Robert Miller Email & Phone Number

Greater New York City Area

Greater New York City Area

• Responsible for all of the company’s encounter submissions to NYS & CMS – over 1 million claim lines per week.
• Consistently exceed compliance thresholds – all encounter data is accepted at over 98%.
• Lead a team of 7 managers/analysts that perform various functions vital to encounter operations and analysis.
• Produce an analysis comparing RAPS to encounter data which is used for determining accruals and forecasting.
• Created a reconciliation process that has helped the company record the highest CRG risk scores in the region.
• In charge of an ROI analysis for various vendors measuring performance to ensure value of risk score lift vs. cost.

Greater New York City Area

• Managed a team of 4 analysts that were responsible for all Medicaid encounter submissions and reconciliation.
• Built a forum for multiple departments to come together and discuss improvements to our front end claims system based on encounter rejection research. This has led to over a $50mil swing from rejected to accepted.
• Initiated the creation of multiple data warehouse tables for accurate and faster reconciliation.
• Directed the development of Essential Plan (EP) encounter 837 files internally and with our associated vendors.

Greater New York City Area

• Served as the lead analyst in transitioning the NYS encounter intake system from MEDS to APD (All Payer Database).
• Created an encounter reconciliation process tying encounters back to paid claims using SAS/SQL.
• Assisted NYS in resolving incorrect eligibility encounter rejections that netted $22mil in paid claims accepted.

Greater New York City Area

• Sr. Risk Adjustment Analyst: Mar 2013-Aug 2015Sr. Data Analyst: Jul 2009-Jun 2012Mgr. Medicaid Reporting: Nov 2006-Jul 2009Sales Ops Analyst: Apr 2005-Nov 2006Asst Mgr. CHP Reporting: Nov 2002-Apr 2005
• Analyze claim encounter data and research rejected claims for resubmission to ensure a high acceptance rate.
• Created a “gap” process via SAS Enterprise Guide to identify encounters that have not been submitted.
• Led a reporting effort between multiple departments to meet state regulations.
• Identified an error in SQL code that allowed the company to submit more claims and earn additional revenue.Managed the Part D Retiree Drug Subsidy process and served as liaison between departments.
• Assisted management of Medicare Secondary Payer project, serving as the primary analyst and SME.

Bachelor Of Science (B.S.), Economics, 3.5

Associate'S Degree, Business Administration And Management, General