Rob Bauer Email & Phone Number

Portland, Oregon, United States

Portland, Oregon, United States

Portland, Oregon

Facilitate partnerships across multiple Kaiser Permanente Program Office and NW Region operational areas and care delivery settings to meet contractual requirements, submission deadlines, and foster alignment with One KP initiatives. Maintain relationships with Oregon Health Plan contractors and associated plan partners to meet Coordinated Care Organization (CCO) objectives in the communities we serve. Responsible for negotiating delegated agreements with CCO contractors and developing service level agreements with internal functional areas to ensure obligations are met.

Portland, Oregon Area

Direct the Medicare Compliance Program, ensuring compliant operations for all business areas. Chairman of the Corporate Compliance Committee. Ongoing reporting to the Board of Directors. Manage the relationship with CMS Central and Regional Offices. Risk analysis and mitigation. Oversee the internal monitoring program and response to CMS audits.

Salem, Oregon Area

Responsible for the Quality Assurance, HEDIS, Claims Administration and Pharmacy Benefits divisions having oversight of multiple staff and contracted vendors. Through my budget management of these divisions and contract negotiations with outsourced partners the company realized Quality 'Stars' bonus revenue maximization, effective utilization management and efficient claims payment processes. I lead service area expansions that resulted in multiple Medicare plans entering new service areas in the State of Oregon. I have directed the conversion to a new case management system, managed multiple yearly Plan Benefit Package (PBP) submissions and had key responsibilities in the annual Bid development process.Other projects of focus include managing the development and implementation of the Claims Payment and Pharmacy Benefits Administration programs as well as Quality Improvement outcomes and Accreditation for new Commercial health plan products both on and off of the Public Exchange. I led the Risk Adjustment program to positive results in risk score improvements and revenue including expansion of the prospective model into a new service area.

Directed the operations and outsourced activities for WVP Health Authority's health plan products. Led the timely and successful submission of multiple Medicare Advantage annual plan Bids that met executive defined profit margins and member premium targets. Managed CMS and State of Oregon routine contract focused audits. Critical path merger implementation and integration with ATRIO Health Plans that resulted in onboarding 2 new Medicare Contacts with multiple Medicare Advantage plans. Other duties included: benefit design, new business development, aligning marketing strategies and navigating projects toward operational integration.

Attained reward of 2 Medicare Advantage contracts that allowed initial launch into the Medicare market. Directed the request for proposal (RFP) application for State of Oregon PEBB line of business. Developed and managed the implementation of Mid-Valley IPA's many operational and quality improvement programs. Coordinated internal and external staff to meet deadlines in launching new business products and responded to governmental entity audits.

Database management, reporting, reconciliation and analysis responsibilities via multiple data sources to ensure operations stayed within budget and well managed industry benchmarks for multiple Medicare, Medicaid and Commercial health plans.

Corvallis, Oregon

Developed and analyzed scheduled and ad hoc reports to support management decision making and quality improvement activities.

Bs, Health Care Administration

Activities and Societies: Sigma Nu Fraternity, Safety Programs Supervisor at Dept. of Rec. Sports

Mba, Business Administration