James R. Email & Phone Number

Zionsville, Indiana, Us

Managing service design and delivery to the provider and payer markets. Providing enterprise risk management, compliance program design, complex claims statistical analysis, IRO services, and compliance assessments directly to healthcare organizations and external counsel. Served as Chief Compliance Officer for a private equity owned dental practices group.

Geneva 27, Ge, Ch

Provide expert advice on the operations, management, finance and investments, audit and controls, benefits and best practices, wellness incentives, rules and governance of the global health insurance program for the approximately 40,000 participants encompassing approximately $3 billion in long-term liabilities. Working with 194 Member States from more than 150 offices, World Health Organization staff are united in a shared commitment to achieve better health for everyone, everywhere.

Providing management consulting to non-profit healthcare, education and governmental organizations in the U.S. and abroad. Specializing in process improvement, enterprise risk management, governance facilitation, and compliance assessment. Served as Interim Chief Executive Officer and Chief Financial Officer for $3 million+, 30+ associate non-profit social service agency.

Louisville, Ky, Us

Appointed by the JCPS Board of Education to establish the Audit and Risk Advisory Committee. The Committee is made up of finance, education, business, health, and public relations experts who focus on the risks to the acheivement of the JCPS Strategic Plan (Vision 2020), Audit Recommendation Closure, and Equity Policy Implementation as well as ongoing Audit and Compliance Oversight Matters. As one of the largest urban districts in the country, JCPS has a budget in excess of $1.5 billion and serves over 90,000 students.

Louisville, Kentucky, Us

Aperture is the largest and most reliable healthcare provider credentialing company in the nation. With more than 16 years of experience - health plans, state governments, and provider organizations can rely on our market-leading operational and financial scale. We adhere to URAC, NCQA, CMS and state-driven requirements. Accountable to the CEO and organization's private equity board of managers for supporting strategic planning, capital expenditures including technology investments, human resources, enterprise program management office, client services team, and overseeing financial management of the organization.

Roma, Rm, It

WFP is a $5+ billion UN Agency delivering food to 100 million in over 70 countries. The Audit Committee oversees the WFP's global governance, risk, and compliance processes in accordance with UN, private, and public sector best practices. The Committee advises the Executive Director of the WFP as well as the Executive Board (equivalent to a private sector Board of Directors) which is made up of diplomatic representatives from member nations. The European Court of Auditors and United Nations Audit Committee council cited WFP's Audit Committee as a model of good practice in 2016. Term began in July 2011 running through July 2017.

Chicago, Il, Us

Director and payer sector compliance practice leader within Navigant's Healthcare and Life Sciences - Disputes, Investigations, Regulatory and Compliance Practice. Responsible for payer sector thought leadership, offering development, engagement oversight, and client support.Clients have included national and regional payer organizations, provider systems, and key payer vendors. Engagements have focused on compliance program development, systems re-engineering, data integrity reviews, organizational design, external counsel support, risk adjustment, false claims act analysis, and CMS independent validation audits. Clients outside payer organizations have included pharma, clinical, higher education, and other organizations interested in maturing their overall governance, risk and compliance infrastructure.

Louisville, Kentucky, Us

Board elected officer responsible for Chief Audit Executive duties as well as facilitation of Humana's Enterprise Risk Management (ERM) Program. Leadership of 80+ professionals with diversified backgrounds including finance, audit, IT, nursing, actuarial, law, investigations, pharmacy, and operations. Led comprehensive ERM and audit consulting program focused on assessing top risks to the attainment of Humana’s strategic and financial objectives. Our success required an ability to comprehend and analyze large-scale complex program design as well as methodologies in healthcare strategy, change management, root cause analysis and operations leadership.Facilitated Executive Team and Operating Committee meetings on behalf of the CEO and COO including strategic initiatives review, corporate metrics analysis, agenda items, presenter coordination, master schedule and action item follow up. Established shared services teams which provided enterprise investigations support, external regulatory audit facilitation, enterprise GRC system thought leadership and implementation, and process documentation support. Envisioned and helped facilitate development of data governance program.

Louisville, Kentucky, Us

Chief Audit Executive responsibilities for Humana covering all aspects of health and wellness operations including insurance, pharmacy benefit management (PBM), mail order pharmacy, disease management, direct patient clinical operations, corporate functions, and information technology. Provided comprehensive risk, root cause, and process improvement analysis to executives and board members regarding strategic, operational, financial reporting, and compliance matters. Led or provided strategic oversight to the development of enterprise initiatives such as Sarbanes-Oxley reporting, process maturity assessments, and risk adjustment coding review.

Created Commonwealth's first Performance Audit Division that continues to exist today. Developed methodology and led efficiency, effectiveness, and business process improvement reviews across various state programs including Medicaid, Information Technology, Labor Laws, and Guardians Ad Litem. Recommended over $8 million in savings some through the introduction of ACL and CAATs methodologies. Testified before legislative panels.Director of Financial Audits for 1st year with APA, supervising 50+ employees conducting financial statement audits across over 200 local entities covering $1 billion in receipts. Supervised forensic accounting investigations with subsequent case files being used by local, state, and federal prosecutors. Eliminated 32,000 hour backlog while reducing total headcount.

Washington, District Of Columbia, Us

Office of the Inspector General - Postings in Washington D.C., Budapest, Hungary, and Bonn, GermanyEvaluated economic development and privatization programs in Russia, Central and Eastern Europe, and Central Asia including stock exchange development, voucher and shareholder privatization programs, housing distribution, trucking and warehouse distribution privatization, as well as, country mission project management. Maintained Diplomatic Passport and Top Secret Clearance.

Researched appropriation and regulatory legislation. Drafted talking points and statewide newsletters. Lexington, Kentucky and Washington D.C. - Summers of 1986, 1987, 1989

Ma, Diplomacy And International Commerce

Enterpreneur Boot Camp Seminar

Executive Program In Strategic Decisions - Center For Professional Development

Executive Program In Corporate Strategy

International Marketing Studies - The Business And Economics University Of Vienna - Summer Of 1990

Bs, Accounting

Education record