Akbar Shareef Email & Phone Number

Dayton, OH, US

Dayton, Ohio, United States

Dayton, Ohio, United States

Dayton, Ohio, United States

Oversees Encounters operation for Medicaid, Medicare Advantage, DSNP, Market Place and Provider Data Claims Support (PDCS) Operations

Dayton, Ohio Area

Greater Pittsburgh Area

• Plan, organize, staff, direct and control the day-to-day operations of Encounters department; develop and implement policies and programs as necessary.
• Perform management responsibilities including, but not limited to: involved in hiring, coaching and development, rewards and recognition, performance management and staff productivity.
• Conduct oversight of detailed, multi-year earnings improvement initiatives under the direct and indirect control of the segment leadership, including measurable initiatives across P&L categories.
• Function as member of the team responsible for developing vision and strategy.
• Provide detailed guidance on the preparation of all financial components of the strategic plans across the business segment.
• Oversee communication of strategy and vision to management and staff and to representatives of the company.

Tampa/St. Petersburg, Florida Area

• Managing activities of Clinical analytics reporting for WellCare; setting overall Targets, MLRs & MEIs, monitoring MEIs, and managed resources to operational and financial goals; ensuring related compliance.
• Managed two teams of 6 direct reports each to provide reporting needs by forecasting and monitoring MEIs (Medical Expense Index) and MLRs (Medical Loss Ratio).
• Supervised in own capacity as Business Owner in the implementation of Datamart/Datalakes for Clinical Analytics.
• Supervised Expansion and Integration projects to adapt best in class methods to monitor expenditures and contractual agreements with the service providers.
• Led Cost of Care Committee to highlight areas of opportunities and presented solutions.
• Worked closely with other business areas which helped to significantly improve data quality and achieve contractual service levels from our government partners.

Tampa/St. Petersburg, Florida Area

• Coordinating activities of State and CMS encounter reporting for WellCare; setting overall goals, performance standards, and operational priorities for one or more functions and managed resources to operational and.
• Worked closely with other business areas which helped to significantly improve data quality and achieve contractual service levels from our government partners.
• Lead a team of analyst which resulted in better way to root cause and fix issues preventing encounters data from being accepted by implement operational and/or technical changes or improvements as necessary.
• Collaborated with business partners, including in the management of vendor relationships, to align business and technological strategies; established and maintained a work plan for encounters ensuring work performed by.
• Managed encounters business requirements and UAT testing strategy and implementation by driving operational and/or technical project estimations, feasibility assessments, prioritization, and resource management.

Tampa/St. Petersburg, Florida Area

• Team Encounters Project Coordinator: Assigned projects to the appropriate team member based on priority, knowledge base and availability which helped to understand any shifts in priorities and upcoming projects..
• Encounters Data Point of Contact: Supported enterprise Encounters data initiatives as assigned and represented Encounters’ interests in meetings interdepartmentally involving data enhancement and other issues related.
• Team Training Coordinator: Took the lead in on-boarding and training new team members by mentoring non-senior team members to provide guidance and support as needed on Encounters reporting projects and ensured.

• Extensively involved in decision making process and documentation for meeting Service Level Agreements (SLA) set by respective states of operation.
• Played important role in numerous full Software Development Life Cycle (SDLC) (Feasibility, Analysis, Design, Implementation, Test and Maintain).
• Reviewed report requests from business users with technical staff to identify, gather, analyze, and document business system requirements.
• Involved in creating and maintaining requirements tractability matrix and prioritization meetings with the Development and Quality Assurance teams; Identifying, Defining, Documenting Encounter Processing System (EPS).
• Mimicked “COMPARISON OF GEORGIA CARE MANAGEMENT ORGANIZATION ENCOUNTER CLAIMS TO CASH DISBURSEMENTS FOR WELLCARE OF GEORGIA” for Fee For Service (FFS) (Provided by DCH) to predict submission percentage beforehand and.
• Internal Audit: Providing Encounters SME support to Compliance team in creating queries, answering data/process related questions in timely and accurate manner.

Tampa/St. Petersburg, Florida Area

• Extensively involved in gathering Business Objectives and Requirements from Business users; creating Business Functional Specifications (BFS), Functional Design and Documentation and Functional Decompositions.
• Supported full Software Development Life Cycle (SDLC) (Feasibility, Analysis, Design, Implementation, Test and Maintain) for variety of platforms and technologies such as entity-relationship diagrams (ERDs).
• Conducted end-to-end project management of large or multiple large projects by creating Design Specifications and Detailed Design Specifications; and performing System Analysis, GAP analysis, Use Case Analysis.
• Performed Agent and Broker Commission analysis on member enrollment and eligibility data using Crystal Reports and SQL Server Reporting Services (SSRS).
• Created Software/Program to audit Pharmacy Benefits Manager (PBM) (auditing Member Coverage Profile, Donut/GAP Analysis, Member drug utilization, True Out-of Pocket (TrOOP), Out-of Pocket (OOP), etc.,).
• Used PROC REPORT, TRANSPOSE, TABULATE, PRINT, SUMMARY, SORT, and SQL extensively in generating reports.