Daniel Roberts Email & Phone Number

Served as Subject Matter Expert (SME) for Office of Compliance of the Mental Hygiene Administration.Provided healthcare management expertise in role as consultant to both Mental Hygiene Administration and Administrative Services Organization, ensuring that new programs were properly implemented in order to meet federal waiver requirements and that all available federal revenue was collected; facilitated more than $3.5 billion in FFP collections. Oversaw and monitored FFP submission performance and improved operational efficiency of programs including CapitationP program, Traumatic Brain Injury Program, and monthly case rate for Psychiatric Rehabilitation Program.Resolved differences in payments by Mental Hygiene Administration and FFP funds collected through implementing improved systems and establishing more effective processes.Performed as liaison with senior Medicaid and Mental Hygiene Administration staffs to ensure accurate implementation of new code and transaction sets.Functioned as Manager of Provider Relations for long-term care facilities and other providers.

Conducted complex examinations of Medicaid claims (behavioral health) to identify deviant patterns that could indicate fraud or abuse of system. Examinations included multi-specialty claims from disparate sources and resulted in numerous exclusions and/or convictions.Ensured collection of Federal Fund Participation (FFP) monies through overseeing system design and management to successfully identify claims subject to federal participation. More than $16M in underpayments recently identified.Recovered more than $35 million in inappropriate payments after designing and implementing system to identify incorrectly funded claims, and establishing thorough post-payment review process.Reduced program expenses while ensuring continued access to services through successfully employing monthly case rate for psychiatric rehabilitation services; program acknowledged as success by both consumers and providers.Developed highly successful processes to identify fraudulent billing enabling Maryland Health Hygiene Administration to lead the nation in compliance efforts.Served on several committees with providers, current Administrative Services Organization (ASO) and MHA.Designed and implemented recent programs to identify high-risk consumers to ensure continuity of care.KAI, IncorporatedSupported key pharmaceutical company research initiatives by directing several large, in-depth vaccine studies involving more than 27,000 telephone interviews. Developed effective quality assurance checks and statistical analysis processes to ensure statistically significant results.

Functioned as project manager on numerous vaccination and depression studies, as well as clinical decision making and medical system review processes; completing projects on time and under budget.Coordinated efforts of clinical research staff and information technology staff, bridging any knowledge gaps between groups to ensure successful project outcomes.Improved efficiencies for producing reports for drug companies and FDA by leveraging use of Access to perform quality assurance checks for vaccine studies.Enabled transformation of Access data for import into SAS datasets for statistical analysis by developing comprehensive database queries.Developed CATI automated calling system to manage call queues to produce statistically significant and useful interviews.

Led final phase of conversion of client and accounting data from AS400 to Advanced Revelation database management system for incorporation into third-party system.