Mr. Gross specializes in the operational aspects of healthcare Revenue Cycle Management, Information Technology and Electronic Data Interchange (EDI) within the healthcare industry. His assignments have included development, implementation and management of a wide range of technology-based services in healthcare financial management and reimbursement. He has more than 25 years of experience in technology and revenue cycle operations for hospitals, physicians, payors and financial institutions, in addition to funding and monitoring of healthcare accounts receivable assets. In addition to his qualifications as a healthcare electronic transactions and services provider and a financial systems provider, he has also been a large customer of those systems and services.
Representative engagements include: due diligence examination of healthcare technology acquisitions, expert testimony in healthcare intellectual property and technology services, healthcare technology research and publishing, clearinghouse design and operations, systems development projects, operations evaluation, mentoring, clearinghouse migration (conversion) planning and competitor assessment for healthcare revenue cycle and EDI organizations such as Siemens, CareMedic, MedUnite, ProxyMed, NDC, Medaphis (now McKesson), SSI, Equifax, and others; product development of a Patient Loan Program and Patient Demographic Verification Services (now provided by a credit bureau and Lexis-Nexis); Acquisition Due Diligence at First Tennessee Bank and at FirstData, software and service product development services for AR-Insight, a healthcare revenue management and receivables quality monitoring service; business and technology services for three healthcare receivables funding companies; technology assessment for North American Healthplans; product development of two healthcare A/R funding products for a national purchaser of healthcare accounts; as well as intranet systems and brand development for a group of 1,300 physicians.
In these and other engagements, he has aided healthcare clients by: reducing A/R risk, improving insurance and self pay processes to reduce AR Days, lock box evaluation, development of Automated Secondary Billing, denial identification and reduction project, refiling and A/R clean-up projects. EDI experience includes electronic claims, eligibility, claim status, Medicare DDE, and the full HIPAA transaction set implementation.
His article on the financial decision process can be found in ADVANCES IN DATA MANAGEMENT. He served as co-publisher and contributor to several publications by the IBM Corporation, in addition to developing clients' documentation and manuals. Co-authored a White Paper entitled: "The Impact of CDH on Providers" .
Mr. Gross served as COO of HBCS, Hospital Billing and Collection Services, a nationwide Healthcare revenue management company serving 25+ multi- hospital systems and $3 billion in annual billing. HBCS managed a 500 million dollar fund from a Delaware tax exempt bond issue for purchasing healthcare A/R and then performed centralized billing, EDI and call center follow-up for hospitals and physicians across the United States. Each client’s computer systems (Siemens, Eagle, McKesson-HBOC, MEDITECH, and IDX) were tightly linked to share claim and cash management information in real time with HBCS’ central system and to provide EDI services with payors and providers. Assignments with increasing responsibility included New Product Development and CIO, building the electronic integration with Clients’ systems and migrating all processing and support systems, before becoming COO and restructuring billing and collection operations for improved customer service and quality. Specific achievements included process re-engineering, development of A/R asset and performance tracking, automated cash forecasting, and denial reduction initiatives.
Previously, he was Vice President of Development and Technology (CIO) for Medaphis Corporation in Atlanta, where responsibilities included managing the nation’s largest non-payor-operated healthcare claims validation and clearinghouse. Mr. Gross managed the development of systems that validated electronic claims (thousands of rule-based edits) and delivered them electronically to more than 800 payors. In this assignment, he led the redevelopment of all software products, the establishment of an effective Customer Service function and improved the operational processes and controls. In the successor organization he managed the technical operations of 30 US-based physician-processing centers and served as GM of the turnkey practice management software business serving hundreds of clinics and large hospital-based physician groups.
Earlier, he was CIO for Fortune 1000 organizations in consumer goods and aviation (9 years). His initial technology and business operations experience was gained during 12 years of successive, increasingly responsible, assignments within the IBM Company in Baltimore and in Atlanta. In these assignments, he managed the implementation of more than 200 business systems, many of them for IBM’s healthcare clients.
He is also skilled in formal project management methods, tools and techniques, having taught and implemented them methods at IBM, at 3 healthcare services organizations, and for several Fortune 1000 businesses.
Mr. Gross received an MBA in Finance from Loyola, and a BA from the University of Maryland, concentrating in Mathematics and Engineering. He currently also teaches in the graduate program at the Rollins School of Public Health of Emory University in Atlanta, teaching Managing Databases in Healthcare, which addresses healthcare data acquisition, security and analytics.