Anthony Werner Email & Phone Number

Provide strategic direction for financial operations, organizational operations, projects, and services to assist patients and their families with navigating the healthcare system through education and guidance. Whether it’s finding the right doctor, precertification or appeals, or checking healthcare bills and insurance explanation of benefits I provide services from beginning to end. Prepare budgets for approval, including those for funding or implementation of programs. Plan and implement policies and activities to ensure continuing operations to maximize returns on investments and productivity.* Support Cancer patients with navigating the healthcare system. provider i.e., center of excellence, and are within insurance networks.* Oversight with standardization and design for medical device regulation & 510K FDA review for submissions with regulators. * Advise on clinical trials protocols with medical affairs including standardization, auditing, clinical application, patient recruitment, and analyzing data.* Analyze data and use technology to assess and ensure delivery of operational effectiveness.* Assisted physicians with prior authorizations & appeals for medical, pharmaceutical, & out of network benefits based on evidence based medical policies and guidelines.* Saved patients over 2.2 million in erroneous medical billing charges and insurance claims processing.* Perform financials for the nonprofit entity and oversee development of employee retention and training for departments.* Converse with physicians and other healthcare providers & relay information between insurance companies & patients.

Us

Managed a staff of 1000 who are the single point of contact via a call center for over one million patients participating in pharmaceutical manufacturing programs, supporting multiple B2B clients with contracts up to and exceeding $1B. Review, implement, and comply with all federal, state, and pharmacy manufacturing regulations within the United States and abroad. Manage department budget of $1M. * Appoint department heads or managers and assign or delegate responsibilities to them.* Developed organizational policies or programs and maintained 95% compliance with URAC call center KPIs of over 750,000 inbound and outbound calls annually between 3 locations* Maintained enrollment and refill rates of over 90% across all lines of business driving revenues to over $12M annually* Improved prior authorization approvals via new SMART process which simultaneously decreased costs, increased efficiencies* Created and build new lines of business for Medication Therapy Management and Opioid Abuse and Reduction* Led corporate initiatives on patient satisfaction, client meetings, URAC, Medicare Stars, and other audits and accreditations* Routinely met with C-suite executives to provide status updates; Oversaw development of employee retention and training * Implemented medical and pharmacy coding integration and training programs to improved customer service

New York, Ny, Us

Manage New York State Medicaid, Children Health Plus (CHP), Family Health Plus (FHP), and commercial lines of business. Work with state goverment and regulators with administering Medicare and Medicaid plan.Assist with administration of New York Medicare and New Jersey Medicare and Mediciad lines of business

• Managed eight employees and daily activities relating to pharmacy utilization management and benefit related issues.• Prepared budgets including new hires, existing staff salaries and bonuses along with departmental needs.• Worked on projects for the oncology and pain management departments, vendors, and committees.• Liaison for pharmacy for Horizon sales force, physicians, and members.

Mba, Healthcare Administration

Bachelor Of Science (Bs), Healthcare Administration