Adam Handley Email and Phone Number

• Developed pricing model and negotiation tools for transition from block to FFS payment for AHCCCS Complete Care• Developed COB algorithm to track accounts receivable by responsible payer• Developed Accounts Receivable reports to monitor encounter rejections, denials, payments, and contractual adjustments

Designed, created, maintained, and populated SQL 2012 data warehouse that housed HCAHPS, Core Measure, DRG LOS, Readmission, CMI, physician encounter, CPT coding, WRVU, and Medicare Fee Schedule dataDeveloped and distributed over 120 reports through SSRS that directly or indirectly supported most financial and clinical analysis for all product lines and regionsDeveloped several ETL methodologies to consolidate disparate database structures across four charge capture paid claim sources and three external billing companiesDeveloped Financial Impact model that determined Sound Physicians’ monetary value to each client hospital

American Physicians, Inc.Streamlined and automated month end close reporting processes to Accounting Department’s specifications. Developed Paid Claim Lag reports, A/R Roll Forward, A/R Aging, other Paid Claim analysis reports to identify action plan items, Supported physician quarterly salary true-ups by comparing salary expense to actual production.Jewish Family & Children's Services (www.jfcsaz.org)I merged the General Ledger system and Electronic Medical Records (EMR) system into a single reporting platform to calculate the total organizational cost per minute of therapy provided to determine required contract negotiation thresholds. This analysis divided administrative overhead into 3 categories and brought in each employee’s, both therapists’ and support staffs’, salaries and benefits to highlight cost differences across numerous dimensions.Health Care Group (www.hcgaz.com)Consolidated membership, utilization, and cost per 1,000 members statistics across three source systems. Developed web-based reporting system using C# in ASP.NET framework. Developed all reporting SQL Server databases, as well as all interfaces with underlying encounter claim databases, to support reporting needs for above system. Aligned actual utilization to Milliman & Robertson guidelines to highlight utilization variances.

Western International Strategic Enterprises - Worked closely with physician owner to develop reports to participants, vendors, and potential clients. Consolidated questionnaire answers with actual lab and fitness data to provide Personal Health Report forms for each participant and identify areas of concern for each employer group. Targeted Metabolic Syndrome, Men’s health, and COPD.CORF Services, Ltd. - Developed site selection demographic reporting package for prospective clients, including target patient population density by zip code, location of target physician offices, and prevalence of target diseases by county. Developed enterprise-wide reporting for Monthly Revenue, Patient Volume, and A/R trends by combining three distinct claims payment packages. Analyzed Medicare reimbursement trends for various product lines, including Pulmonary Rehab, Sleep Disorder, Social Services, and Physical Therapy. Developed and periodically updated nationwide Charge Master to meet strategic unit pricing goals. Provided assistance in Managed Care, PPO, and Workers’ Compensation contracting for licensed facilitiesVarious physician clients - Developed custom software interface to produce monthly financial and physician productivity reports. Developed custom software to provide drill down analysis and recovery of A/R. Analyzed claim payment and patient demographic information with proprietary software to develop reports detailing physician productivity, patient visit trends, revenue by insurance company, fee schedule trends, and comparison of reimbursement by CPT by insurance company as a percent of the Medicare Fee Schedule. Developed negotiation presentations to insurance companies to justify rate increases by highlighting competing physician office locations, zero paid claim and bundling patterns; and patient visits. Developed contract analysis package to determine if contract re-negotiation offers should be accepted.

Developed Outpatient Services application (MS Access) that combined actual Paid Claim experience and contract structural characteristics to identify cost structure variances across all markets.Migrated Outpatient Services application to the company’s intranet and changed to ASP.NET framework using VB.NET.Worked on team that developed actuarial-based intranet analysis and trend tool for all inpatient facility contracts. This tool ultimately received a corporate excellence award.

Provided information and guidance in all areas of developing and implementing a Managed Care strategyDeveloped and populated data warehouse to analyze paid claim and patient demographic dataAnalyzed reimbursement, as compared to the Medicare Fee Schedule, for top 30 HMO, PPO, and Indemnity Payers and negotiated rates as necessary Determined profitability of all in-Office Laboratory procedures, PSA, Urinalysis, and Testosterone Injections Completed Credentialing of newest Physician added to Practice

Developed PCP Network to support Risk based contracting model for IPA. Responsible for negotiating and developing contract through several revisions utilizing in-house Legal support.Headed multi-department task force to implement Risk Model contracting. Included development of Capitation rates and Cost Targets; press announcements to media; communication with provider Network; and Delegated Oversight activities.

Provided financial analysis, reporting, and support of all major contracts between CIGNA and provider community; including PHOs, Specialty Capitations, Inpatient contracts, Medicare Risk Capitation, and Outpatient SurgeryInstrumental in development, monthly reporting, and renegotiation of Specialty Capitation Rates for Cardiology, Orthopedics, Oncology, Radiology, and NeonatologyResponsible for development and maintenance of PHO Capitation rates, monthly reports, risk pool reconciliation, and IBNR methodology

Completed numerous projects including RBRVS Fee Schedule analysis; Paid Claim and Encounter Analysis by CPT and Physician Specialty; hospital utilization reporting, variance, and drill down analysis by DRG; DRG and stop loss reimbursement modeling; and moving from Outpatient Surgery case rate to ASC Grouper reimbursement Prepared Pro Forma of Rural Expansion of Medicare Risk Product, including Inpatient CapitationSupported Medicare Risk Line of Business, including Capitated contract renegotiation with hospital providers; risk pool settlements; and monthly Utilization reportingDeveloped Preferred Hospital Network and Hospital Bed Day Reduction Strategies

Provided financial and operational support to Healthcare Centers; Primary Care; and Specialty Departments, including Urgent Care, OB, Surgery, and PediatricsPrepared and monitored Staff Model Budget and Operating Targets

Received extensive training in TQM, Statistical Process Control, and Systems Thinking Facilitated several System-wide Process Improvement Teams

Participated in Human Resources Strategic Development Committee

Targeted disease groups for potential cost reductions through use of clinical and financial databasesIdentified physician specific practice pattern variances to reduce cost variation between providers

Implemented and managed Productivity System, including reporting of monthly departmental salary variances, development of System-wide personnel budget, in-depth productivity analysis of Rehabilitation Therapy departments, and System-wide Standards Update Project

Mentored by Senior Management of Acute Care, Psychiatric, and Rehabilitation Hospitals in all areas of finance, operations, and marketing during Administrative Residency