David Creek Email & Phone Number

Washington, Dc 20006

Baltimore, Maryland, United States

Detailed analysis of business requirements to determine impact on current processes across various platforms currently utilized in Government sponsored claim processing systems. Collaborated with team members to develop analysis documents to communicate identified risks and requirements to ensure success of the implementation of CMS mandates.

Frisco, Texas

Government AR oversight for 75+ hospitals, clinics, and various specialized facilities. Critical knowledge of Governmental processes and procedures to assure smooth assimilation into working systems. Instrumental in enhancing efficiency, introducing process improvements, and implementing change management strategies. Comprehensive background in client implementations, including offshoring of strategic components of the AR work stream, as well as workflow and process development. Significant exposure to compliance awareness and government auditing. Worked directly with upper management across the company to effect critical changes necessary to integrate many system designs during Nationwide acquisitions.

Responsibilities include coordinating government audits for Medicare and Medicaid initiated by Recovery Audit Contractors, CERT, Office of Inspector General, and Medicare Administrative Contractors. All level of government appeals were included in our efforts to recover any funds retracted due to the audit decisions.

Dallas/Fort Worth Area

Responsibilities included the transition and implementation of workload from various offices throughout the United States to the corporate office for Revenue Cycle accounts pending collection from Medicare and Medicaid. CCS is a national DME supplier. I am the Implementation lead and tester for Medicare and national Medicaid enhancements. Current projects include implementation of Med Assets, PECOS updates, preparation for the National CMS DME CBID. I am the primary manager for the Medicare Revenue Cycle and back-up manager for the Medicaid Revenue Cycle team.

Dallas/Fort Worth Area

Responsible for multi-department coordination and implementation of multiple system software changes. This includes the oversight of project administrators required to analyze requirements, develop test plans, test system enhancements and coordinate with appropriate divisions. Also ensuring the necessary file maintenance and reporting requirements are implemented timely and within budget. All aspects of claims processing are monitored including receipt, editing, processing, payment and crossover. The processing of the information includes movement of data through many different companies. Knowledge of PMBOK utilized throughout.• Project manager responsible for oversight of over 12 project administrators• Change management review and analysis, including Federal Register guidelines• Review and development of test plans, monitoring implementation schedules• Averaging over 100 system modification per quarter• Participate in early development conferences with CMS for future regulations• Participate in early walk-through conferences with system maintainers to identify programming requirements• Responsible for CMS status reports of testing, identifying and prioritizing issues preventing implementation• Areas of processing include all facility type Billing, Pricing, Local and National Coverage Decisions• Current projects include Electronic Medical Records - ICD-10 review and implementation• Quality review and reporting

Dallas/Fort Worth Area

This area included 6 project administrators required to review CMS Change Management requirements, analyzing, developing processes and reports to meet the necessary requirements for claims processing and creating work instructions. Responsible for processing Part A claims utilizing multiple systems, including the Fiscal Intermediary Standard System (FISS), Expert Claims Processing System (ECPS), Common Working File (CWF) and the Health Care Integrated General Ledger Accounting System (HIGLAS). In addition, the department is responsible for processing claims-related financial transactions, identifying and researching system issues. The department also, processed changes or corrections to all facility claims including the national contract for Indian Health Services and Veteran’s Administration. Transitioned two workloads effectively which increased workload by over 35%.• Lead the implementation of new departmental requirements, utilizing 6 project administrators • Statement of Work standards are identified, monitored and reported in the mandated timeframes• Processing original claims, adjusting claims for CERT, RAC, ZPIC, Providers and all OIG projects• Oversight of multiple departmental standards• Hiring, training and development of direct reports – ranging from 20 to 60, which included clinicians• Implemented and maintained ISO 9000/9001 standards covering all audit requirements, four audits annually• Identifying, tracking, reporting and testing system issues, enhancements, and corrections• Communicate and coordinate effectively with other departments• Developed adhoc reports on demand• Created budgets and writing proposals for new workloads and contracts

On-Going, Business Administration And Management, General

Additional course work with emphasis in Project Management and Accounting.

Assosciates, Computer Programming