Max Garner Email & Phone Number

Brentwood, Tn, Us

Alpharetta, Ga, Us

Key Focus:- State and Local Government Sales - Responsible for new growth initiatives and management of new and existing client partnerships. - Primary focus is to work between client and internal stakeholders to setup all contracting requirements in accordance with internal and Federal rules and regulations. - Primary contact for all clients within an assigned territory, with a focus on maintaining relationships and aligning clients to the most appropriate solution(s) that match business needs. Expertise Utilized:Leadership, Communication, Sales, Optimizing the Customer Experience, Influence and Negotiate, Pipeline Development and Management

Eden Prairie , Mn, Us

Research & Development Lead - responsible for developing and overseeing four client portfolios/teams consisting of pre-payment and post-payment analytics, and ideation activities within a matrix environment. Key Focus:- Primary focus is to achieve and/or exceed client's annual savings targets through identification, development and delivery of cost savings opportunities i.e. prepayment claim edits. - Oversee E2E process and execution of analytic related work, in collaboration with a variety of matrix partners. Investigation of material variances required where needed, with subsequent report-out to executive staff. - Maintaining transparent and trust based working relationships with client and internal staff is essential to success in this role. This is accomplished by promoting a collaborative team environment internally and with client staff. - Effectively communicate with client, daily, via both written and verbal communications, and manage client governance and escalations process. - Responsible for direct management and/or oversight of 14 total staff members i.e. Associate Directors and Senior and non-senior Analytic Development Consultants. Expertise Utilized:Communication, Leading Change, Optimizing the Customer Experience, Influence and Negotiate, Applying Financial Knowledge, Pipeline Development and Management, SQL, New Client Implementation

Eden Prairie , Mn, Us

Key Focus:• Managing a team of 8 healthcare fraud investigators while promoting a culture of collaboration and talent development, utilizing stretch assignments and innovation via Lean initiatives and collaborative projects.o Spearhead all operational and team projects, and guide investigative stepso Generate and monitor process improvements to ensure maximum return of invested efforto Oversee development of cost savings proposals/benefit limits aimed at reducing the overall cost of the TennCare Program and potentially reducing fraud, waste and abuse (FWA)o Assist with oversight of Managed Care Organization (MCO) Special Investigation Units (SIU) contract compliance• Lead and coordinate communications with internal and external partners i.e. Tennessee Bureau of Investigations (TBI), Attorney’s General (AG), The Centers for Medicare and Medicaid Services (CMS), TennCare data group, TennCare Managed Care Organizations (MCOs), etc.• Project Manager over OPIs relationship with the Medicare Program Integrity contractor management and executive staff. Specific responsibilities include establishing the relationship, providing guidance, feedback and direction to the contractor, project oversight and instruction, and resource management.• Provide presentations and training to other states’ and law enforcement officials at the Medicaid Integrity Institute (MII), and other events as needed, regarding the History of Medicare/Medicaid, Program Integrity Fundamentals, TennCare 101 and Managed Care. Expertise Utilized:• Leadership, Auditing/Data Analysis, Project Management, Continuous Improvement, Public Speaking, Communications

Key Focus:• Investigated Medicare/Medicaid providers for alleged FWA.• Led and conducted onsite provider audits, policy research and significant data analysis, sampling and overpayment determinations.• Maintained communications with CMS, MACs, RACs, QICs, beneficiaries and providers.• Trained new and existing staff and collaborated on team and company-wide process improvements; e.g. Management Mentor Program.Expertise Utilized:• Leadership, Data Analysis, Investigations, Medicare Subject Matter Expert, Trainer, Sampling Analysis

Nashville, Tn, Us

Key Focus:DME MAC, Provider Outreach and Education (March.08-Nov.10)• Conducted face-to-face education, workshops and seminars for DMEPOS suppliers on all aspects of the Medicare DME program for the DME MAC Jurisdiction C states.• Provided on-going training and educational support to DME suppliers, medical groups and association groups regarding Medicare policies, procedures and requirements.• Developed educational resources; including workshop materials, computer based training, publication articles, Webinars, teleconferences, and other provider resources including audio and video instruction, and supplemental print materials.• Received nationally recognized award from the Centers for Medicare and Medicaid Services (CMS), the RocStar Award, for new and innovative ideas.Credentialing, Medicare Provider Enrollment (Dec.05-July.07)• Reviewed, developed and processed complex Medicare Part B provider enrollment applications for individuals, groups and organizations in a production driven environment.• Utilized work Instructions and CMS guidelines to ensure only eligible and qualified applicants were enrolled.DMERC Congressional Liaison / Correspondance Unit (Sept.02-Dec.05) (Aug.07-Feb.08)• Received and responded to sensitive and highly complex Congressional and other high-level, written inquiries on all phases of the Medicare program.• Completed all high-level inquiries requiring the investigation of Medicare beneficiary and provider claim history and extensive research into Medicare’s rules, regulations and guidelines.DMERC Claims Processor (Sep.01-Sep.02)• Held initial position with CGS in Medicare Claims Department; processed claims for durable medical equipment, prosthetics, orthotics and supplies for the DMERC claim operation.Expertise Utilized:• Provider Education, Medicare Subject Matter Expert, Governmental Liaison, Training Development, Data / Metrics, Reporting, Collaboration / Communication

Bachelor'S Degree, Healthcare Administration

Associate In Arts, Marketing