James Bosley Email and Phone Number
My mission is to partner with business and operational leaders to help shape healthcare delivery strategy. I lead provider transformation change initiatives focused on value-based care, defining, and developing provider and member experience improvements from conception through implementation, changing how all constituents experience modern healthcare.My areas of expertise include:• Practice transformation evolving practices from FFS volume to value-based care (VBC)• Healthcare Process and Program design and optimization• Business and Market Development Strategies to grow membership and revenue• Improving connectedness and collaboration to drive efficiencies • Designing Medicare Risk Adjustment, Quality Programs to enhance network performance• Medicare Advantage, Medicaid and Commercial strategy and designI have a strong track record of managing complex projects and leading high-performing teams, along with a list of highly specialized skills that involve taking the most pressing healthcare problems and creating feasible solutions through strategic engagements via IT automation, process improvement and organizational behavior alignment. I possess a specialized skillset developed over 18 years of working in many key areas within managed care that drive the member and provider experience.My partners and clients appreciate my operational vision, focus on inclusion, and establishing key internal / external relationships. I excel at managing ambiguity and uncertainty, attention-to-detail, and sound judgment. I’m passionate about taking on challenges to align resources and guide strategies that execute on consultancy of value-based led strategies and negotiations as well as corporate provider and member experience priorities that drive member reported initiatives showing clear ROI to organizations.My skills include inspiring innovation, driving performance and growth, practice facilitation, coaching and leadership. I am an experiential learner, creative, and relentlessly positive. KEY STRENGTHS:Operations Leadership | Technology Management | Value-Based Care | Risk Adjustment | Strategic Planning | Process Transformation | Talent Management | Enterprise Design Thinking | Consumer Centered Design | SDOH ROI Valuation | Artificial Intelligence (AI) / Machine Learning (ML)- Customer Experience (CX) / Provider Experience (PX) Application Please connect to me here on LinkedIn or send me an email: jpbosley1@gmail.com
Wellcare Of Kentucky
View- Website:
- wellcareky.com
- Employees:
- 28
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Vp Network Development And ContractingWellcare Of KentuckyLouisville, Ky, Us
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Staff Vice President Provider StrategyCentene Corporation Apr 2024 - PresentSaint Louis, Mo, Us -
Sr Director - Provider Strategy Preferred Partner StrategyCentene Corporation Apr 2023 - Apr 2024Saint Louis, Mo, UsLead enterprise-wide vision to shape healthcare engagement and performance, service delivery strategy and partnership expansion through provider transformation change initiatives with focused lens of value-based care (VBC) progression and adoption. Design specific enterprise-wide provider experience improvements from conception through execution.
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Executive Director Collaborative Health Systems Al Fl Ky TnCentene Corporation Jan 2022 - Apr 2023Saint Louis, Mo, UsLead market-level strategic vision and implementation physician incentive programs including ACO REACH, Direct Contracting Initiatives and Medicare Shared Savings Programs (MSSP) for Southeast region. Achieve quality, cost, and growth targets set forth in the clinical strategy and pursue growth of new Provider groups through business development targets. Lead Market Managers, Practice Transformation Coaches, LPNs and Community Health Workers to identify opportunities to improve cost of care and provider’s performance in quality outcomes. Responsible to own and grow market P&L within four state region, transitioning provider successfully to risk-based relationships. Lead tactical plans to integrate EMR connectivity in Population Health tool to improve prospective and retrospective Risk Adjustment opportunities and cost savings initiatives by focusing on beneficiaries who have high risk, high acuity conditions. Analyze, synthesize, and create enterprise action plans based on data, performance outcomes, observations, and provider interactions. Lead Market Acute Care Follow (ACF) program to drive reductions to avoidable admission and re-admissions.
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Market Development Advisor Fl Medicaid OperationsHumana Oct 2020 - Jan 2022Louisville, Kentucky, UsFlorida Medicaid Operations, Market Development, Advisor – Louisville, KY 2020 - 2022Lead process and quality improvement efforts by managing product design and implementation for provider analytics and member predictive modeling. Lead team to re-designing how we assign membership, address provider and member complaints. Create solutions to positively affect social determinants of health that remove barriers driving access to care and consumer wellbeing. Expand and enhance the design of the analytics model for FL MCD by developing and streamlining key reports in a centralized PowerBI location, incorporating into Azure AI environment for better resolution and enhanced Provider and consumer experience. Incorporate Artificial Intelligence (AI) into FL MCD by operationalizing machine learning models into business processes. Focusing predictive modeling around complaint propensity with designed pro-active interventions increasing retention, reducing member calls. Created methodology for provider tiering, and automating workflow through API frameworks, thus creating more efficient assignment of member to PCP performance increasing HEDIS and quality outcomes of Medicaid network. Align key process around enrollment and PCP assignment to improve customer experience reducing call volumes by 2.3% for all tenure membership while reducing new member PCP change call topics by 7.9% and reducing repeat calls from 25.2% to 20%. -
Strategy Advancement Advisor Office Of Health Affairs And Advocacy (Ohaa)Humana Jan 2019 - Jan 2022Louisville, Kentucky, UsDelivered alignment and concise translations between different types of organizations and groups to enable the creation of multi-sector partnerships. Development of academic partnerships, engineering solutions to advance pressing, complex health care problems and attract external resources. Bridged technology platforms build capabilities to show social utilization of food resources, transportation and housing insecurity issues (Connecting internal data sources to profile and intervene, reducing re-admits and ER visits /1,000). Advanced analytic capabilities to measure SDoH pilots showing ROI of interventions and measuring health improvement. Built processes to integrate Humana learning practices with academic partners to develop curriculum, create job rotations, adjunct professorships, recruiting strategies to matriculate health college graduates into full-time employment. Evaluated and launch vendors for disruptive home health offering to track diabetic disease progression through wide-field retinal imaging and vascular microangiography.
