Adirondack Health, Lake Placid, NY
Dec 2012 – Current
Duties: Provide administrative and analysis support the Physician Network Services leaders, providers and staff in terms of finance, human resources, policies, provider contracting, overall reporting and special projects. Work in a dynamic integrated team environment under little to no supervision. Respond to telephonic inquiries by patients and other health care staff regarding access to health care, availability of services and other health care related issues. Assist case manager with projects related to patient care, patient compliance with required diabetic protocols, contacting specialists to obtain required reports, etc. Develop, distribute and maintain Health Center provider schedule on a regular basis which requires extensive coordination and attention to detail. Able to view provider schedules in eCW to determine provider availability and patient workload. Assemble and analyze data and performance indicators relevant to understand current performance of large outpatient practice along key operational and financial dimensions. Tasked with development and maintenance of quality indicators to monitor outcomes in support of the NCQA requires CMS requirements and local requirements. Assure integrity of financial and statistical data through review of invoices, reports, schedules, worksheets, reconciliations and other analysis. Process divisional purchase and check requests, initiate and track all human resources activity in a timely manner, compile divisional policies, provide capital and operating budget support. Primary liaison to Press Ganey contracted to provide patient satisfaction survey and analysis. Coordinate with the Press Ganey support team and manipulate web site and reporting systems to derive the necessary quarterly reporting to advance divisional patient satisfaction among the providers and sites. Develop and perform reporting tasks as required of the Medical Home, PQRS and Meaningful Use project requirements. Knowledge of eCW, Meditech, Policy Manager, Contract Manager, Performance Management, SharePoint, Health Stream, as well as MS Office Suite and various healthcare related websites.
I was able to help the Physician Network Services department to become more organized and responsive to the providers needs. Developed many tracking sheets and processes to ensure accountability.
Knoweldge of medical strategies/processes
Knowedge of Medical Terminology
Knowedge of Excel
Attention to detail
Director, Specialty Practices
Adirondack Health, Saranac Lake, NY
Feb 2012 – Current
Supervisor: Mr. Steve Giardino Contact: Yes
Duties: Director of Specialty Services for a small rural hospital with several developing hospital based outpatient professional specialty practice reporting directly to the Assistant Vice President for Physician Services. Direct and manage daily operations of several specialty practices employing roughly 20 staff focused on optimal access, high quality medical care and targeted RVU production. Duties include managing patient flow, patient satisfaction, policy development, regulatory compliance, quality performance initiatives, staff selection and performance management and employee discipline. Evaluate practice operational needs and makes recommendations for financial and facility planning, and personnel. Working knowledge of revenue cycle management, appointing, scheduling, registration, and insurance verifications. Work closely with senior leadership and providers in order to facilitate operating efficiencies between the outpatient hospital owned practices, independent hospital based practices and hospital itself. Interface billing staff and finance to optimize and streamline coding, billing and collections. Able to assess every aspect of the practice and create and direct the implementation of those items necessary to improve patient care, improve efficiency, increase revenue, lower overhead and plan for the growth and expansions. Participate in the development of organization Patient Centered Medical Home model for outpatient practices. This includes access, care coordination, quality chronic disease management, collaborative care, shared responsibility, educations, patient satisfaction, EMR/IT optimization and change management. Coordinate with physicians to ensure timely and accurate reports and completion of patient charts. Compile data, analyze data and prepare statistical and narrative reports such as the number and type of procedures performed with cost analysis and time analysis for planning and productivity purposes. Analyze cost of services for the practices, developing ProFormas, preparing operating budgets and variance reports as well as make recommendations for capital equipment. Determine staffing levels utilizing staffing model and makes recommendations to leadership. Conduct practice staff meetings and conferences. Development administrative and technical policies and communicates policies and procedures to subordinates. Ensure compliance with Federal and New York State laws, as well as Joint Commission. Serve as a patient and customer advocate; investigate problems, complaints and issue of concern from both the patients and providers. Provide supervisors with policies, procedures and protocols required for clinic operations. Assist site supervisors with operations, personnel, and financial issues related to site performance. Working knowledge of Kronos, Press Ganey survey process, Meditech and the E-clinical (eCW). Proficient in Microsoft products such as PowerPoint, Word, and Excel.
