Meet the Sherlock Holmes of solving claim errors: Northwell Health’s Anthony McCallum
Give him a mystery.
Northwell Health’s own Anthony McCallum, CPC-I, CIRCC, CPC, CCS received the 2018 Omar Brito Life Achievement Award from the Roxbury Institute for Medical Management in recognition of his extraordinary personal and professional achievements. Here’s how he got here.
Anthony pursued coding over twenty years ago, starting with the CPC credential. He worked as a coder and coding consultant and then joined the Revenue Integrity Operations (RIO) team with Northwell Health in 2005 as an Outpatient Revenue Coding Specialist. “After a few years into my coding career and having worked for many years as a patient access representative, I was looking to return to a part-time position at Northwell,” Anthony said. “During the application process, the hiring manager picked up on my revenue cycle experience and felt I would be a good fit for RIO. From there I was interviewed, tested and ultimately offered the greatest opportunity of my life.”
While in RIO, he received three additional prestigious coding certifications, a B.S. degree in Health Care Management and an M.B.A. in Health Administration. “Northwell has provided a platform in which I have been able to advance. There is so much growth in this field and Northwell has provided an environment which encourages that growth. This has had a direct and positive impact on my career and job satisfaction.”
So what is the revenue cycle? According to Anthony, Revenue Cycle includes clinical and administrative functions which contribute to the capture, management, and collection of patient service revenue. RIO has the rare opportunity and skill of analyzing claims in their entirety and assuring that the medical record documentation supports every line item on that claim appropriately. The comprehensive analysis of claims and medical record documentation in conjunction with knowledge of charge capture processes allows RIO to identify the root causes of claim errors. Claim errors can be due to an array of issues; coding, charging, documentation, registration, and software application failures to name a few. RIO directs claims correction and works with the appropriate departments in an effort to mitigate future errors. Anthony feels like “in a sense, we are the Sherlock Holmes of solving claim error mysteries.”
Anthony is dedicated to providing continuous coding education with integrity and intelligence, and his contributions have also been recognized by the health information management community. “I was approached by Frank Chisena, the president of the Roxbury Institute for Medical Management; he explained that the award was given to prior students deemed to have excelled in the profession and he wanted to present me with the 2018 award due to my advancement in healthcare revenue cycle.”
Anthony’s greatest award is a rewarding career. “RIO is constantly seeking innovative ways to improve the organization’s bottom line is the most rewarding aspect of my job,” Anthony said. “It is particularly rewarding when RIO has identified additional revenue opportunities while mitigating claim errors and compliance concerns. It is gratifying to know that our work directly impacts the financial health of the organization, enabling Northwell to fulfill its mission.”
Under the bold and delicious vision of Northwell Health’s VP of System Food Services Corporate Michelin Chef, Bruno Tison, the recipe for hospital food as you once knew it has changed. Michelin Chef Tison, along with other award-winning Michelin chefs like Andrew Cain, is helping Northwell Health redefine the culinary experience for patients, their families, and Northwell employees.
“I want to help cook better food for people who really need it,” says Chef Tison, “Northwell Health is a pioneer for redefining hospital food for 23 hospitals.”
A recipe for culinary success.
A native of northern France, Chef Bruno Tison began his culinary education at Belgium’s prestigious Institut Technique Des Metiers De L’Alimentation, where he graduated with highest honors and was awarded first prize for excellence in culinary achievement. His more than 30 years of experience includes serving as Executive Chef of the legendary Plaza Hotel in New York City. Chef Tison’s nouvelle cuisine has earned critical acclaim. Most recently, his leadership enabled the Fairmont Sonoma Mission Inn and Spa in California to receive the celebrated Michelin Star recognition for three consecutive years.
Chef Andrew Cain started working under an executive chef at the age of 15, received a Bachelor’s degree in Hotel Restaurant Management and went to work at the Fairmont with Chef Tison 10 years ago. They’ve made a great team ever since. This relationship is now helping to dramatically elevate Northwell Health’s food experience.
The two believe that crafting delicious meals shouldn’t change by location. “Whether it’s a patient in a bed, or a person in the restaurant,” says Chef Cain, “when it comes to cooking great food, you truly have to care about it.”
Redefining the culinary experience.
Having reached the pinnacle of the culinary profession, Chefs Tison and Cain were looking for a new challenge and the opportunity to bring the highest level of culinary expression not just to people who could “afford it” but to people who truly needed it, people whose lives could be changed by a world-class food experience.