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Strategic Consultant Medicare Risk AdustmentHumana Jul 2017 - Jan 2019Louisville, Kentucky, UsSet up processes and aligned regional teams to analyze and outreach to Integrated Delivery Systems and advanced Primary Care Providers to compare electronic health records (EHR) output to claims DX codes captured. Reviewed gaps in experience to solve systematic and process issues that drove revenue creation for accurate code capture of chronic conditions. Accelerated revenue by $150 MM through East Coast Development and program enrollment, achieved by applying a capitated model to a fee for service (FFS) environment, finding additional HCC submission opportunities. Led regional and divisional strategies to impact MRA programs, claim/encounter performance and execute improvement opportunities. Led team that helped expand the Provider Reconciliation Program with 12% month over month membership growth.
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Strategic Consultant Provider Development Centers Of ExcellenceHumana Sep 2014 - Jan 2019Louisville, Kentucky, Us Collaborate with Enterprise Vice President and Vice President Operations, PDCOE, to design strategy and ensure deployment and execution of set strategy. Work with the Vice President Operations and PDCOE to develop and monitor the annual budgeting and monthly departmental financial activity, which will include current SPARC work and any associated activities that arise from this work. Oversee project related activities within the PDCOE, as well as related enterprise-wide initiatives. Analyze the physician experience and make strategic recommendations to improve outcomes. Coordinate and mobilize the training resources across the enterprise to achieve a cohesive training strategy around risk contracting. Develop and manage all PDCOE reporting, such as the Executive PDCOE Monthly Report, which requires working with Enterprise VP PDCOE, VP Owned/JV Entities, and VP Provider Development; and the weekly 4Blocker Reports, which requires coordination with VP Business Development PDCOE and VP Operations PDCOE along with a number of other high level department leaders. Manage project management resources and initiatives for the PDCOE.
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Program Manager Applications EngineeringHumana Jan 2013 - Sep 2014Louisville, Kentucky, UsLed teams in delivery of high-quality programs and solutions, including build and go to market efforts for bi-directional data exchange of electronic health records. Defined business need and use cases across the enterprise to more effectively and efficiently use medical record extracts. Assisted market leaders with strategy to partner on Meaningful Use / EHR incentive program (directly with CMS), and provider population health / value-based care growth. Collected, analyzed, and communicated competitive intelligence to influence network development strategies. Partnered to ensure EHR extracts are being fully utilized to advance Humana population health strategy. Led team of three Strategic Consultants to design and maintain EHR transaction status and reporting tools for enterprise use.
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Large Practice And Ancillary ContractorHumana Apr 2012 - Aug 2013Louisville, Kentucky, Us• Negotiate and re-negotiate high-volume, transactional-style physician contracts. • Function as the single point-of-contact for all on-going contractual and service issues as needed by providers. • Facilitate provider education, training them in order to increase their familiarity and satisfaction with Humana’s systems and strategies. • Create trend analyses and summaries for decision-making purposes. • Interface with market leaders to align contracting needs and business efforts. • Set targets and priorities in order to meet national and market-specific network needs
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Corporate Provider Relations ConsultantHumana Oct 2007 - Apr 2012Louisville, Kentucky, UsManage strategic relationships with large hospital systems to secure lab data for maximization of HEDIS / Medicare Advantage STAR revenue and expanded disease management opportunities company wideLowered administrative cost and reduction of 211,710 manual chart reviews through electronic clinical connectivity Initiated the implementation for HL7 interface that streamlined clinical information exchangeManage and lead market team to improve encounter submissions by 53% year over year and reduced encounter rejections from 15% to 3% contributing to HEDIS / STAR maximizationFacilitate production of hospital and key provider metric reports (top 60 systems and others as required)Facilitate and manage annual provider feedback survey, including managing the content team, budgeting, working with vendors and analyzing/reporting results.Manage and prepare companywide annual access plan and reporting for Commercial and Medicare PPO ensuring NCQA accreditationDevelop, implement and manage program to identify provider education opportunities (gathered from claims rework data and other sources), leading to rework reduction and better experience for providers (6.3% to 5.5%)Work with teams to provide automated solutions for providing just in time information related to provider experienceDevelop and maintain productive and long term working relationships with contractors, providers, and internal Humana associates
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Audit AnalystHumana Apr 2004 - Oct 2007Louisville, Kentucky, UsAssisted in analysis and reporting of physician contract load accuracy through conducting contracts and claims reviewsReviewed claims processed to determine payment accuracy and extrapolate incorrectly paid claims to total applicable claims population to determine misstatementConsulted with the physician contract loading team to optimize processes and achieve Humana’s adjudication goalsReported, analyzed and interpreted financial and operating data Provider Network Operations (Aug 2004– April 2006)Investigated and troubleshot claims payment problems to ensure quality claims payment resolutionParticipated in process improvement team to continually update and improve department processes.
James Bosley Education Details
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Indiana University SoutheastGeneral -
University Of Southern IndianaMasters Of Health Administration (Mha)
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University Of Southern IndianaBusiness Management; Quality And Innovation
Frequently Asked Questions about James Bosley
What company does James Bosley work for?
James Bosley works for Wellcare Of Kentucky
What is James Bosley's role at the current company?
James Bosley's current role is VP Network Development and Contracting.
What schools did James Bosley attend?
James Bosley attended Indiana University Southeast, University Of Southern Indiana, University Of Southern Indiana.
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