferris State University. He is a current member of the Michigan Great Lakes Chapter of HFMA.
With over thirty-five (35) years of financial management, reimbursement and compliance, revenue cycle and operations experience, Deborah offers our clients an expertise grounded in strong technical knowledge and innovative problem solving capabilities. She has held the executive level positions of Vice President, Chief Financial Officer for a post-acute care division of a national Catholic integrated health system; Director of Reimbursement and Director of Special Projects for an Academic Medical Center, and has worked for Big Four accounting firms.
Deborah’s past experience covers a broad range of accomplishments. Highlights of these include:
- Member of a senior management team responsible for the implementation of a competitive plan that enhanced patient care, streamlined services, consolidated facilities, relocated two hospitals and resulted in significant reduction of system costs.
- Captured and analyzed cost data for a nationally recognized academic medical center, identifying opportunities to manage costs. Integral team member in developing operational benchmarks and targets.
- Responsible for developing and managing a corporate reimbursement and revenue enhancement department to provide direction to seven hospital subsidiaries and a nursing home.
- Provided reimbursement and revenue cycle consulting to urban and rural hospitals and clinics as well as home health agencies, an infusion therapy company, inpatient psychiatric hospitals and physician home visiting companies.
- Provided litigation support to national law firms as part of a multi-million dollar Qui Tam defense for a multi-state home health organization and hospital based skilled nursing unit, resulting in considerable savings to both organizations.
- Performed revenue cycle audits for various physician practice offices to identify lost charges, inaccurate claims payments and revenue cycle improvement opportunities.
Deborah is currently a consultant on our Volume Decrease Payment (VDP) Adjustment team, working with hospitals nationwide to take advantage of this Medicare reimbursement opportunity. She has prepared VDP requests for Sole Community and Medicare Dependent Hospitals as well as Preliminary and Final Position Papers presented to the PRRB, working to ensure all reimbursement opportunities are optimized.
In addition to her activities, Deborah is an active member of the Eastern Michigan Chapter of Healthcare Financial Management Association (HFMA). She has held the past positions of Chapter President; Treasurer; Secretary and served on several committees. She is also a member of the Michigan Association of Certified Public Accountants. Deborah currently is an adjunct professor in the Master of Health Services Administration program at the University of Detroit Mercy where she teaches various health care accounting, finance, economics and the Capstone classes.
Deborah received her Master’s degree in Health Care Administration and a Bachelors of Business Administration in Accounting from the University of Toledo.
With over ten years of financial and accounting experience, Sarah has developed an expertise in various facets of accounting, finance and revenue cycle. This includes work as a Revenue Cycle Specialist for a rural referral center and teaching hospital and as a Financial Analysis as part of a health system.
Over the years, Sarah has provided analytical support for process improvement initiatives, as well as assisted with the annual budget, monthly close processes, and bank and G/L general ledger reconciliation. She has worked on audits in conjunction with hospital compliance departments, drafted policies, procedures, and user guides to improve productivity and compliance and served as the Program Coordinator for a hospital system benchmarking program that included over fifty departments. Additionally, Sarah has developed and provided training classes for physician practice support.
Currently Sarah serves as a Reimbursement Consultant, working with hospitals of various designations, Continuing Care Facilities, Federally Qualified Health Centers, and Rural Health providers to assist them in optimizing their reimbursement opportunities. Her focus includes work with contractual reviews, preparation of various cost reports, cost report strategies and governmental and third-party appeals and reopens.
Sarah holds a Bachelor of Science from Evangel University. She is a current member of the Michigan Great Lakes Chapter of the Healthcare Financial Management Association.