John Eppley Email & Phone Number

Pittsburgh, Pennsylvania, Us

Manager of Medicare Encounters and HCC Rick Adjustments.

Pittsburgh, Pennsylvania, Us

Oversee the implementation and maintenance of QA and Fraud and Abuse databases, department intranet site, and other software tools. Devise sampling methodology and retrieve audit samples from appropriate data sources. Design and maintain databases, reports, auditing tools and related documentation. Create and maintain department auditing tools Act as liaison with IT department to support the creation and maintenance of departmental data systems. Identify error trends to determine appropriate training needs and suggest modifications to policies and procedures. Understand customers including internal Health Plan Departments and external customers, and respond to customers¿ requests in a timely fashion. Acts as liason between Health Plan operations and IT departments for all lines of business, including Medicare, Medicaid, and Ancillary departments. Monitor and enforce staff production and quality to meet departmental standards and timelines. Provide leadership to Technical Team staff and serve as a role model by providing quality services and that are responsive to client needs and proactive in scope. Participate in all training programs to develop a thorough understanding of the materials presented to the claim and service staff. Develop compliance data reports, databases, Insurance Services Division audits and all related documentation Assess, investigate and resolve difficult issues to ensure customer satisfaction. Compile and report statistical data to internal and external customers. Participate as needed in special projects and other auditing or monitoring activities. Serve as a process expert for all QA monitoring and reporting technical tools. Maintain employee/insured confidentiality Provide assistance to other departments as requested

Pittsburgh, Pennsylvania, Us

Bachelor Of Arts, Business Finance

Education record