Adam Warren Email & Phone Number

New York, Ny, Us

Eden Prairie , Mn, Us

• Serve as Lead SME on the Content Management team on the development and management of Optum’s technology that houses the entirety of Optum’s intellectual property for Payment Integrity (Payment Integrity Content Library).• Participate in cataloging, categorizing, translating, and assessing payment integrity content to enable it to be stored in a content library for end users to be able to search the content in a usable way. • Review concepts in the library to find opportunities to improve analytics or cross pollinate a concept to other teams of concept ideators for increased savings potential. • Consult with Optum’s internal business partners to advise in the development of growth opportunities within our payment integrity business.• Our team manages the process for Code Management updates for the enterprise. We gather data to be loaded to Optum’s tables for use throughout the enterprise

Eden Prairie , Mn, Us

• Serve as Project Manager over a large-scale technology development designed to connect multiple payers, providers, and consumers. • Serve as payment integrity SME.• Provide consulting services to healthcare providers to streamline and improve processes and data collection in the payment integrity space.• Develop, maintain, and manage multiple reporting functions across the organization.• Assist in obtaining and retaining client base within our area for payment integrity services.• Coach the client in establishing their Payment Integrity Office structure.• Train clients on Optum’s exclusive payment integrity data reporting solutions.

Louisville, Kentucky, Us

• Manage, train, and educate a team of skilled associates that create and manage numerous audits that originate from overpayments identified by our vendor partners.• Communicate with vendors regarding overpayments and processes we find to be incorrect.• Collaborate with other areas and teams to identify and correct issues with claim payments such as contract load errors, CMS pricers, ambulance rates, auditing errors, overpayment setup errors, etc.• Implement and document major process changes to the Inpatient Pricer audit process, including developing multiple new databases, dashboards, and reports.• Develop, maintain, and manage multiple reporting functions for the Missed Opportunities team. Created multiple reporting dashboards for several of the audits for our department.• Work and analyze inventory utilizing multiple internal systems to develop query concepts.• Create and analyze reports and implement action items as needed.

Louisville, Kentucky, Us

• Lead the management, implementation, and reporting of over 70 different internal queries for the Clinical Guidance Team (CGT) / Clinical Ancillary MD Team (CAMD).• Utilize MOAT, SCIO, MRM, CAS, and CCP2 to reconcile claim issues and monitor the status of claims as they move through the audit process.• Create and manage the CAMD reporting dashboard to show all savings, findings, inventory and other tracking items for CAMD programs.• Load claim files to update statuses and add claims to various systems: findings files, referral files, selection files, MRM batch update files, etc.• Created process flows and trained other areas and vendors on CGT processes.• Manage the CGT mailbox and CGT CCP2 tanks for the entire Clinical Guidance Team.• Run queries and provide reports for leadership and requesting areas.

Louisville, Kentucky, Us

• Clinical Collaboration and Collaboration and Opportunities teams worked with multiple areas to lead new projects and initiatives that would allow our clinical audit programs to be more efficient. • Project Owner of the Vendor Record Retrieval Project. Managed all aspects of the project including: interviewing vendors, training of vendors, training of internal associates, reporting, invoicing, decision making, etc. of the entire process from start to finish.• Partnered with the rest of my team in managing portions of the Referrals project. I reviewed referrals submitted to identify waste and abuse, made monthly selections, and retrieved claims data using TOAD to be evaluated by our team.• Created Access database for audit leaders on our team to utilize in monthly reporting of setups. • Partnered with the audit leaders under our team to streamline the internal and external comments used by the vendors of each audit program.• Owner of the New Ideas SharePoint site and handled the evaluation of new ideas submitted through the site to determine if they added value to any of our programs.• Collaborated with multiple areas on additional projects such as: Text Mining, MOAT and Pre Pay Tool testing, and Office of Inspector General research team.

Louisville, Kentucky, Us

• Use the Missed Opportunity Database (MODB) to research claims that were contested by the IPA to find additional recoveries via query building for multiple audit types. One of the initial members on this new team and tasked with creating processes for the team.• Validate contract information for potential Missed Opportunities and initiated system fixes based on contract information and send claims to audit after all appropriate fixes were complete.• Use Access to build queries for finding claims that have not yet been contested and should be recovered. Build queries for other projects and work with FR Solutions builders as needed.• Directed the team in funding project for California IPA’s claims that have paid to the incorrect fund for Out of Area (OOA) and Out of Network (OON) contract provisions. Team built and executed the criteria for OOA queries, executed the OON queries built by the Florida Contestation team and submitted the results for audit.• Created the criteria and process for capturing Capitation overpayments related to Contestations.• Handled all Hospice FR opportunities that were set up via Connolly Consulting and National Audit Service (NAS) as part of our vendor Missed Opportunity team.• Learned multiple aspects of Service Fund for reference in validation of capitation and California IPA project.

Louisville, Kentucky, Us

• Handled calls from participating and non-participating providers regarding claim overpayments. • Identify valid and invalid financial recoveries set up by auditing teams using various systems and programs such as: CAS, Metavance, CCP2, CIS, Claims Xten, Web.Strat, etc.• Identified as Subject Matter Expert (SME) for our department and elevated to team lead. Became the primary contact for escalated issues and handled multiple aspects of reporting for leadership. • Trained new hires to the department.

• Personally developed the club’s Policies and Procedures for Inside and Outside Service Golf Staff.• Served as member of Golf Committee and Tournament Committee comprised of clubmembers. First assistant professional in club history to be on these committees• Supervised 12 employees via scheduling, training, and mandating constant improvementof customer service.• Managed inventory and tee sheet through point of sale system and Microsoft Excel• Gained responsibility of producing the clubs monthly newsletter as well as doing variousflyers, advertisements, etc.• In charge of scoring for all five of clubs golf leagues in addition to preparation andtournament direction for golf club and outside events.