Olaf Reyes Email & Phone Number

Washington D.C. Metro Area

A&M's Healthcare Industry Group is made up of a dedicated team of senior executives with an established track record of personal accountability and of delivering measurable improvement for healthcare organizations. Our professionals are dedicated to implementing ideas through an action-oriented approach designed to move clients forward. The A&M network.

• Developed and implemented Claims Accuracy programs for multiple health plans
• Led and implemented the claims accuracy program for a managed Medicaid plan identifying over $20M in claims inaccuracies and $16M in recoverable findings across the plan’s institutional and professional providers
• Developed and implemented a Payment Accuracy Center of Excellence for a national Managed Medicaid insurer that identified over $6M in claim inaccuracies and rolled out people, process, and technology initiatives to.
• Developed a contract modeling and simulation analytics application for a managed Medicaid plan to assess the financial impact of state mandated payment methodology and provider network changes to assist the plan in.

• Remediated integration of PBM CDH application
• Provided technical leadership on analysis and requirements definition to remediate applications supporting CDH product for large health-plan
• Developed and managed test environment setup and test execution plan on a NASCO and proprietary claims platformDeveloped and rolled out reporting and dashboard architecture
• Developed enterprise dashboard and reporting architecture to support monitoring and audit controls for a Managed Medicaid plan’s enrollment, provider, and claims workflows
• Developed dashboard and reporting solution to monitor and track employer group migration to ACA compliant products as well as consumer direct subscriber retention and product selections

• Re-engineered and re-platform electronic enrollment system
• Lead business team in defining functional, business rules, operational reports, and dashboards requirements to re-engineer a regional Blue Cross Blue Shield plan’s electronic enrollment system doubling transaction.
• Implemented SaaS solution to augment electronic enrollment system’s intake capabilities expanding a regional health plan’s ability to connect with its brokers, employer groups, and members
• Mobilized and directed client’s External Trading Partners to adopt new automated enrollment solutionImplemented and rolled out new products for a large regional health plan
• Managed cross functional teams to implement and deploy product enhancements in Maryland, DC, and Virginia
• Coordinated with Legal and Contracting Team to develop and submit contracts and application forms to appropriate state regulatory board

• Implemented Healthcare Claims System - Application Controls Report and Dashboard
• Managed and supervised requirements and development teams to create reports and dashboards to monitor and track claims end to end processing using Cognos reports and dashboards.
• Defined issues management, risk management, test management, budget & schedule tracking, and status reporting processes for an offshore team of 15 resources based in Bangalore, India.
• Prioritized, monitored, and resolved development and quality assurance issues identified by the engagement.
• Communicated overall performance of the offshore teams to the client and Accenture senior management.

• Implemented Health Insurance Portability and Accountability Act (HIPAA)
• Effectively provided overall coordination and work management between Onshore (US) and Offshore (Manila) Teams to allow for a smooth handover of work between the two sites.
• Managed three Offshore Application Teams to successfully incorporate HIPAA regulations in the Claims System.
• Communicated status, issues, and overall progress to the client’s senior management, resulting in goals identified and strategies defined for the project engagement.
• Developed offshore transition specification packages by analyzing business and technical requirements of HIPAA solution.

• Implemented Healthcare Claims Processing System Enhancements
• Developed the engagement’s Estimating Model, one of the project’s key business analysis and planning tools.
• Managed the Offshore Team in effectively delivering enhancements to the client’s Claims System on a VMS platform.
• Defined the project’s workplan, resulting in an exemplary resource plan used in future project phases.
• Coordinated work pipeline between the Onshore and Offshore Teams, thereby facilitating efficient work turnover between the global teams.