Jonathan Sauerschell, Mba Email & Phone Number

United States

Albany, New York Area

· Assist in the transition of behavioral health (BH) benefits to Medicaid Managed Care· Assist in the implementation of Health and Recovery Plans (HARP)· Work across state agencies to coordinate, clarify and issue institutional billing/claiming guidance for behavioral health providers and Managed Care Organizations (MCOs)· Develop, review and monitor Managed Care claiming standards· Assist providers with claim submissions, both paper and electronic· Work with licensed and designated providers to implement new billing standards and transition into Managed Care environment, including part of NYS Delivery System Reform Incentive Payment Program (DSRIP)· Involved in contractual oversight of providers and MCOs · Leverage relationships with providers to effectuate change on micro and macro level· Develop and communicate best practices for claiming, revenue cycle management and contracting· Develop and review data driven analysis to identify areas of concern for providers and MCOs· Developed and Operationalized NYS BH Value Based Payment (VBP) Readiness Program with NYS Office of Alcoholism and Substance Abuse Services (OASAS) and NYS Department of Health (DOH)· Assist in development and implementation of integrated billing policies· Represented NYS OMH in public stakeholder engagement forums· Responsible for creating Children’s System Transformation Billing policies that impact Medicaid Managed Care· Working with interagency leadership to secure approval and distribution of billing policy/guidance· Developed Division tracking method to respond to provider questions· Supervise staff

Albany Area, New York

· Assist callers with complaints and inquiries regarding Managed Long Term Care Health Plans · Work independent case load, as well as helping department with macro issues· Maintain effective working relationship with health plan representatives to ensure consumers receive needed services· Extensive knowledge of institutional claiming procedures· Ensure health plans adhere to contractual guidelines as outlined by Department of Health· Extensive use of analytical skills to determine deficiencies and implement proper resolution · Use issue tracking modules to ensure all appropriate data is captured · Work within guidelines of Center for Medicaid and Medicare Services (CMS) and NYS

Albany Area, New York

· Monitoring of inbound and outbound customer calls and completed correspondence· Serve as phone support for representative inquiries regarding claims, policies and eligibility· Reinforce departmental beliefs, systems, and company policies· Coordinate with supervisors to implement educational programs and workforce improvement· Interact with other operational departments to properly solve escalated member issues· Speak with members in a supervisory role to improve their customer experience· Have a working knowledge of regulatory policies and procedures including commercial contracts, state regulations and federal regulations· Assist division with outward facing projects, including website development and customer facing materials· Member Services representative on Enhanced Primary Care (EPC) workgroup· Review data analysis to identify areas of improvement for department· Communicate with providers and members to resolve concerns· Review claim submissions, both institutional and professional· Supervision of staff

Albany Area, New York

· Strong product knowledge of all Government programs: State (Medicaid, Family Health Plus, Child Health Plus) and Federal (Medicare).· Consistently meets and exceeds department production and quality standards while adhering to State and Federal guidelines.· Resolve member concerns using all available written resources, interdepartmental communication, and outreaches to providers and vendors.· Given access to secure member email function, reply to member emails within a 24 hour time period, while meeting quality standards, for all lines of business including government programs, commercial, and self-insured· Assist departmental senior analysts with their functions, including assisting floor representatives with complex issues

Master Of Business Administration (M.B.A.), Health/Health Care Administration/Management, 3.3 Gpa

Online courses while continuing to hold full time employment, I graduated on schedule with a 3.3 GPA.

Bachelor Of Arts (B.A.), Political Science And Government, 3.0

Associate'S Degree, Individual Studies, 3.5

Bachelor Of Arts - Ba