Gregory Brown Email & Phone Number

New York, Ny, Us

Atlanta, Georgia, Us

Provides strategic leadership and hands-on management of all aspects of prescription benefit management operations; TPA integration, benefit configuration, EDI inbound/outbound file management, claims processing, formulary and networks. • Develop strategy for new implementations to achieve financial targets and meet client expectations. • Direct and drive standardization of all business processes and operating procedures• Develop key performance indicators and metrics to monitor, assess and optimize Operations performance• Continuous monitoring of all processes and working collaboratively with other leaders with implementing improvements to eliminate inefficiencies, reduce cost and improve quality and turnaround time • Provide ongoing engagement and relationship management with clients, TPA's, brokers, and vendor partners• Provide hands-on leadership for all key projects though implementation• Employee management and development

New York, Ny, Us

Operations leader responsible for E2E provider onboarding for network participation in the contracted lines of business. • Collaborated with key leaders to define and implement process improvement initiatives to provide visibility to provider onboarding inventory, establish performance metrics and improve onboarding timeline. • Monitored individual and team performance and optimized operations through continuous process improvement.• Business sponsor of the $16M Provider Engagement Transformation portfolio of initiatives in support of Healthfirst’s strategic goals. Responsible for business case justification (benefits, cost, value/ROI), executive presentation and approval, budget management, resource capacity management, risk and issue management, change management and team stand-up in accordance with the scaled agile framework (SAFe) methodology.

St. Louis, Mo, Us

Responsible for leading the development and implementation of the necessary changes to the business processes in accordance to the ACA regulations and requirements. • Developed and led a cross-functional project strategy to ensure the completion of all milestones and deliverables to meet the federal January 1, 2014 deadline.• Partnered and consulted with Account Teams and health plan clients to implement compliant solutions pertaining to pharmacy benefits. • Identified and evaluated all pertinent legislation, regulatory and sub-regulatory guidance and state specific guidance that impacted our clients and the organization and developed appropriate compliant and value-add products and solutions.• Partnered with state and federal regulatory agencies to shape further guidance and regulations.

• Identified partnership opportunities and engaged with key provider to grow membership.• Provided recommendations and guidance regarding resolution of contract and reimbursement disputes• Identified and led process improvement projects that improved the provider experience and reduced administrative costs.• Assisted with strategies to ensure the retention of high-quality contracted providers.• Participated in large and complex network expansion strategies to recruit physician specialties and large physician groups.

Woonsocket, Ri, Us

Led a team supporting retail claims reimbursement, cash application and billing. Responsible for compliance of the X12 835 remittance and the X12 837 billing transactions and implementing solutions to resolve risk and process gaps. • Partnered with vendors and payers to ensure timely claim reimbursement• Led a cross-functional project team, with representation from Legal, Operations, Regulatory, IT and vendors to resolve/mitigate compliance risk opportunities within the MED B claims reimbursement process.• Defined and implemented quality process improvements that reduced AR DSO to less than 30 days. • Automated customer reimbursement processing, reducing operational expense by $250K annually. • Collaborated with pharmacy claims payers to ensure timely remittance and compliance with the X12 835 remittance transactions.

Led a team of 4 Managers and staff of 32 analysts supporting daily operations of the Provider Enrollment and Network Management Departments. Managed $2.2M operating budget, $3.7M capital budget and $125M margin revenues.• Defined and implemented automation tools that improved speed, closed quality gaps and improved mean-time-between-failures by 46% year-over-year in 2009 and 52% in 2010. • Led several Six Sigma speed-to-market initiatives for provider network management, within budget and on plan targets, which produced $450K cost savings, $60M in incremental operating revenue and improved provider relations.• Enhanced provider enrollment processes that improved and streamlined enrollment processing, network configuration to realize margin faster and improve provider directory reporting and increase network utilization. • Developed a long-term strategic plan to restructure Provider Enrollment and Network Management and bring it more in-line with client benefit fulfillment processes.• Achieved 3 year URAC (Utilization Review Accreditation Committee) accreditation in provider enrollment, credentialing and monitoring.

Represented the voice of all Account Management market groups on CMS regulatory and compliance initiatives to mitigate risks to account team benefit enrollment and installation processes and exposure to clients. • Created and communicated account team client talking-points for Medicare product initiatives. • Communicated and partnered with customer service operations to define processes that support call handling and mitigate impact to operating plan.

Led a team of 5 Managers and staff of 35 professionals supporting claims processing operations and defining functional requirements to support all products and client, business and regulatory compliance initiatives. Managed $2.8M operating budget and $275K capital budget. • Participated on various Six Sigma project CORE teams to ensure compliance with regulatory requirements and in accordance with the NCPDP electronic claims processing transaction and defined functional requirements to support these critical initiatives. • Defined process and documentation standards for defining business and functional requirements to support SDLC requirements gathering and analysis.• Defined claims processing requirements adhering to service level standards and compliant to the NCPDP claims transaction standards, to support key business initiatives and product and client specific requirements.

Led various service projects, from scope definition through implementation, to support key customer service and home delivery operations initiatives that improved quality, service, efficiency and cost reduction. • Led a team to define and implement operations requirements, to support the NCPDP v5.1 transaction standard in compliance of the 2001 HIPAA electronic claims processing transaction standards, for home delivery claims processing, call center applications and B2B and B2C applications. • Led all call center and home delivery operation initiatives that improved quality and turn-around-time and reduced call handling time, waste and repeat calls. • Signatory approval for all marketing materials, member and client communications.

Led a team of 5 Supervisor and staff of 87 supporting daily operations of the Customer Service department within the first front-end home delivery pharmacy. Managed $1.7M operating budget. • Responsibility for staffing and development of all staff• Defined all customer services processes, metrics and reporting for the customer service unit.• Reduced cost per transaction and increased contacts per hour, compared to other sites, by 20%. • Led productivity initiatives across sites to share best practices that improved quality and reduced cost.

Led a team of 21 customer service representatives in call center operations, supporting both inbound and outbound call handling, supporting member inquiries for all aspects of their benefit.

Us

Bachelor Of Science, Business Administration, Information Technology

Associates, Business