Nathan Johnston Email & Phone Number

Rancho Cordova, California, United States

Leading team of over 500 to improve customer health outcomes by enabling customer care technologies with a wide range of programs and sustainable engineering teams, driving quality, efficiency, and digital transformation. Led strategic planning and operations to solve critical business problems, defining business processes, researching, and identifying enabling technologies to and support overall corporate and business goals.• Modernized and consolidated four legacy telephony platforms supporting 25K agents and 50M annual inbound calls with Amazon Connect and AWS cloud technologies, transformed the user experience by driving call containment, reduced average handle time, and drove operational savings of over $15M annually.• Transformed Customer Relationship Management (CRM) system leading to reduction in average handling time and increase in first call resolution with annualized savings of over $10M annually.• Implemented Amazon Connect Chat across member, provider, and consumer portals along with IT Service Desk. Chat provided an additional channel for customer engagement providing a 10% call deflection.• Deployed AI / Machine Learning solution for benefit and coverage information delivering a simplified search within the CRM leveraging both medical and non-medical terminology, summarizing information into an easy to understand script to respond to customer inquiries.• Delivered an updated user interface to the Appeals and Grievances application that improved user experience and reduced case handle times across Centene health plans by 30%.• Created Site Reliability Engineering teams and instilled SRE standards improving the stability and resiliency of the customer care applications by over 90%.• Implemented vendor onshore / off-shore support model for legacy technologies and re-skilling program for key full-time resources aligned to strategic technologies reducing operating costs, improving team engagement, and aligning key-contributors to high value work.

Rancho Cordova, California

Built and led full-stack technology teams supporting all lines of business and operations for Health Net Federal Services. Responsible for overall technology strategy and roadmap, security and compliance programs, IT RFP strategy, and large-scale program implementation and operations.• Oversaw Information Technology department for Health Net Federal Services supporting Federal programs including $18B TRICARE T2017 West Region, $9B Patient-Center Community Care (PC3), and Military & Family Life Counseling (MFLC).• Led the successful technology delivery for the T2017 TRICARE West region implementation building new data centers and applications integrating with DoD TRICARE systems to support the contract. Applications built and maintained included: Pega Customer Relationship Management (CRM), Pega Appeals & Grievances, McKesson Provider Manager, CareRadius Medical Management, Aspect IVR, Aspect Telephony, Aspect WFM, Secure and Unsecure Web Portals• Developed processes and controls for DoD Security NIST Certification program, HIPAA, SOX, FEDRAMP, SOC, and internal compliance programs successfully certifying and maintaining compliance. • Migrated the Health Net Federal Services data center footprint from IBM to Centene owned data centers in O’Fallon, MO and Rancho Cordova, CA.• Responsible for AWS FERDRAMP Certified Gov Cloud hosting for the VA PC3 Program COTS Claims Platform, Membership, Provider Network and Data Management, and Medical Management applications, and leveraging Availity as the provider portal.• Established auto certification processing, assisting in maintaining URAC accreditation for network providers, and identified network gaps to enhance provider network performance.

Rancho Cordova, Ca

Experienced professional responsible for government reporting and analytics . Skilled in utilizing SQL, Crystal Reports, Business Objects, Visual Basic, and various reporting tools to deliver contract deliverables and support business operations through the development of real-time and historical dashboards and reports spanning Finance, Claims Processing, Provider Network, Provider Data, Authorization Management, Medical Management, and Call Center domains.• Delivered contract deliverable government reporting and analytics for all contracts including DoD TriCare, Veterans Administration Patient-Centered Community Care (PC3), Military Family Life Counseling, and California Prisons leveraging SQL, Crystal Reports, Business Objects, Visual Basic, and other reporting tools.• Supported business operations with real-time and historical dashboards and reporting including Finance, Claims Processing, Provider Network, Provider Data, Authorization Management, Medical Management, and Call Center.• Increased VA PC3 claims auto adjudication from 5% to 60% integrating APIs for pricing engines including 3M and Burgess for institutional claims, standardizing all sources of data automating EDI processes including 834 eligibility, 835 payment files and 837 payable professional claim files, and standardized provider and authorization data for claims adjudication.• Reduced paper consumption by implementing electronic funds transfer process, established financial reconciliation tools, and integrated 835, 820 for payment reconciliation with Wells Fargo and Bank of America.• Managed data warehouse strategy including maintenance, updates, and quality assurance leveraging Teradata, Oracle, and SQL Server.

• Primary point of contact for Data Analysis Team to manage internal and external customer requests and expectations• Manage CA Prison data warehouse including maintenance, updates, and quality assurance• Meet with customers to evaluate reporting needs to create and implement solution• Develop, prepare, and analyze reports for internal and external customers review utilizing Business Objects, Access, and Excel • Provide analytical support for CA Prisons Contract including cost analysis, provider network efficiency, utilization management and other contract related issues• Process improvement and creation for implementation of new government contracts• Document processes, policy, and workflow utilizing Zavanta application for business unit• Manage Health Net Provider Suffix Expansion Project for CA Prison Data Warehouse• Manage development and maintenance of Provider Network Database (MS Access)

• Develop, prepare, and analyze reports for management review utilizing Crystal Reports, Business Objects, Excel, and Access• Provide analytical support for multiple projects simultaneously, establish work plans and timelines; coordinate with internal and external sources• Work with MTM and Performance Guarantee groups to create valid population for audit • Build yearly executive summaries for all Performance Guarantee accounts

• Assist and defuse upset members to resolve complaints or questions• Maintain and document customer information and calls• Efficiently handle inquiries while ensuring complete customer satisfaction • Research complex benefit/claims questions from Sales Representatives and Customers• Respond to internal and external customers using professional, concise e-mails and letters

Bachelor'S Degree, International Business

Master Of Business Administration (M.B.A.), Business Administration And Management, General