Chief, Managed Care Division / Health Systems Specialist
US Army Medical Department Activity, Fort Drum, NY
Jan 2009 – Feb 2012
Fort Drum, New York
Title: Chief, Managed Care Division / Health Systems Specialist
Supervisor: LTC Kyle Patterson Phone: (315) 772-4024/7657 Contact: Yes
Salary: $86,500 per year / Hours per week: 40
Duties: Chief of the Managed Care Division within the Medical Activity at Ft Drum, NY - a large multispecialty outpatient clinic with a minimum of four separate locations on post. Position encompasses supervisory and managed care management responsibilities for the military TRICARE benefit which includes health benefits, debt collection/claims (TRICARE), utilization management, enrollment/empanelment, referral management and the tracking and posting of referred care medical reports. As a Division Chief, communication skills, both oral and written, are a critical component of the position. Position involves continually fostering relationships with internal and external agencies such as the Veteran's Administration, local physician offices and hospitals, the managed care support contractor (Health Net) and other military treatment facilities for the purpose of coordinating benefits, gathering information, and sharing resources. Actively participate in the development and implementation of the clinic's strategic mission, goals and initiatives. Maintain supervisory responsibility for 21 individuals which include health systems specialists, a utilization management nurse, an auditor and medical support assistants. Required to respond to taskings on a wide variety of subjects ensuring suspense dates are met and critical approvals are obtained prior to final submission. Delegated projects and taskings frequently involved gathering data, organizing and preparing written and graphic reports and papers, to include responses to Congressional inquiries, GAO audits, MEDCOM and 10th Mountain Division inquires. The Division Chief position is multifaceted and requires the ability to work a significant number of projects and issues simultaneously, in addition to the daily management of the division itself. Managed Care duties include projecting future trends, analyzing historical data and presenting courses of action. Adept at researching and interpreting policies and regulations. Frequently called upon to measure the effectiveness, efficiency and productivity of the TRICARE program, as well as managed care support contract in the market area with a focus on civilian network adequacy, optimization of MTF provider resources, referral management, and adherence to contract requirements. Integral member of the business operations team which involved in depth, system wide analysis of health care process and out year projections for workload, staffing and utilization of civilian network resources. A participating member of Strategic Planning Committee, Performance Improvement Committee, Data Analysis Work Group, Patient Centered Medical Home initiative team, Space utilization committee, Patient Safety committee and many others. Skilled at preparing charts, graph and information papers. Possess a working knowledge of Powerpoint, Excel and Word, as well as the government
electronic medical record. Delegated responsibility for financial management of the Division budget, including analysis of budget allocations and projection of future expenditures. Lean Six Sigma "yellow belt" with extensive experience in evaluating services available and identifying opportunities for efficiencies and performance improvement with regard to the provision of health care within the military health care system. Due to limited resources and the need to reduce costs and increase efficiencies, called upon to develop creative and innovative solutions to problems and issues focusing on "work smarter, not harder" philosophy.
Health Systems Specialist
US Army Medical Department Activity, Fort Drum, NY
Mar 2004 – Dec 2008
Supervisor: MAJ Zeckler Phone: (315) 772-xxx Contact: No (no longer in military service)
Salary: $64,870 per year / Hours per week: 40
Duties: Designated Chief of the Managed Care Branch within the Clinical Operations Division. Supervisory responsibility for 10 employees. Responsible for ensuring teamwork of staff, coordination and management of TRICARE Health benefit program, beneficiary assistance program with regard to referrals and claims, the Referral Management Office to include coordinating receipt of consult reports, debt collection assistance, and maintenance of the Commander's Discretionary Fund. Assist beneficiaries and providers in resolving issues, addressing complaints, and clarifying TRICARE/clinic policy. Adept at researching and interpreting government and local policy related to the provision of care within the government military treatment facilities as well as the TRICARE Program. Foster relationships with outside agencies such as the VA and the local hospitals for the purpose of coordinating benefits, exchanging information and sharing resources. Gather data, perform analysis, and document trends in healthcare usage and referrals. Monitor daily access in the civilian network, patient and provider satisfaction and adherence to TRICARE program objectives. Actively participate in special projects related to offsite clinics, financial initiatives such as MHSSIs, VA sharing agreements and external resource sharing agreements. Liaison between the military treatment facility, the North Atlantic Regional Medical Command, the TRICARE regional office and the Managed Care Support Contractor (MCSC). Responsible for ensuring MEDDAC staff and command are trained and kept abreast of changes to the TRICARE Program and the managed care support contract focusing on access to care, referral management and quality of care. Contracting Officer Representative for approximately $6 million worth of contract task orders for health care provider services.
Health Systems Specialist
US Army Medical Department Activity, Fort Drum, NY
Jun 1996 – Mar 2004
Supervisor: MAJ Barrett Phone: (315) 772-xxxx Contact: No longer in military service
Salary: $45000 per year / Hours per week: 40
Contracting Officer's Technical Representative performing daily surveillance. Coordinated closely with contractor and MEDDAC staff to ensure contract compliance, as well as successful partnership between the contractor and the government. Instrumental in the implementation of the TRICARE Program at Fort Drum. Primary Point of contact for all in-house health care contracts of the MEDDAC at Fort Drum. Developed new contract requirements in close coordination with various supervisors/leaders and the Contracting Office. Researched, developed and finalized statements of work for health care contracts. Performed workload analysis, market research and developed independent government estimates to ensure cost effectiveness of contracts and determine appropriate method of obtaining required services. Monitored contract funds to ensure appropriate utilization and payment. Coordinate closely with staffing/recruitment companies to fill contract requirements, i.e. daily interaction to evaluate resumes and determine if qualifications match contract requirements. Conducted classes/briefings.
Employment history 1985 - 1996 available upon request (no lapse).