Raymond Jimenez Email & Phone Number

Los Angeles, California, Us

Reporting to the Chief Executive Officer (CEO) and member of the corporate Board of Director’s. Full organization operating budget control, responsible for designing and implementing healthcare strategic plans, developing high-quality, cost-effective, and integrated clinical and operational programs for Medicare Advantage, Medicare, PPO and other value-based care/ managed care programs to increase EBITDA. Lead business planning and oversight of 200 physicians, across 150+ locations, 5 Independent Physicians Associations, 2 Accountable Care Organizations and 1,200+ employees. Implement operational strategy designed to improve performance of managed care model, building high performing teams across organization to include: capital improvements (revenue/costs), resourcing and staffing management, patient safety, culture and talent development, operational excellence, quality programs, procurement, Healthcare management, software development, comprehensive goals for performance and growth strategies, continuous process improvement, physical security, clinical operations, electronic medical and paper records management, purchasing, practice management, workforce management and leadership development. Lead efforts and designing programs for physician compensation and contracting, physician relations, payer contracting, vendor management, de novo office start up, property and facilities services. Oversight of Utilization Management, Claims Management, Case Management, Disease Management, Risk Management, Human Resources, Product Management, Space Management, Compliance Management, Hospitalist Program, HEDIS/Star Ratings, Meaningful Use, PQRS, Regulatory Compliance, OIG Work plan, application of Federal and State laws (DOH/DEA).

Miami Gardens, Fl, Us

Account ExecutiveReporting to the Chief Administrative Officer, business owner responsible for end-to-end setup of local market and national level complex health plan and TPA contracts. Designed and controlled policies and procedures for health plan and TPA implementations. Formalized and maintained ownership of systems for ensuring compliance with the contract terms, laws, rules, regulations and accreditation requirements.Director Shared ServicesResponsible for the revenue cycle management of $650 million annual claims processing, payment and revenue generation. Overseeing the quality, cost, reliability and automation of encounter/claims billing serving 40+ clinics nationally. Accountable for monitoring and closing submission gaps related to HEDIS and RAF scores.Manage all aspects of medical Credentialing, Provider Enrollment with Payers and Pharmacy Benefits Manager contracting. Oversee staff operations, business planning and budget development. Ensure services follow professional regulations, bylaws, state and federal regulatory requirements.National Director Market OperationsReporting to the Vice President Managed Services Organization and Affiliates, responsible for leading the enterprise operations multi-state expansion driving market growth and development, operational performance, relationship management, contractual compliance and provider adoption of value- based model of care. Managed utilization costs ($200 million under management), medical loss ratios, Medicare risk adjustment, and HEDIS quality outcomes.

Miramar, Florida, Us

• Managed servicing for seven Client applications which generated $6M in 2010 annual revenue with a gross margin of 30%. • Responsible for delivering the financial results for the client and company around the forecast, metrics and outcomes.• Directed growth of existing client relationships, expanding contract and services that can be offered.• Accountable for gross profit margins and call volume targets are met.• Managed all call center operations of 400 virtual agents, keeping oversight of performance, service fees, training, contracting, escalations and shared services.

Us

Directed national operations team, managing a portfolio of multiple outsourced partner call centers, including training, program launches, monitoring service levels and performance scorecards.- Streamlined complex servicing infrastructure and identified and implemented outsourcing efficiencies to fortify servicing infrastructure, resulting in an improved network which exceeded performance metrics by up to 40%.

New York, Ny, Us

• Led operations team in building servicing infrastructure to support new card launch, creating a service delivery network to support all aspects of customer servicing including: plastic procurement, mapping Interactive Voice Response System, customer service staff, disputes, fraud, billing and remittances.• Successfully created and implemented compliance and vendor oversight program with partner. • Managed vendor performance and corresponding service level agreements in addition to identifying service level targets to add in contracts to support product growth.Program- ManagerResponsible for re-engineering/revitalizing the management of critical commodity vendors with an annual spend in excess of $19MM in Billing and Payment Services. • Renegotiated contractual terms and monitored service level agreements.• Managed the temporary staffing relationship as well as the USPS relationship worth $120MM annually.• Lead Mass media team providing operational support in managing commodity design, distribution, receipt and warehousing.Successfully managed day-to-day relationship with outsourced remittance processing sites • Monitored and provide ongoing performance feedback to support service level agreements and quality metrics to external and internal customers, including monthly site reviews and risk assessments.