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Leader with extensive experience in developing, operationalizing and executing Provider Payment Arrangements, Value Based Care Relationships, and Building Provider Networks. Deep knowledge and expertise in Medicare Advantage and Medicaid networks and products. Recognized as a expert in the field of network adequacy and availability. Strong track record of delivering results.
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Senior DirectorGenesiscare Jun 2024 - PresentSydney, Nsw, Au -
Director Of Strategic Payer PartnershipsAledade, Inc. Oct 2022 - Jun 2024Bethesda, Maryland, Us -
Director, Medicare Network ProgramsUnitedhealth Group Mar 2015 - Sep 2022Us -
Director, EpmoFlorida Blue (Bcbsfl) Feb 2004 - Jun 2014Directed the Enterprise Program Management Office with accountability for execution, tools, standards, reporting, and financial management. • Managed a diverse project portfolio (both IT and Non-IT) with multiple programs and a total budget in excess of $100 Million annually• Facilitated strategic capability planning for an enterprise with over $9 Billion.• Simplified and streamlined processes to take cost out and increase focus on value.• Aligned project management processes to SDLC and Agile.• Managed capital budgets, vendor relationships, and sourcing opportunities.• Directed Financial Operations within the Information Technology Organization. • Facilitated cost improvement efforts to optimize administrative costs. • Provided controllership over an operational budget in excess of $200 Million, plan versus actual, forecasting, and cost planning.
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Project DirectorFlorida Blue Apr 2000 - Jan 2004Jacksonville, Florida, UsDeveloped and implemented innovative solutions to multifaceted problems leveraging expertise from multiple disciplines. • Managed business relationships and led for multiple teams focused on remediation and prevention of provider, customer, and other enterprise quality issues. This included the collaborative prioritization of business needs and alignment of resources (both business and IT) to address the highest priority issues.• Increased the automation rate of the claims systems by 9% through resolution/mitigation of causal data quality issues. These changes included enhancements to end to end business processes with external vendors, and direct interventions with large transmitting entities.• Facilitated the development and implementation of a claims rework reduction program, which reduced rework by 37% within a business unit.• Managed teams and vendors in multiple locations.• -
Senior Project ConsultantFlorida Blue Jul 1996 - Mar 2000Jacksonville, Florida, UsFacilitated medical cost improvement projects at an enterprise level.• Managed business improvement plan in the Tampa Market to attain medical cost reduction targets in excess of $20M. This included renegotiating high cost hospital and physician group contracts.• Managed a business improvement plan in the Pensacola Market, which resulted in a 20% reduction of medical costs through renegotiating all provider payment arrangements.Managed a business improvement plan in the Pensacola Market, which resulted in a 20% reduction of medical costs through renegotiating all provider payment arrangements. -
Project ManagerFlorida Blue Jul 1995 - Jun 1996Jacksonville, Florida, UsImplemented provider payment infrastructure.• Managed the first statewide implementation of Resource Based Relative Value Scales (RBRVS) fee schedules for physician services in the Florida Market resulting in over $50M in annual medical cost savings.• Developed a stand alone hospital contract simulation tool to provide a real time information stream in support of hospital negotiations.• Developed enterprise payment policies, standards, and business rules to govern physician payment arrangements. -
Health Industry AnalystFlorida Blue Aug 1990 - Jun 1995Jacksonville, Florida, UsImplemented quality, care and utilization capabilities.• Developed a risk adjusted provider profiling and analysis capability to facilitate network composition and performance.• Managed development of a quality management data system to monitor and evaluate provider network performance.• Performed complex data analysis in support of quality improvement efforts. -
Staff StatisticianProfessional Foundation For Healthcare Apr 1988 - Aug 1990Acted as the enforcement agent for hospital performance (readmission rates, inappropriate admissions, and adverse events such as nosocomial infections).Performed focused studies measuring quality improvements resulting from regulatory intervention.Utilized SAS, SPSSX, and PC-SAS to perform complex statistical modeling and analysis.
Rob Harmon Skills
Rob Harmon Education Details
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Florida State University - College Of BusinessRisk Management And Insurance -
Birmingham-Southern CollegeSociology/Political Science -
Plant High
Frequently Asked Questions about Rob Harmon
What company does Rob Harmon work for?
Rob Harmon works for Genesiscare
What is Rob Harmon's role at the current company?
Rob Harmon's current role is Senior Director, Payer Contracting and Relations.
What is Rob Harmon's email address?
Rob Harmon's email address is ro****@****uhc.com
What is Rob Harmon's direct phone number?
Rob Harmon's direct phone number is +190436*****
What schools did Rob Harmon attend?
Rob Harmon attended Florida State University - College Of Business, Birmingham-Southern College, Plant High.
What are some of Rob Harmon's interests?
Rob Harmon has interest in Politics.
What skills is Rob Harmon known for?
Rob Harmon has skills like Leadership, Business Process Improvement, Sdlc, Management, Process Improvement, Strategic Planning, Strategy, Vendor Management, Project Management, Program Management, Analysis, Data Analysis.
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