That’s why Chef Tison joined Northwell Health and later brought Chef Cain onboard, with Chef Tison stating, “I came to Northwell because they are very serious about making this shift in the healthcare food industry happen.”
Chef Tison has championed a number of important initiatives for Northwell’s culinary efforts:
Bring outstanding talent from the outside and retrain existing chefs.
Having worked with Chef Tison for 10+ years, Chef Andrew Cain shared his passion for elevating the food experience for people who genuinely need it. With a background in Four- and Five-Star restaurants in New York, San Francisco and Washington, D.C., Chef Cain is helping Chef Tison bring a Michelin-inspired sensibility to Northwell Health. Northwell is also partnering with the Culinary Institute of America to attract the next generation of great chefs.
Knowing that Northwell is a place known for the most innovative clinical technology, Chef Tison is bringing this same commitment to modernizing the food service area.
Higher quality food.
This includes fresh, locally-sourced food instead of frozen, replacing instant coffee with fresh coffee, getting rid of candies/sugar and eliminating processed food.
Chef Tison’s ultimate goal is to deliver restaurant-quality food to patients, families and staff. “It’s a new frontier,” says Chef Tison, “and that’s exciting for new and tenured chefs alike.” He even has an eye on applying for inclusion in the Michelin Guide!
Helping patients take the next step: Discover the Clinical Coordination Center
The continuum of care is incredibly broad, and for patients looking to navigate this alone, the process can at times become overwhelming. That’s why at Northwell Health we created the Clinical Coordination Center, which takes patient referrals from our physicians and helps them discover what the next step should be in their path toward better health.
The Clinical Coordination Center consists of experts who are capable of addressing the needs of a patient and coordinating their access to care. They take into account the urgency of patient needs, their location, physician availability, and many other nuanced factors that play into providing the best possible care. Clinical Coordinators work at the center of Northwell, gaining insight into nearly every aspect of the health system. It’s the sort of role that attracts high-level intellectual caregivers, and fosters collaboration. The results of this team have been astounding. Patient satisfaction is through the roof reaching a whopping 95%, and physician satisfaction is at 93%.
The rewarding reception to the work being done at the Clinical Care Center is matched by a rewarding work environment. Clinical Care Coordinators benefit from a bright room, flexible hours, fun activities and, above all, a team of enthusiastic colleagues.
“There are no wrong numbers in this office. If you call us by accident, we’ll never steer you away. We are the yes people. Yes, we can!” – Ronda Gross, Assistant Vice President, Clinical Coordination Center
Northwell Health is excited to offer new opportunities to join this dynamic team in the following roles:
As a Patient Care Coordinator, you will be the eyes and ears of the Clinical Coordination Center. As the first line of defense, you will triage patients to determine the next step in their care and what the patient needs.
To qualify you must have:
Associate’s Degree required, Bachelor’s preferred
A minimum of three years clinical experience. Candidates with experience in careers such as, but not limited to, LPN, Medical Assistant, CNA, PCA, OR & ED Tech are encouraged.
Looking to work beyond the bedside? Join a team where you will have an even greater hands-on approach to patient care. In this role, you will help take patients through their entire care journey from triage to referral to outcome discussions and future follow up visits.
We’re seeking Registered Nurses or Nurse Practitioners with:
BSN and a Master’s Degree (MSN, MPH, MBA, etc.)
Clinical care experience required
Grow your expertise of our world-class health system while guiding patients, physicians, and a multitude of other departments toward a more seamless health journey.
Inside Northwell: How to Stand Out While Applying for Jobs in 2018
At our first Inside Northwell Facebook Live session, we sat down with members of our Talent Acquisition team who gave the best tips for candidates looking to join our team in 2018. Check it out!
1. How can candidates stand out while applying for jobs in 2018?
My best piece of advice would be to only apply to positions that you meet the minimum qualifications for. With the volume of applications we receive we can’t contact everyone and we are contacting only those who most closely match the department’s specific needs. If you don’t hear from us, you will remain in our database and we can contact you for other positions you are suitable for. Just because you were not the right match for one, does not mean you wouldn’t be the right match for another so don’t lose faith – the needs vary from department to department.
