Knowledge of:

(1)  reimbursement and documentation processes for Medicare's:

• inpatient PPS
• outpatient PPS (for clinics, HOPDs, ASCs)
• PACPPS (LTACHs, SNFs, HH)
• HCP and ambulance retrospective payments
• value-based payment systems
• alternative payment systems
• other payment systems (e.g., Hospice)

(2) and also:

• US government healthcare insurance plans
• managed care and private insurance plans
• ICD-10
• revenue cycle management techniques

K, S, & A's regarding:

• financial statement creation and interpretation 
• margins analysis
• costing method application
• financing, leasing, and amortization application
• breakeven analysis and investment appraisal (NPV, ROI, IRR, PI, PBP)
• operating and capital budget creation
• business plan creation

Knowledge about:

• measuring and determining market power, supply, demand, deficit, and surplus regarding goods, services, and labor
• price elasticity and rigidity
• health insurance effects on patient demand for healthcare services
• competition/concentration effects on healthcare prices and quality
• economic analyses (EIA, PCA, BCA, CEA, CUA)
• socioeconomic disparities

K, S, & A's regarding:

• costs of hiring and firing determination
• setting recruiting, interviewing, and candidate selection criteria
• labor:work ratio evaluation
• use of job change matrices and labor shortage and surplus assessment
• advantages and disadvantages of organizational power structures (governance) and communication structures
• job and workflow design strategies
• job description creation and use
• employee training
• employee performance monitoring
• employee motivation, demotivation, and goal setting
• employee engagement and satisfaction improvement

K, S, & A's regarding:

• the Project Management Institute's PMBOK 7th ed. contents (most of the PMI's 60 tools and 74 artifacts, like a project charter, stakeholder register, work breakdown structure, burn chart, and Gantt chart)
• chartering and stakeholder analysis
• scheduling and schedule crashing
• resourcing and budgeting
• risk and quality planning
• supply chain management
• Agile vs. waterfall approaches

Certification :

• National Association of Healthcare Quality

Experience: 

• I have  used Lean and Six Sigma strategies at multiple hospital radiology departments.

K, S, & A's in HCO quality management:

• run charts, including control charts... the tool that HCOs most under-use
• bar charts (Pareto)
• flow charts/flow maps/algorithms 
• true maps (spaghetti)
• matrices (FMEA)
• checklists (SMART aims)
• scoring systems (net promoter score)
• design of experiments

Experience:

I have led diagnostic and interventional radiology teams of nurses and technologists at multiple hospitals since 2014.

Knowledge regarding:

• directing team dynamics
• resolving conflict (relationship, status, task, process)
• setting organization culture
• leadership theory other (Drucker)
• see also the overlapping entries in the more specific management areas

Experience: 

• writing strategic plans (please see my CV skills section)

Knowledge regarding:

• competitor analysis resources
• market entry forces and value chain links (Porter)
• mission alignment/linkage (e.g., with IT and HR)
• pre-implementation strategy types (Glueck, David)
• tools for evaluating strategy types 
• balanced scorecards
• outsourcing

Knowledge of how an HCO can look outside the HCI to improve its:

• customer service (e.g., hospitality)
• automation (e.g., manufacturing)
• digital readiness (e.g., travel)
• regulatory auditing (e.g., professional athletics)
• safety (e.g., airlines)

Certification :

American Society for Healthcare Risk Management / American Hospital Association

Familiarity with:

Pay for performance law

• 2015: Medicare Access and CHIP Reauthorization Act

Corruption, fraud, abuse, and anti-trust laws/regulations

• 2009: MFSRP
• 2007: MMSEA 111
• 2002: Sarbanes-Oxley Act
• 1989: Stark
• 1986: anti-kickback
• 1914: Clayton Act
• 1890: Sherman Act
• 1863: False Claims Act
• other federal laws, CMS conditions of participation, and other regulations affecting medical billing and billing compliance

Other HCO-specific laws of the last 50 years (numerous... only several listed here)

• 2015: MACRA
• 2012: PPACA
• 2009: HITECH
• 2005: PSQIA
• 2005: DRA
• 2003: MMA
• 1998: CLIA
• 1996: HIPAA
• 1990: SMDA
• 1986: EMTALA
• 1986: HCQIA
• 1982: TEFRA
• common law decisions related to HCO and physician professional liability

Employment discrimination, endangerment, and harassment laws

• 2009: Lilly Ledbetter Fair Pay Act
• 1993: Family and Medical Leave Act
• 1990: Americans with Disabilities Act
• 1978: Pregnancy Discrimination Act
• 1974: Employee Retirement and Income Security Act
• 1970: Occupational Safety and Health Act
• 1967: Age Discrimination in Employment Act
• 1964: Civil Right Act Title VII
• 1963: Equal Pay Act
• 1938: Fair Labor Standards Act
• 1868: 14th Constitutional Amendment
• 1865: 13th Constitutional Amendment

Familiarity with issues such as:

• underprevention and overtreatment
• medical error epidemic
• payment systems/models: prospective,  retrospective, value-based, capitated, private, public, universal, employer-based, and combinations 
• options for healthcare system improvement based on international healthcare policies (e.g., cost reduction, health outcomes)

Knowledge regarding:

• CDC, AHRQ, and other federal and state organizations that affect healthcare
• public health institutes and population health measures
• community needs assessments
• county and census tract analysis
• epidemiology concepts: incidence, prevalence, attributable risk, mortality rate, social determinants of health

Experience:

• Please see the website quality page and my CV.

K, S, & A's regarding:

• data types
• measures of frequency, location, spread, probability, and reliability
• tests of correlation vs. differentiation and when they should be used
• criteria for determining causation
• design of experiments (DOE)... both business experiments and scientific experiments
• minimizing chance, bias, and confounding variables

Experience using EHRs such as:

• Cerner
• Epic
• Meditech
• eClinicalWorks

Knowledge regarding:

• EHR effects on HCO performance
• data mining software and algorithms
• automation (e.g., EHR coding automation)
• dashboards
• networks, including layers and layer defense strategies (cybersecurity)
• deep learning (AI)
• personal health monitoring devices