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Jeffrey A. Snyder, AHFI, CPC-H5521 James Drive
Hamburg, NY 14075Phone: (716) 481-3159 Email: [email protected]
SYNOPSISHealthcare business leader offering diverse healthcare industry experience. Thorough knowledge of payer-provider contractual arrangements through the claims payment cycle, and extensive experience with payers, providers and clients, focusing on regulatory compliance and payment integrity. Thought leader with proven consulting, product and service management, delivery, operational and client skills.QUALIFICATIONS AND COMPETENCIES Program Infrastructure Development Leadership in a Large Matrix Environment Proven Team Building & Motivational Skills Creative and Aggressive Approach to Business Goals & Objectives Client Service & Relationship ManagementRELEVANT EMPLOYMENT HISTORYCGI Federal 10/2010 – PresentDirector, Audit Operations Lead the activities of all healthcare audit, audit strategy, and appeals teams in the execution of client contracts to
identify inappropriate payments for all healthcare services and provider types for Federal, State and Commercial clients.
Forecast and plan for future growth potential and opportunities, anticipate required increases in staff and identify necessary infrastructure developments to accommodate growth and new services
Grew audit team from 23 to 137 members and increased recoveries by 300% over October, 2010 levels directly contributing to record profitability
Implemented an Audit Steering Committee comprised of clinical, coding and physician leadership to review audit criteria and policies and enhance transparency in the overall audit process
Decreased appeal reversals and modifications by over 40% (2011) to 8% (August, 2014) Ensures compliance with all service level agreements and other client-issued directives Develops and defines clinical scenarios with a high probability of improper payment and sustainable volume. Oversees development and continuous improvement of processes and workflows that support all audit recovery
projects. Drives reporting and analytics for clients and senior management.
HealthNow New York, Inc. 09/1999 – 10/2010Manager, Special Investigations/Reimbursement Integrity Unit 02/2001 – 10/2010 Responsible for all aspects of facility, ancillary, and professional provider audits, including recovery of excess
funds billed to HealthNow. Defined audit and investigation roles and objectives, as well as developed project plans consistent with accepted
professional standards. Managed, prioritized, and directed auditor and investigator workflow. Monitored completion of retroactive adjustments to accurately reflect proper reimbursement for services. Developed and implemented the annual business plan. Developed and monitored annual budget, validating that all projects, audits, and investigations were completed
within the time frame and budget allotted. Conducted Fraud and Abuse training for all HealthNow staff. Collaborated with the Regional Anti-Fraud Task Force groups and Office of the Medicaid Inspector General to
Jeffrey A. Snyder, AHFI, CPC-H5521 James Drive
Hamburg, NY 14075Phone: (716) 481-3159 Email: [email protected]
share information on fraudulent providers and emerging schemes.
Senior Network Management Representative 09/1999 – 02/2001 Responsible for relationships between two BlueCross BlueShield Plans and approximately 102 facilities
consisting of hospitals, home care agencies, infusion therapy providers, and mental health providers. Contracted new providers to ensure member access, quality of care and reasonable reimbursement. Worked closely with Utilization Management, Medical Management, and Internal Audit departments to identify
improper payment issues and develop corrective action and recovery plans. Worked closely with case managers to facilitate smooth, cost effective continuity of care for chronically ill
members.Brylin Hospitals, Buffalo NY 03/1993 – 09/1999Clinical Operations Manager Worked with New York State Office of Mental Health (OMH) and Office of Alcohol and Substance Abuse
Services (OASAS) to develop or revise mental health and substance abuse treatment modalities, validating compliance with State program and licensure requirements.
Responsible for state-mandated reporting and encounter data submissions.PROFESSIONAL REFERENCESReference 1: Dominic Bethel II, Manager, Recovery Vendor Relationships, HealthNow New YorkTelephone: (716) 887-8652E-mail: [email protected]
Reference 2: Randy Ball, Director Client RelationsCGI FederalTelephone: (706) 866-3148E-mail: [email protected]
Reference 3: Shirley K Lawrence, Esq. Telephone: (716) 662-6964E-mail: [email protected]
EDUCATION & TRAINING A.A.S. Business Administration, Erie Community College, 1984 Accredited Healthcare Fraud Investigator, National HealthCare Anti-Fraud Association, 2006 Certified Professional Coder – Hospital (CPC-H), American Academy of Professional Coders, 2010