2. How can they make their resume stand out throughout the bunch/mix?
Your resume is a living breathing document so you can make changes as you learn or develop new skills sets throughout your career, even if you are not currently looking for a new job. Make sure you mention the special project that you have taken and the impact to the organization because it’ll show you ambition to make a direct impact. If you are looking for a new job, always remember, the job description is your friend – use the information provided to help you craft your resume and use the keywords they have listed within the job description in your resume too. If your previous experiences don’t exactly match the job you are looking for, don’t forget to add the transferable skill sets you’ve learned. (ie: “Customer Service” is really “Communication Skills”)
-Arthur Beechman, Clinical and Non-Clinical Recruiter, Talent Acquisition
Remember to add keywords. We have advanced technology that we are using to source through a variety of candidates. If you have the keywords within your resume our searches will be able to match with yours and pull up your information before someone else’s. Also, remember to send the final version of your resume. You wouldn’t believe the amount of resumes we receive with a coworkers/family members/metors edits on them. Always double check!
If you’re updating your resume, as you should be all the time, make sure that any past experience is referred to in past tense. If it looks like current tense language for a position you held 3 years ago, we notice that and it shows less attention to detail. Also remember to quantify information. If you work for an organization that we aren’t familiar of, it’s very helpful to a recruiter to have some sense of how large that organization is, adding the number of direct reports (if any) you have, if you’ve saved the organization any money and how you achieved that – this will help us quickly understand who you are and what you do for what type of organization.
-Esther David, Director, Talent Acquisition
3. What makes a candidate “made for Northwell Health”?
4. What are the most appropriate ways for them to follow up with recruiters?
5. What is your last piece of advice for our candidates?
Experiencing health care through the Healthcare Management Program Internship
Written by: Ketrah Mugambe
When I first started my summer internship at Northwell Health in the Healthcare Management Program, I thought I had a sound idea of what I wanted to do in my career. Being a science major, it made perfect sense to want to pursue healthcare from a clinical standpoint. I had no idea of what an administrative job in health care could offer. I figured – why not go against the grain a bit? Why not see what else is out there?
So I spent eight weeks with a little yellow notepad and a ballpoint pen, trying to absorb every aspect of health care management I would encounter. From finance to operations to data analytics, my learning curve was intense. My projects were new and overwhelming. And unfortunately for me, my pure science course load in undergrad proved to be absolutely zero help.
Every day in the office was different, and the variety of projects that I had was a true testament to that. To name only a couple, I was tasked to give suggestions of improvements to an oncology lab based on my observations, as well as to create an internal employee survey measuring employee satisfaction and engagement. I was working with real-time data, and important information that was of great use to my preceptors. It was a bit intimidating, determining the best way to utilize it all.
What motivated me, though, was the trust my preceptors had in me to get the job done, despite me being an intern with so much to learn. Throughout each of my projects, I was expected to know exactly what was expected of me, but to also know what my limits were and when to ask for help. I was called on to report back the results I found, making me feel like an integral part of the discussions that took place in that second-floor conference room. And most importantly, I was held accountable for ensuring that my output was my absolute best effort. Each day brought a different challenge, but I had the guidance and the support I needed to meet each one.
So while I came into my internship not really knowing what to expect, I can happily say that this summer turned out to be an incredibly rewarding experience for me. I not only learned a lot about Northwell, and their commitment to their patients and employees, but I also learned a lot about myself, and about what my capabilities are. This summer I had the great opportunity to be a part of a team, a team that needed me just as much as I needed them.
For those of you wondering where I stand in terms of my career plans now, the administrative side of healthcare has definitely caught my eye. The hustle and bustle that occurs behind the scenes, and not on a care facility’s main floors is an experience like no other. But overall, I have come to learn that there is definitely a career for me in healthcare, regardless of what path I will ultimately decide to take.
Submit your resumeto become a Summer Associate in the 2018 Healthcare Management Program Internship.
My journey in the Healthcare Management Program Internship
Written by: Jimmy Yoder, 2017 HMP Intern
I got the call I would be working in the Big Apple this summer in the middle of my finance class. Filled with excitement, I was practically squirming the rest of class. Needless to say, I didn’t do too well on the quiz that day. Four months later, I was on the way to my dream city for the summer to work at Northwell Health in the Cardiothoracic Surgery and Cardiology Service Line.
I’ve always had this obsession with living in a big city. Maybe it’s because I grew up in a boring suburb or maybe I just love breathing sub-par air. Regardless, I was made for New York. Northwell Health was the perfect internship for me. However, Healthcare Administration hasn’t always been my path. The majority of college was spent preparing for medical school. This let me dip my toes in the water and see if this is the right choice for me.
