Andrew Wolfe Email & Phone Number

Austin, Tx, Us

United States

Austin, Texas Area

Austin, Texas Area

I served as the team lead and senior rate analyst for the Calculation and Analysis team in the Long Term Services and Support division of the Rate Analysis department. My team is responsible for reviewing cost reports and setting rates for all LTSS facilities. We perform an advanced review and reconciliation process after auditors review the cost reports for general information. I also oversee the rate setting and program interactions for the former DARS programs. I also establish reimbursement models for special programs. I am currently at the end of bringing my latest project, the Quality Incentive Payment Program (QIPP), online. I worked with multiple stakeholder groups, legislative staff, and executive staff including briefing the Executive Commissioner. Prior to QIPP, I lead the update to the reconciliation of the payment amounts for the Minimum Payment Amount Program (MPAP). This was an intensive process that required analysis of managed care encounter claims and comparisons of payment amount to Medicare. I updated the Comprehensive Rehabilitation Services (CRS) program reimbursement methodology through multiple stakeholder groups and DARS executive leadership. Bringing these programs or program updates online quickly and efficiently required problem solving skills and clear root cause analysis. These are the ways my current role requires me to combine detailed analysis and high level elements to generate an effective result in a project.

Austin, Texas Area

I negotiated contract reimbursement amounts, amended and reviewed existing contracts, and reviewed contractor’s budget and financial worksheets for the Early Childhood Intervention (ECI) program. I provided support and direction to staff and managed special projects assigned by leadership. I led the funding application process, which is a 5 month process coordinating the receipt of the funding applications, the review of the application by financial and programmatic staff, execution of the funding methodology process, and finally, amendments to existing contracts. This process resulted in a fully executed contract with each ECI contractor. The funding application process involves staff statewide within all of the ECI programs.From a management perspective, I reviewed staff work and served as a resource when they encountered problems or challenges. I instituted data driven process improvements thereby saving staff time by identifying issues quickly for staff to address rather than waiting until they were identified via a manual process later.

Austin, Texas Area

As a Program Specialist VI, I set Medicaid reimbursement rates, updated existing Medicaid Texas Administrative Code reimbursement rules, implemented technical initiatives, and managed stakeholder involvement for both inpatient and outpatient hospital reimbursement. In addition to the new responsibilities as a PSVI, I maintained continued responsibility of programs I was responsible for as a Program Specialist V which included: Graduate Medical Education (GME) program, Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Ambulatory Surgical Centers and Hospital-based Ambulatory Surgical Centers (ASC/HASC), Renal Dialysis Centers, and Freestanding Psychiatric Facilities. I managed multiple initiatives and coordinated new policy changes for the programs listed above. Each program update required completion of detailed fiscal analysis, research, coordination with HHSC oversight and medical policy staff during the development process. I worked with other State agency staff to complete reviews and new benefit analysis. As a result of these reviews and new benefits, I drafted memorandums for the HHSC Executive Commissioner outlining proposed changes and associated fiscal impacts. I conducted rate hearings to receive public comment on proposed Medicaid rate changes. During legislative session in SFY2016, for 2014-15 Biennium, I was responsible for distribution and management of assignments received through the Legislative Tracking System (LTS) for the Rate Analysis Department. To do so, I read and analyzed legislation and assigned responses with associated deadlines to the appropriate section director or staff member.

Austin, Texas Area

As a Program Specialist V, I set Medicaid reimbursement rates, updated current Texas Administrative Code reimbursement rules, and implemented technical initiatives. I maintained communication with stakeholders regarding reimbursement changes for the following programs: Graduate Medical Education (GME) program, Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Ambulatory Surgical Centers and Hospital-based Ambulatory Surgical Centers (ASC/HASC), Renal Dialysis Centers, and Freestanding Psychiatric Facilities. I have managed multiple initiatives and coordinated new policy changes for the programs listed above. Each program update required completion of detailed fiscal analysis, research, coordination with HHSC oversight and medical policy staff during the development process. I worked with other State agency staff to complete reviews and new benefit analysis. As a result of these reviews and new benefits, I drafted memorandums for the HHSC Executive Commissioner outlining proposed changes and associated fiscal impacts. I have conducted rate hearings to receive public comment on proposed rates. During legislative sessions, I responded to inquiries from legislative staff using the Legislative Tracking System. I worked collaboratively to implement Rider provisions applicable to hospitals participating in the Medicaid program. I utilized project management skills to develop a timeline, identify required resources, and estimated fiscal impact for each Legislative Rider. I have presented Texas Administrative Code rule changes to the Medical Care Advisory Committee. I have met with stakeholders about the proposed rule changes in order to incorporate public input and support. Similarly, I have met with representatives from the Texas Hospital Association to address concerns, discuss proposed changes, and receive feedback on rules, policies, and rates.

• Help plan, organize, and setup campaign functions.• Brought Qbase Fundraising Manager software online.• Performed basic data entry for Qbase to update recent campaign contributions.• Received training to perform tax returns in partnership with Heart of Texas Goodwill.

• Identified, collected, and conformed patient claim data.• Interpreted and summarized insurance contracts.• Redesigned and upgraded insurance department website.• Examined and analyzed financial data for negotiation team.

Mba, General Business

Activities and Societies: Rawls Graduate Association (RGA): 2006 - 2007

B.S., Political Science

Activities and Societies: Treasurer of Circle K International Zeta Chi Fraternity Model Arab League Organization of American.