John Roche Email & Phone Number

Lombard, Il, Us

Lombard, Il

Responsible for regulatory filings with various state agencies for dental line of business. Tracks legislative and regulatory changes and coordinates implementation of changes to business processes to comply with new legislative and regulatory requirements. Analyzes new legislation and regulation, gathers data and works with business units to determine whether changes in business processes must be implemented. Implements legislative and regulatory initiatives of lesser complexity. Assists with implementation of initiatives of greater complexity. Leads, coordinates implementation of operational changes, working across business functions. Documents actions taken to comply with legislative and regulatory requirements to support ongoing compliance monitoring.

Downers Grove, Il

Basic functions include managing all complex dental provider inquiries received by the Provider Administration Department. Assists with data and claims issues as well as patient/provider/carrier disagreements/misunderstandings. Is a contact person and researches/assists/resolves a variety of issues brought to department's attention by dental providers including large group practices, DNoA network field representatives and network support personnel, DNoA and BCBS Federal Employee Program claim and member services supervisors, the sales and marketing department for DNoA and Dearborn National, client service specialists, DOI regulatory inquiry specialists, DNoA network partners, and the Labor Network Program accounts management along with many Labor Fund internal administrators, as well as network lessees, and the network relations administrators for DNoA Select dental discount program.

Chicago, Il

Employed knowledge of dental procedures and ADA codes to make monthly compensation to 75+ dental offices according to the terms of individualized contracts and the restrictions and limitations of patient’s coverage reconciled against per member per month capitation reports. Created Explanation of Benefits on Excel spreadsheets for each DHMO office. Maintained spreadsheets by updating fee schedules and co-payment schedules. Maintained and distributed monthly payment report of all manual payments for services generated by the network management department. Responded daily to individual office and management group inquiries through conversations, email, and letters. Provided training internally on implementation of agreements. Executed agreements processing claims monthly for over 75 offices with +95% accuracy. Transitioned all spreadsheet files from Lotus to Excel keeping payment process seamless for providers. Helped company transition position and responsibilities to Spokane, WA.

Chicago, Il