Day 1 at North Shore University Hospital rolls around and it was a whirlwind. For starters, my boss LOVES the stairs and my body does not love the stairs. The campus was and still is, so incredible. Almost a tiny city filled with thousands of employees and patients surrounded by world-class healthcare. From the get-go we had assignments. Whether it was data analytics, operations or marketing, we were pushed out of our comfort zone. I literally spent a week staring at excel trying to figure out that beast. The panic of not knowing a single thing about what I was doing began to hit. I sat down with one of the Management Associate Program associates and she told me you’re not growing if you’re comfortable. So I kept on trucking and utilized all the people around me. We were given work that actually means something and can benefit the service line, which not a lot of interns at other companies can say.
My Northwell Health experience has been one for the books. Aside from learning perhaps more information than I have in the classroom, the other interns have pushed the experience from great to incredible. A group of us, the out of state “commuters”, have gotten so close. From after work dinner, Broadway shows, happy hour and so much more, we became closer than ever. I think that is going to be the hardest part, going back to our respective universities and not seeing each other for an absurd amount of time. You know us millennials though; we will stay in touch through one of our 20 social media platforms. Lastly, I am so thankful I had such supportive preceptors pushing me to grow and challenging me, but most importantly helping me learn.
Whether my journey with Northwell Health continues or I end up someplace else, I’ll look back and know I was Made for this.
Update: Jimmy has been offered and accepted a full-time position at Northwell Health after he graduates from the University of Texas in May.
Submit your resume to become a Summer Associate in the 2018 Healthcare Management Program Internship.
An Appointment With: Senior Vice President, Chief Marketing and Communications Officer Ramon Soto
Welcome to “An Appointment With,” where we sit down one on one with leadership, doctors, nurses and more to bring you their stories. Today we’re meeting SVP, Chief Marketing and Communications Officer Ramon Soto, who was the most recent winner of the AHHE Hospital Executive of the Year Award.
How did you know that coming to Northwell Health was the right career move for you?
I didn’t at first. I was born in Brooklyn and raised in Patchogue. When I heard about the Chief Marketing Officer position at Northwell Health, then known as North Shore-LIJ Health System, I just remembered the small health care company from my childhood. After doing my research, hearing Michael Dowling speak, and learning about the advancements at the Feinstein Institute for Medical Research and the Hofstra School of Medicine, I fell in love. I saw the power of this organization and I knew there were stories waiting to be told. This is the best job I’ve ever had.
How has the rebranding process at Northwell Health impacted the organization?
Fundamentally, our hospitals used to run regionally and people associated themselves with the single hospital they worked for. Now people feel like they are all together, and there is a sense of community. This has helped improve our engagement scores. As separate entities, people didn’t know who we were and how we were all connected and now they see all of our locations as one. There has been an undeniable unifying effect on the inside, and ability to shine as a destination health care system.
What is your perspective on leadership?
90% of leadership traits are trainable and there are things you can do throughout your career to be a good leader. My philosophy is: don’t just “dabble” in anything, take it on with all you’ve got. You should know your stuff and strive to be the subject matter experts. When making a decision, you should bring everyone together to help. Leverage diversity of thought and unity in action. If you give people a voice, the execution is always better. If you can adapt your leadership style to fit the needs of your audience as well as the organization, you will be able to grow and flourish.
You recently earned the AHHE Hospital Executive of the Year Award. What have you learned from that experience and what did that mean to you?
The most important part of the awards evening was that my family was there and I was able to reflect on my heritage. This award made me think of my father. He came from Puerto Rico when he was 12 and he didn’t speak a word of English. He pulled himself up from poverty by going to school at night and working hard. He believed you always had a choice: work a job you enjoy or work a job as a chore. He also said to always stretch yourself, whenever you think you can’t do more, you can. His wisdom helped shape who I am today. I went back to get my MBA at 40 even though I had a successful career because of the drive he instilled in me.
Many people of diverse backgrounds have stories like this, and that’s why in terms of diversity in the workplace, it’s important to include individuals from all backgrounds based on their experience and what they’ve done. We need qualified candidates and we need to choose the best of the best. If we don’t include everyone in that pool of candidates, we’re missing out.
However, no institution should ever settle for people who aren’t the top or relax their standards to bring on talent that isn’t qualified.
What is an interesting fact that people should know about you?
I had a perm in high school!
We invite you to come back for the next moment in our Appointment With… blog!
It is the policy of Northwell Health to provide equal employment opportunity and treat all employees equally regardless of age, race, creed/religion, color, national origin, alienage or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, generic information or genetic predisposition or carrier status, marital status, partnership status, victim of domestic violence, or other characteristics protected by applicable law. Northwell Health leaders, including the CEO, are committed to the principles of Equal Employment Opportunity and Affirmative Action.