Andrew Burkhart Email & Phone Number

Tampa, FL, US

Pinellas Park, Florida, United States

• Assisted with establishment and ongoing operations of new Primary Care Practice including identifying and negotiating office space, obtaining insurance payer contracts, licensing, credentialing, systems set up and.
• Execute all revenue cycle management functions such as ensuring claims are coded correctly and meet clean claim requirements, payment posting, insurance/patient billing and receivable collection, and root cause.
• Conduct regular audit functions to verify all services are billed, all payments meet contractual pricing, claims are adjudicated according to prompt pay requirements and all claims are in a finalized status.
• Partner with health plans to identify Patient quality care gaps and coordinate closure during measurement year.
• Perform all company financial operations including bookkeeping, payroll, financial reporting, and reconciliations.

Tampa/St. Petersburg, Florida Area

• Oversee 4 remote teams including the Provider and Patient Billing Escalation Team, Claims Appeal Team, Service Validation Team and Client Network Services Team.
• Responsible for assisting Providers with claims and billing issues, resolving and identifying root causes of patient billing issues, optimizing patient NPS scores by analyzing survey data and taking appropriate.
• Assisted in implementing several new clients on CareCentrix Utilization Management services for Traditional Home Health Care and Post Acute Care (PAC) and now provide ongoing support to these Provider networks with.
• Previously led several functional areas within Revenue Cycle Management and Network Management including Provider network initiatives, Provider payment support team, and large account dedicated business unit.
• Experienced in analyzing and trending claim denials and rejections, sampling denials and rejections for appropriateness, assigning root cause, and driving remediation through system remediation/configuration, Provider.
• Led business efforts with new claim system implementation and ICD10 implementation including business requirement gathering and documentation, system UAT, communication and training, and provider, clearinghouse, and.

Tampa/St. Petersburg, Florida Area

• Collaborated with organizational leadership in implementing third party administration (TPA) services such as customer support, premium billing, paper/electronic enrollment, exchange connectivity, and 834/820/APTC.
• Responsible for new carrier set up, on-boarding, and continued account management to ensure that TPA services are meeting or exceeding established operational metrics.
• Coordinated project action plans and deliverables with internal functional teams and carrier partner to meet plan and project deadlines.
• Well versed in Health Care Reform (HCR) regulations for both the Federal Facilitated Marketplace (FFM) and Covered California (CC) state based marketplace.
• Drafted multiple internal training documents containing guidance on FFM and Covered California regulations and procedural rules for handling various exchange transactions such as special enrollment periods.
• Developed operational workflows to document services, processes, and identify gaps between HPS and carrier, carrier and exchange, and HPS and exchange.

Tampa/St. Petersburg, Florida Area

• Responsible for operational and business oversight of a $180MM annual Medicaid product across 16 Florida counties.
• Grew overall Medicaid membership by 7% to 65K members from 2012-2013 through increased product branding, increased outreach and education, and improved expanded benefit offerings.
• Collaborated with Community Outreach, Provider Operations and Member Services to collect member data, design initiatives to improve member experience, build community brand awareness, and enhance existing network.
• Designed and implemented a comprehensive Member Retention program aimed at reducing turnover both during open look and at time of annual renewal.
• Developed and implemented Quality initiatives to close HEDIS and other Medicaid Quality Measure Care gaps.
• Improved child health check-up participation ratio by 41% and overall screening ratio by 13% through targeted live call, unattended call, and mail campaigns.