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. •Oversee compliance matters including product filings, resolution of regulatory issues, responses to regulatory inquiries, for a variety of products and programs marketed across the United States. •Provide counseling/advice with respect to regulatory developments in the external environment, product development issues, and the interpretation and administration of commercial markets products. •Accountable for activities required to maintain financial records, the preparation of financial statements, and the preparation of statutory reports for submission to the Department of Health Services (“DHS”). •Lead the business segment department operating expense oversight, including maintenance of budget development processes and assessment of operating effectiveness with respect to current and multi-year financial performance targets. •Conduct oversight of the business segments initiatives, ensuring that the initiative business cases are thoroughly documented and that measurable success criteria are contemplated in current and multi-year budgets, projections, etc.

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.•Managed a team of analyst which resulted in better way to steer the expenditure and minimize cost of care while providing best in class service to our members.•Established and maintained a work plan for Utilization team ensuring work performed by the team will achieve yearly Spend targets and MEIs.

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 financial goals; ensuring related compliance.• 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 the team will achieve target goals for submission.• Managed encounters business requirements and UAT testing strategy and implementation by driving operational and/or technical project estimations, feasibility assessments, prioritization, and resource management activities.

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. Coordinated results with affected team members. Lead regular meetings with Encounters reporting team members to review projects globally, coordinated collaborative efforts and knowledge sharing among all team members, seeking opportunities to leverage existing processes/code to satisfy requests, and leverage fellow team SME’s to assist on projects as needed.• 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 to Encounters processes or data affecting the Encounter Reporting and Analytics Department. Coordinated with fellow team SME’s as needed to accomplish tasks or attend meetings where appropriate by escalating issues/concerns.• 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 code/results are reviewed by a SAS expert on the team as needed for validation before placing new processes into production. Strengthened team’s knowledge. Closely monitored project and trigger tracking database for accuracy, timeliness and metric reporting successful implementing of Encounters-related projects.

• 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) improvement options and alternatives as per business needs; validating reports generated on COGNOS for business requirements; implementing reporting needs for NY MEDSIII to NY PACDR, HIX IPA/Vendor Crosswalk: Created IPA/Vendor Crosswalk to enable vendor level reporting.• 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 to support submissions team in meeting GA state SLA.• Internal Audit: Providing Encounters SME support to Compliance team in creating queries, answering data/process related questions in timely and accurate manner.• Support/Training: Created Data Dictionaries for the datasets of Information fields and reports generated. Carried out Knowledge Transfer sessions for peers to understand the newly adopted encounter processing system (EPS). Involved with Medicaid Encounter Submissions team in meeting the Service Level Agreement (SLA) per state requirements. Helped Business Analysts with technical and functional knowledge in creating Business Requirement Documentations (BRD).

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; analyzing Coordination of Benefits (COB); loading National Plan and Provider Enumeration System (NPPES) data to determine changes in registered NPIs.• 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), client/server and web with relational database concepts and object-oriented programming.• 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.• Collaborated extensively in loading plan communication files from CMS for Part A, Part B, Part D and PDP plans such as TRR weekly and Monthly, NoRx, LIS/Part D Premium Data File, Batch Eligibility Query (BEQ) Request File Acknowledgment, Failed Transaction Data File etc.,• Imported Medicare Physician Fee Schedule data using SQL Server Integration Services (SSIS) 2008/2005 to help Claim adjudication.• Audited Member Co-pays data basing on Low Income Subsidy (LIS) information from CMS.• Support/Training: Developed Training Materials required for transfer knowledge to the end users and to the administration and support.