David M. Email & Phone Number

Franklin, Nc, Us

Provider data is critical to nearly every aspect of healthcare payer operations. It impacts member experience, medical management, claims, finance, quality management, and regulatory compliance to name just a few.Over the course of over 30 systems migration, assessment, and optimization projects with major claims systems like QNXT, HealthRules, Facets, Conduent Meditrac, and many legacy platforms, I've collected a wealth of experience in addressing the challenges that face payers in managing their provider data successfully.While there is no "silver bullet" at this point in time, there are approaches that can make a difference. I started Maven One Health to make these approaches accessible to payers of all sizes.Maven One Health offers a suite of software and service solutions to help payers identify the issues lurking in their provider data, prioritize those based on the impact to member and provider experience, and implement a road map to make rapid incremental improvement.If you're working in a healthcare payer organization - a health plan, TPA, ASO, IPA, MSO, or even a medical group (whether you share risk or not) - let's talk about your Provider Data Management journey. I'm happy to share ideas and thoughts and explore whether Maven One Health is a good fit for your organization.

Eddystone, Pa, Us

Eddystone, Pa, Us

Responsible for all IT functions at InsPro Technologies, a leader in Policy Administration Systems for Life, Health and Annuities carriers and TPAs. Oversight of Platform Development, Solution Architecture, Infrastructure and ASP Services delivery.

Eddystone, Pa, Us

Eddystone, Pa, Us

Eddystone, Pa, Us

Lead implementation of InsPro core administration system, impacting all key aspects of Sterling's Medicare Supplemental line of business.Managed project to build and deliver Model of Care, NCQA, CCIP and QIP reporting along with submission of NCQA Structure and Process measures for Medicare Advantage SNP plans in all states covered by Windsor Health Plan.

Teaneck, Nj, Us

Technical consulting services on QNXT implementations to a wide variety of TriZetto clients from initial architecture, technical design and planning, developing data conversion and systems integrations strategies and performing post-implementation systems reviews. Functional areas include:- QNXT Architecture and Deployment- Health Plan Data Conversion and Data Quality Analysis- EDI Implementation (HIPAA X12, 837, 834, 835, etc.)- IT Operations Strategies with QNXT- Active involvement in the Project Management process- Custom solutions design- QNXT Configuration design for maximum acceptance of EDI transactions

Operational and IT consulting services for Medicare Advantage plans, payers and providers for:- Gaining operational efficiencies through application of IT systems- Systems analysis and enhancement design- Analysis of IT impact on regulatory and operational compliance- Improvement of data flow between systems and disparate entities- Security and policy analysis, development and training- Vendor oversight and management advisory services- Process automation consulting (operational and IT)- Managed care systems implementations- Healthcare data warehousingIn the following areas:- Provider data management (provider directories, data quality analysis, contract management and configuration, etc.)- Claims operations (timeliness, inventories, automation, EDI, etc.)- Encounter data collection and workflows- CMS data submission: HCC / RAF improvement projects, Medicare risk adjustment analysis (using MOR / MMR), RAPS, HIPAA 5010 implementation, CMS Encounter Data Processing System upgrades- Member and enrollment data management and quality analysis- Executive dashboard analysis and development- Call center processes, tracking and tools- Capitation and risk pool payment management- Marketing automation and enhancement through IT solutions- Broker oversight solutions- Implementation of systems and processes for meeting new CMS regulations for MA/MAPD- Assistance with IT portions of CMS readiness assessments- MOOP (Maximum Out of Pocket) reporting and data management- Health Risk Assessments (HRA) automation, process streamlining and systemsFor healthcare IT systems and services vendors:- Market needs analysis- Opportunity identification based on real-world experience in the marketplace- Product development research, consulting and oversight- Sales support- Project management- CRM / Sales Support- Regulatory and operational environment monitoring and analysis services

Us

Provided senior IT leadership for a rapidly growing managed care organization including responsibility for software development and database administration, project management, reporting and analytics, infrastructure and telecommunications, systems architecture and strategy and systems implementation and business configuration.- Overhauled entire network and telecomm infrastructure to address deficiencies, stabilize operations and position the company for rapid growth- Led efforts to collect, scrub and warehouse medical encounter data for submission to CMS for risk adjustment (RAPS) leading to $10m in recovered revenue over two reporting years- Led development of applications to handle automation of Medicare billing requirements in compliance with CMS regulations (premium, LIS, late enrollment penalty)- Technical Project Manager and Executive Sponsor for implementation of TriZetto's QNXT core administration platform, resulting in a dramatic reduction of overpayments and improved operational efficiencies and data integrity, leading to one year $1m savings and immediate ROI on the project- Stabilized IT operations by implementing help desk services and software, establishing policies and procedures, developing desktop procedures and training staff

MedlockWeb provides software engineering consulting and project management services to a wide range of clients in the healthcare industry including integrated web based marketing and back office solutions, managed care systems and Medicare processing development applications.

Franklin, Tn, Us

Managed development and support of over 70 web sites, web based staffing application development, development support for marketing campaigns and specifications and launch of hospital-specific intranets.

New York, Ny, Us

Us