John Wheatley Email & Phone Number

Bellbrook, Oh, Us

Ohio, United States

Helping people build families through Egg Donation & Gestational Surrogacy. In my current role, I have accountability for the surrogacy and egg donation journeys from the time a match is made through egg retrieval and post birth. This includes a team of clinic coordinators that help to gain the medical clearance for the egg donor or gestational carrier. This also includes a team of match managers who help to maintain the journey milestones, provide relationship management, and case management.

Centerville, Ohio, United States

Ohio, United States

Resolve complex business problems related to operational processes, claims rework, and organizational structure. Conduct executive reporting by developing effective presentations and data analytics for to update leadership. Serve as Subject Matter Expert (SME) and as business lead for the successful implementation of a provider data management platform. Cross-functionally collaborate among teams/departments to design and implement new processes to optimize program/project efficiencies, identify opportunities, and advocate growth.• Defined requirements for new system implementations, working closely with all internal stakeholders.• Act as a communication lead for the executive team and individual health plans, facilitating effective communication strategies.

Dayton, Ohio

Presided over all provider data management activities; manage provider data of more than 400k providers for five markets across 14+ products lines. Directed day-today operations of a team of ~75 associates. Led and managed diverse teams, including provider load/enrollment, Market Relations, data analytics, regulatory, network reporting, and IT business ownership. Orchestrated various provider relations to drive credentialing, contracting, configuration, claims adjudication, and related activities. Acted as a change agent, successfully driving team-wide transformations through reorganization, process redefinition, analytics implementation, inventory management, and strengthening relationship building. Identified gaps and introduced efficiencies through the implementation of RPA technology, advanced analytical models, and various other process enhancements. Effectively managed claims reprocessing initiatives based on provider and configuration updates. Oversaw the successful implementation of new market expansions and new system implementations.• Successfully redefined provider loading strategy to improve the auto-adjudication of claims by more than 10%.• Developed and led cross-functional team focused on the reduction of manually priced claims ultimately reducing overall volume by 70% across multiple lines of business and improving overall efficiency.• Improved inventory management; led team to reduce all aged inventory by 92% over a 4-month timeframe.

Louisville, Kentucky

Demonstrated strong leadership in overseeing Network Operations, Provider Relations, and Member Services for a Managed Care Organization, utilizing the QNXT Platform. Held influential responsibilities in areas such as credentialing, contracting, configuration, claims adjudication, and provider relations. Implemented efficient processes; enabled enhanced tracking of inventory, claims rework initiatives, and fee schedule management. Successfully managed diverse aspects of inventory, including provider data updates, contract loads, claims rework projects, provider inquiries, state complaints, roster management, and standard contracts. Led the development of a high-performing team of 60+ associates, fostering engagement and driving large-scale, cultural change. Played a key role in network development, driving numerous high-impact projects to improve satisfaction and increase membership, while also overseeing contract execution.

Jeffersonville, In

Navigated the design and successful implementation of a comprehensive curriculum for an undergraduate program, ensuring the delivery of high-quality education to students. Demonstrated exceptional teaching abilities while instructing a diverse student base, both online and on campus, to foster an inclusive and engaging learning environment. Served on the Teaching Standardization Committee; actively contributed to the improvement of teaching methodologies and educational standards.

Louisville, Ky

Oversaw and acted on problem management, handling system defects, process conflicts, and user support for 19k + clinical users. Coordinated testing management, including regression testing, user acceptance testing, and post-production validation for projects worth over $100M annually. Managed and implemented tactical projects for the Clinical organization and established relationships with various clinical business segments. Collaborated with Information Technology team to ensure a high-quality, efficient, and user-friendly software product to positively impact overall health outcomes.

Successfully developed and executed various large-scale initiatives leading to cost savings exceeding $1M+. Established and developed new organizations to support new business ventures and optimizing existing ones for improved efficiency. Took lead in identifying and creating meaningful metrics to drive business decisions and measure performance, with a particular emphasis on cost allocation.

• Demonstrated ability to refine existing business processes – revamped entire audit process, including sampling, workflow, and recommendations based on audit results.• Developed and implemented departmental performance metrics summary for use by senior leadership, which was not previously available.• Utilized research and business operations knowledge to assist in the implementation of new dialer strategies that resulted in an increased contact rate.• Leveraged knowledge of call center practices to enhance dialer and process strategies

Master Of Science (M.S.), Business/Corporate Communications

Activities and Societies: Graduated with Honors

Bachelor Of Business Administration (B.B.A.), Management Information Systems & Business Management

Activities and Societies: Graduated Summa cum Laude, President's List.