Leonard Bubis Email & Phone Number

Richardson, Texas, United States

Richardson, Texas, United States

• Developed analytics more incisive than utilized in network contracting to explain claim experience and recommended necessary contractual solutions. Oversaw tracking and reconciliation of pre-pay claim review program to.
• Utilized a non-standard metric to identify a DME Vendor receiving $20 million annually in excess reimbursement, which was quickly remedied.
• Successfully implemented a program to review Emergency Room claims from out-of-network providers to eliminate up-coding and unnecessary observation hours, saving millions.

Richardson, Texas, United States

• Oversaw the development and implementation of a platform to track value-based care activities. Led numerous statistically appropriate reviews of value based care programs and ACO performance. Evaluated proposed.
• Managed the development and implementation of a process to generate a quarterly report monitoring the progress of each of the numerous “value-based initiatives” throughout Health Care Service Corporation’s five Plans.
• Developed and implemented a process for engaging statisticians in the development of the Performance Metrics section of vendor agreements. The result of this was to ensure that program results related to outcomes and.

Richardson, Texas, United States

• Engaged in numerous projects evaluating financial aspects of delivery of care. Measured network performance with respect to established performance criteria and provided remedial response. Spearheaded cost/benefit.
• As Company introduced an ACA compliant product with a reduced network to a population unused to such restrictions, out-of-network claims experience was initially 50%. Through introduction of a report monitoring the.
• Noted a significant disparity in reimbursement among hospitals in reimbursement for joint replacement surgery. Developed a program to incent individual surgeons to provide this service at nearby, less expensive.

Richardson, Texas, United States

• Documented and oversaw quality control of state of Texas facility contracts. Developed singular program to evaluate hospital contracting parameters essential for negotiation. Led negotiation of hospital and health.
• Became aware of the inadequacy of the metrics used to prepare for hospital and system rate negotiations. Developed and maintained a report that corrected this inadequacy and by tracking over time, created a valuable.
• Effectively negotiated successful contracts for new hospitals or new networks created by BCBS and re-contracting within established guidelines with a number of hospitals and hospital systems. The results of such.

Richardson, Texas, United States

Served as sole managing director for contracting, payment term monitoring and compliance, MCO relations, and care management for not-for-profit, full service community hospital with 209 beds. Decreased percentage of uninsured by 10% over two years.

Dallas, Texas, United States

Led sales, communications, product development, and data review and submission in class action recovery against major MCO. Recovered eight times more per physician and four times more per claim for clients than competitor endorsed by AMA. Signed 10,000 physicians for settlement recovery.

Dallas-Fort Worth Metroplex

Oversaw insurance verification, insurance processing, coding, patient relations, accounts receivable management, and reporting for physician group of 50+ cardiologists, cardiovascular/thoracic, and vascular surgeons.

Dallas-Fort Worth Metroplex

Administered managed care contracting, reimbursement monitoring, and contract relations for physician group. Implemented and maintained superlative delegated credentialing program.

Dallas-Fort Worth Metroplex

Oversaw network development and maintenance of six provider networks for a 24 county service area with emphasis on hospital network management and expansion of physician network.

Dallas, Texas, United States

Provided financial management, internal physican practice consultation, and managed care contract negotiation and maintenance for a 1,500 provider ophthalmologic and optometric network in 20 states for 1.4 million covered lives.

Arlington, Texas, United States

Designed a unique reverse capitation model with no cost out-of-network benefits that projected a low premium product. Completed submittal for State licensing.

Richardson, Texas, United States

Directed the managed care contract selection, solicitation, negotiation, maintenance and retention for Hospital and 200 member physician hospital organization. Developed and implemented a managed care assessment and strategic plan including delegated credentialing. Designed and put in practice a comprehensive productivity management assessment system.

Dallas-Fort Worth Metroplex

Directed a staff to recruit, contract, orient and service a 1400 provider HMO and PPO network in DFW Metroplex.

Dallas-Fort Worth Metroplex

Managed the healthcare delivery component of a 45 member physician group practice. Services overseen included clinical nursing, medical records, pharmacy, home care, urgent care and 24-hour triage, physical therapy, laboratory, radiology, transcription. optometry/optical and health education.

Dallas-Fort Worth Metroplex

In-house consulatant for Cigna's 12 nationwide Healthplans on projects requiring problem identifiation, analysis, and recommendation of specific improvement activities.

Dallas-Fort Worth Metroplex

MAnaged the ancillary and support services for 250 employees of a 555 bed tertiary hospital including Diagnostic Imaging, Cardiopulmonary Services, Engineering, Utilzation Review and Quality Assurance, Food Servcies, Anesthesia, Medical Records and Pharmacy.

Master Of Business Administration - Mba, Health And Hospital Administration

Bachelor Of Science - Bs, Summa Cum Laude