Eric Moffat Email & Phone Number

Canton, MA, US

• Led a team of senior analysts reporting on and forecasting commercial standard & value-based/risk contracts covering up to $75M in settlements of risk, quality and related payments annually.
• Collaborated with IT, Contracting and Analytic teams to distribute electronic financial data files for settlement reconciliation.
• Partnered with Harvard Pilgrim/Payor teams to allow for smooth transition of membership and contracts related to merger.
• Researched and provided detailed support information for provider performance teams meeting with external providers.

Canton, Massachusetts, US

• Senior Manager/Manager, Network Contracting – Contract Strategy & Analytics 2014-2021
• Led a team of senior analysts reporting on and forecasting commercial standard & value-based/risk contracts covering up to $75M in settlements of risk, quality and related payments annually.
• Collaborated with IT, Contracting and Analytic teams to distribute financial data for settlement reconciliation.
• Partnered with internal and external audit teams to facilitate annual audit needs and requirements.
• Spearheaded a quality improvement program in conjunction with IT to improve provider satisfaction and accuracy of outbound settlement data files.
• Researched and provided detailed support information for provider performance teams meeting with external providers.

Canton, Massachusetts, US

• Led a core team responsible for configuring commercial contract reimbursement (Fee for Service, DRG, Capitation, etc…).
• Maintained and implemented industry-standard codes, withhold and capitation. Consulted with partner departments to evaluate system changes and capabilities.
• Implemented Trizetto pricing system enabling more flexible and efficient provider/employer group contracts while maintaining legacy systems with reduced staff.
• Oversaw $40 million claims editing program including vendor relationship and cross-functional edit logic review team. Consolidated two vendor edit system to sole source relationship providing additional savings to the.
• Represented AHIP on Massachusetts Uniform Coding and Billing Advisory Committee.

Canton, Massachusetts, US

• Assembled cross-functional group comprised of multiple stand-alone teams responsible for issue identification, root cause analysis and resolution of commercial claim related issues.
• Led a team of 25 staff to collaborate with relevant partner departments to resolve significant operational issues.
• Served as a central servicing contact for alliance-based open access network product with Cigna.

Canton, Massachusetts, US

• Directly supervised and worked alongside Business Analyst and Provider Account Specialists to support key strategic provider accounts.
• Executed and provided data analysis supporting both Payment Policy implementation and Medial Trend Management.

Canton, Massachusetts, US

• Supported department staff in the management of both new and existing hospitals and provider group accounts. Active resource for department identifying opportunities for process improvements.
• Progressively responsible positions in customer service assisting members and providers with a range of issues from general benefit inquiries to subrogation acting as both a mentor and acting supervisor.

AHIP representative to state advisory committee seeking to promote uniformity and consistency in the reporting of patient diagnostic information, patient care service and procedure information as it relates to the submission and processing of health care claims.

Norwalk, CT, US

• Staff / Charge Paramedic / Supply Officer
• Medical Technician in Primary Care / Emergency Room

Management Certificate, Management

B.S. - Management, Accounting Information Systems

Education record