Phyllis Hartstein Email and Phone Number

Supplement Revenue Recovery for Medicaid Agencies and Health Plans from liable other parties, using new strategies and technologies.

Consulting services to the Health Care Payor Community, including: Cost Containment Strategies and Contracts; Business & Contract Development; Strategic Planning; Research & Product Development; Speeches & Webinars; Compliance Reviews, Business Process Engineering; CMS and State Health Care Compliance

Business Development and Executive Management of 72 managed care accounts providing broad range of cost containment services; built a team of 20 professionals who delivered revenue growth from $1.3M to $70M in six years. Provided executive oversight to service delivery, including operational and financial managementIdentified and developed new business opportunities for target markets; Built strategic alliances with CMS, State Medicaid Agencies, business leaders and partner companies to develop/expand products and services; Developed and directed Managed Care Federal and State government relations agenda, partnering with industry associations, to achieve cost containment goals.National conference and webinar speaker (NHCAA, ICC, MHPA, ACAP); on federal/state compliance and payment integrity requirements, issues and opportunities Developed metrics-based reporting systems, to assure maximum service delivery, now used by HMS for all clients .

Managed Coordination of Benefits and Payment Integrity services for Medicaid/Medicare Managed Care and State Medicaid accounts and developed expanded recovery operations department Established R&D division to identify and develop service lines and expand current services based on CMS and State Agency requirements; Developed long-range division goals based on extensive knowledge of CMS and State requirements; Identified services that are applicable to the Medicaid/Medicare MCO market segment, including COB, cost containment, overpayment identification and recovery and others. Medicaid Managed Care: Developed, marketed and managed overpayment identification, recovery and revenue maximization services for multiple clients. Marketed and Contracted with target MCOs Advocated with Federal and State agencies and health insurers on behalf of clients; Managed client support staff and certain operations including the oversight of work and quality control for centralized staff.  

Health Care Fraud and Abuse Services: Identified opportunity and created, planned and implemented this initiative, including the overall account management and service delivery approach. Identified and contracted with “best of breed” technology, marketing and supplemental service delivery partners. Developed and implemented marketing strategy, directed development of service delivery plan, and prioritized technology upgrades. The Gartner Group cited solution as industry leader.Health Benefits Consulting: Member of executive leadership team to develop strategic plan for expanding cost containment services to commercial insurers and large employers; Directed the consulting and technical teams that provided broad range of claims review services to large commercial payers and self-insured Fortune 500 Companies; major services included Medical claims reviews hospital claims issue identification and coordination of benefits (TPL identification and recovery). Medicaid TPL: Oversight of IT division responsible for serving the TPL practice area.

Directed the operations development and service delivery to 14 State Third Party Liability Recovery contracts; services included identification and recovery from Medicare, Commercial Insurers, Blue Cross/Blue Shield plans, accident claims, estate recovery and inter-title funds transfers, using automated data matching, claims preparation and editing and electronic and paper claims submissions. Identified potential for recovery from commercial insurers; implemented successful strategy that increased results by 20% annually (now the major source of HMS revenue) Managed staff of 12 analysts, programmers and operators.

Developed project design and directed the implementation of Disability Entitlement Advocacy Program (DEAP) for the State of MarylandManaged the recovery process that resulted in $10 million for the State from the identification of and assistance to 7,000 welfare recipients to qualify for Social Security and Medicaid benefitsRecruited, trained and managed 35 staff for this contractDeveloped subcontracts with local non profit services agencies and medical providers for support services.

Executive supervision of the Program Division, which included development and management of all Medical Assistance, Income Assistance, and Child and Adult Welfare services. Established network of housing for emerging homeless population.Developed and monitored service delivery contracts with non-profit and for-profit organizations for wide group of services including: foster care services, child care, nursing home and home health care, homeless housing.Established innovative staffing and outreach programs for Children's Services/Foster Care DivisionHeaded Management/CSEA committee for two years, focused on job content and salary issues for DSS employees.Directed 350 staff with matrix management of 1150 staff.