Mike Yorks Email & Phone Number

Eden Prairie , Mn, Us

• Responsible for the intake and clinical review of claims for medical necessity reviews, which involves the following tasks;− Supervision of over 300 staff members; United States, India and Philippines− Development and coordination of strategic business plans and budget allocations; and− Analysis of operational performance, such as financial metrics and performance metrics ensuring attainment of client expectations with regard to claim turnaround timesKey Highlights Developed operational dashboards and day-to-day huddle cadence to ensure metric compliance Implemented global operations in India and the Philippines Produced multi-code analytics to determine and eliminate claims with negative return on investment (ROI)  Led the implementation of a work routing system to deliver correct work item to the appropriate agent, as well as created a financial-saving reporting to demonstrate affordability performance to clients

Minnetonka, Mn, Us

• Directed the implementation of new markets for all lines of business within UnitedHealthcare• Supervised multiple Reconciliation and Remediation and Michigan Federated teams to ensure data accuracy and confidentialityKey Highlights Spearheaded the migration of providers and products from one UnitedHealthcare claim application to another, including 17 dual eligible special needs plans (D-SNPs) products, from COSMOS to CSP with no negative claims impact Successfully grew client base by 250,000 covered lives by adopting an UnitedHealthcare's Midwest health plan in Minnesota, North Dakota, South Dakota, and Wisconsin Contributed in improving provider data accuracy from 90% to 98% by correcting inaccurate provider data Deployed a national worker compensation product, as well as several healthcare exchange products in seven states, allowing UnitedHealthcare to reenter the individual market

Eden Prairie , Mn, Us

• Strategized and created fraud, waste, and abuse operations for UnitedHealthcare specialty benefits to meet revenue goals• Played a key role as the business implementation leader for UnitedHealthcare business and system migrations, which involved the creation of a program that can be used simultaneously• Held accountability for six different operations, which included notifying providers of potential overpayments to providing strategy and leadership on new business implementation and system-to-system data migration• Communicated with UnitedHealthcare Payment Integrity, UnitedHealthcare Networks, and the provider community to address provider complaints on fraud, waste, and abuse processesKey Highlights Made major contributions by establishing a scalable and sustainable media referral process to identify media fraudulent providers, as well as a provider escalation process to manage provider complaints Effectively identified media fraudulent providers by establishing a scalable and sustainable media referral process Increased the number of the team by more than 200% to prioritize the client’s needs within two days

Eden Prairie , Mn, Us

• Directed a team of 150 non-clinical and clinical staff performing pre-pay reviews for professional claims, pharmacy claims, and facility claims• Took charge of developing waste and error P&L statement, designing strategic programs and interfaces with clients, and implementing policy and procedures to ensure legal compliance and clarity• Coordinated daily partnerships with the Offshore Team of 150 staff membersKey Highlights Led company reorganization which significantly increased overall efficiencies and broadened the Management Team's span of control Introduced a reporting process to evaluate client program performance and ensure program transparency  Implemented operational metrics to boost productivity and efficiency Redesigned the professional audit program, resulting a 15% increase in productivity Achieved 400% savings by developing a vendor management program

Eden Prairie , Mn, Us

• Directed and lead a team of more than 150 professionals in four locations, Minnesota, Tennessee, Maryland, and Illinois responsible for servicing UnitedHealthcare clients and commercial payer. • Handled day-to-day subrogation and out-of- network claim negotiations operations. • Drove process improvement and implementation through managing and directing projects. • Oversaw client relationships and monitored them by using Net Promoter Score (NPS). • Served as the point of contact for sales and marketing. • Responsible for responding to RPFs and RFIs. • Served as a key stake holder and consultant in new business deals.Key Highlights  Exceeded recoveries and savings targets every year. Developed several employees into leadership roles. Successfully migrated case management systems. Restructured subrogation legislation in Louisiana in 2010 and 2011. Implemented several clients in both subrogation and out-of- network claim negotiations. Managed and implemented process improvement initiatives with senior leadership. Secured multiple client case studies based on performance and client services. Successfully maintained 100% of our clients.