Mark Buffington Email & Phone Number

Indianapolis, Indiana, Us

• Provider Network Strategy Lead for Florida Individual market.• Subject matter expert on provider network development.• Data-driven decision support for new provider network development, including prioritization of geographic area entry/expansion and identification of key health systems and providers to partner with that provide sufficient access for members to conveniently receive the care they need.• Regulatory filing support including the analysis of provider data to demonstrate network adequacy/access compliance for Qualified Health Plans (QHP), as defined by the Centers for Medicare & Medicaid Services (CMS) as well as various state Departments of Insurance (DOI)• Developed an innovative solution to optimize health system strategy by identifying and prioritizing various scenarios with different combinations of health systems participating in network and identifying the best outcomes. Scaling this solution to support multiple markets simultaneously by leading cross-team collaboration between Network Strategy, Actuarial Pricing, Health Economics, and Network Analytics teams.• Across all markets and lines of business, provide analysis of provider networks and develop collaborative, innovative solutions to support membership growth and deliver high-value healthcare to millions of members.

Indianapolis, Indiana, Us

• Responsible for model development that supports provider network strategy and development, contract negotiations, termination analyses, and actuarial rate filings.• Project management of a web-based modeling tool, in collaboration with IT and other teams, serving as the product owner in an agile framework.• Manage annual budget of $0.6M – $1.2M and provide monthly expense forecasting.• Leverage claims (including episodic ETG & PEG data), membership, and quality data from multiple data warehouses, across multiple platforms (Teradata, SQL Server, SAS, Python, Tableau).• Perform ad hoc network analytics and present findings to leadership in non-technical ways.• Manage workload for and support development of junior team members.

Indianapolis, Indiana, Us

• Developed network pricing adjustments and consulted multiple local pricing teams (IN, KY, MO, OH, and WI).• I updated existing Excel models using VBA to gain considerable efficiency in my work.• I was responsible for analyzing network savings and performing ad hoc analyses to find drivers for healthcare cost savings.• Benefit relativity product pricing• Developed reimbursement rates for veteran facilities in Indiana on an annual basis and implemented process improvements to that process.

Us

Supported StepWise software suite implementation and configuration for health plans

Indianapolis, Indiana, Us

INDIVIDUAL AND SMALL GROUP ENTERPRISE PRICING AND FILING: • Developed and maintained enterprise pricing tools for ACA rate buildups and the populating ACA filing documents such as the Unified Rate Review Template (URRT), Actuarial Memorandum, and QHP Rate Template • Developed and maintained automated (i.e. Excel VBA macros) tools used to produce files submitted to internal implementation team and validate these against filing documents to ensure consistency • Supported 14 different teams in the rate buildups and filings for ACA Individual and Small Group business • Supported pricing for non-ACA (grandfathered/grandmothered) productsSTUDENT REPRESENTATIVE TO THE ANTHEM ACTUARIAL DEVELOPMENT PROGRAM: • Represented the interests of actuarial students to the program committee

Bloomfield, Ct, Us

• Market pricing lead for Individual medical plans in North Carolina and South Carolina • Perform rate reviews and rate filings • Work directly with sales, product, operations, and other matrix partners • Perform ad hoc analyses as needed to support the business

Bloomfield, Ct, Us

• Manage monthly client generic drug price updates and design/implement process improvements • Provide non-standard adjustments to support underwriting • Implement and test changes to pricing engines • Provide actuarial and underwriting support for third party administrators

• Provide counseling to behavioral health inpatients • Manage and document in confidential electronic records • Facilitate direct admissions and insurance pre-authorizations • Answer and counsel crisis calls with clients in distress

Bloomfield, Ct, Us

• Evaluated organ transplant costs • Developed and proposed new pooling fee rates for fully-insured business

Aurora, Co, Us

• Provided direct patient care and counseling • Managed and documented in confidential electronic records

Bachelor’S Degree, Mathematics With Probability And Statistics Concentration

Bachelor’S Degree, Psychology