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ARCADIA Healthcare Solutions, Headquarters - Supervisor: ACO GPRO Accounts & Remote Data Collection Team Resume Example

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Danny Sample
808 Sample Street, Lake Zurich, Illinois 60047 - 800-652-8430 (H) - 800-867-5309 (C) -
Adaptable administrator accustomed to the integration of new healthcare delivery systems and restructuring of work in an increasingly complex regulatory environment. Value based care driven. Expertise in areas of strategic account support, combining more than 18 years of work. Delivering solutions to raise the stature and rankings of healthcare quality.
  • Account Management and Operations
  • Crisis management and Resolution
  • Data Mining, Collection and Reporting
  • EHR Documentation Optimization, 
  • Recruiting & Hiring, HR experienced
  • Auditing, Cycle-Billing/Invoicing, Coding: CPT, ICD-10 and ICD-9, E&M and Surgical Billing,  Referrals, Medicare & Medicaid Claims & EOB, Claims Appeal SME
  • Commercial & Government (Medicare &Medicaid) Payers Experienced

ARCADIA Healthcare Solutions, Headquarters September 2014 to June 2017 Supervisor: ACO GPRO Accounts & Remote Data Collection Team
Burlington, MA

Healthcare Technology QI - MCS Division.


Led newly established (September of 2014) Group Practice Reporting Option (GPRO) department for Sage Technology Company, acquired by ARCADIA Healthcare Solutions May of 2015 Reporting ACO Client's Quality metrics to CMS for Medicare Shared Savings Program (MSSP) / Quality of Care Improvement Program

  • Developed, documented and implemented: department manuals containing Policies and Procedures, reference materials, as well as all Project "life-cycle" Management Plans
  • Consistently met account and organization expectations via successfully reporting in 2014, 2015, 2016, resulting in NO Post CMS GPRO Audit
  • Comprehensively managed strategic accounts life-cycle. Influenced, gained the trust of account stakeholders / leadership through effective communication - resulting in contract extension and renewals
  • Worked in tandem with legal for all account and vendor contract updating
  • Collaborate with the client support team, comprised of data analysts, clinical operations, and product experts, in the delivery of the company's services and successful completion of all assigned projects
  • Led data initiatives, Extract Validation and Reporting Tools' Audit in Test & Live Environment
  • CMS Medicare Shared Savings Program (MSSP), Accountable Care Organization (ACO) Quality Measures yearly proficiency
  • Served as subject matter expert on EHR, EMR & Paper Chart Clinical Documentation Validation, Documentation Auditing thus reporting findings, resulting in system optimization improvement and best practices
  • CPT, ICD-9 and ICD-10 Codes Validation
  • Managed multiple projects simultaneously, each account with diverse needs, demands, goals and strategic outcomes
  • Managed, recruited, interviewed, coached and mentored successful Remote Data Collection Team. Proven employee retention track record
  • HIPAA (Secure transmission of any PHI, data files-sftp transfers, encryption) best practices.
Edwards-Elmhurst Health May 2011 to June 2014 Clinic Manager
Elmhurst, Illinois

Women's Healthcare and Wellness Hospital Clinic, Physician Practice Division.


Smoothly, effectively & successfully executed merger of private practice with hospital, maintaining high energy and a positive mission focused Culture Collaborated with Health system leadership, physicians, and on-site / remote staff, using open dialogue, identifying and resolve issues and concerns by way of excellent communication techniques Responsible for optimizing staff roles and productivity to meet all site performance expectations

  • Facilitated cooperative working relationships between the site staff, Physicians and all other Medical group and ancillary departments
  • Collaborated tightly with Physician Practice Division & Hospital billing / coding department following office protocols to maximize billing turnaround-reimbursement by validating physician documentation supporting level of care provided
  • Monitored insurance, ROI, billing issues support Surgery scheduling, referrals and managed care program requirements
  • Managed all front end and back end daily operations of assigned clinic sites
  • Led transition of paper chart medical records system to Electronic Medical Records. NextGen & Epic EMR/ EPM system SuperUser status         
  • Responsible for optimizing staff roles and productivity to meet all site performance expectations.
  • Facilitated cooperative working relationships between the site staff, Physicians and all other Medical group and ancillary departments
  • Joint Commission & HIPAA Lead
Bravo & San Juan, SC February 1998 to April 2011 Practice Manager
Elmhurst, Illinois

 OB/GYNE   Women's Health & Wellness 

Successfully reduced A/R from 25% outstanding to below 5% outstanding in nine months. Managed all aspects of practice / business operations: expenses, budgeting, mass mailings, inventory-supply management

  • Supported and maintained practice mission: patient centered, compassionate, stellar service and high-level quality care centered
  • Maintained A/R below 5% outstanding consistently increasing revenue yearly
  • Commercial Payer Project Management & Contract negotiations
  • Skilled in Insurance verification, Surgery pre-certification, Medicare & Medicaid Reimbursement, SMECPT & ICD-9 coding, coding yearly review
  • Full Cycle Billing & Collections, Patient Invoicing & Collections, EOB & patient payment posting, Claim Denials & Appeals SME, Medicare & Medicaid, Commercial Payers, Third Party Payers, Self-Pay & Collections
  • Med Mgr. EPM System, scheduling template building and maintenance / System SuperUser
  • Audit preparation for malpractice, risk and non-risk products / contract maintenance and renegotiation
  • Accounting support, data gathering as needed, Year End tax prep, W2
  • Monthly-quarterly-year-end reports, credentialing / re-credentialing
  • HR administrator and maintained highest level of HIPAA
  • Routinely perform: quality assurance checks and reporting, benchmarks for best practices (weekly, monthly)Excellent communication with all internal and external parties
  • Recruiting, Interviewing, hiring all personnel
  • Coached and developed staff with a strong emphasis on EXCELLENT high-level service, understanding, patient, compassionate patient centered service
  • Developed positive co-worker relationships and cultivated great team efforts delivering quality care Developed and implemented short and long-term work plans, projects and goals (malpractice audits, insurance plan audits, physician re-credentialing)Patient tracking tickler logs, all department forms, instrument / devices & equipment maintenance
  • HIPAA, Practice Confidentiality Officer    
Technical Skills
  • EPIC, NextGen - (EMR and EPM),  
  • Cerner ASP, OneChart-PowerChart,
  • Meditech, Alexicare, Athena, e-Clinical and Works
  • Paper Charts
  • Clinical Documentation validation 
  • GoToMeeting, Ultipro, and Concur
  • Paychex, Kronos, and When2Work

  • ACOHS: A Data Mgmt.- Data Aggregation / Quality Registry 
  • CMS Web-Interface  
  • Patient Cycle Billing   E&M and Surgical Coding
  • Referrals Medicare & Medicaid Proficient
  • Office 365 (Outlook, Skype for Business, Microsoft Word, Microsoft Excel, Microsoft PowerPoint)

Northwestern University Psychology and Sociology Studies Evanston, Illinois
Oakton College Psychology and Sociology Studies Des Plaines, Illinois

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