Rob J. Email & Phone Number

Baltimore, MD, US

• Lead development and execution of a portfolio of ELT technical solutions that cover value-based care, enrollment/disenrollment, financial performance, network adequacy, benefit-cost, sales and marketing, and customer.
• Collaborate with IT to develop and support enterprise-wide strategies, telehealth, processes, and standards for business intelligence, data discovery, and reporting.
• Co-chair vendor management activity including contract and service level agreement performance.
• Oversee tracking, development, submission, and monitoring of data for regulatory reporting, program audits, and RFP responses.
• Create staffing model projections for Enterprise and M&A initiatives.

Chicago, IL, US

• Lead the FEP Benefit Cost Program through working with local BCBS Plans, Plan Clinicians, Benefit Cost Analysts and divisional Subject Matter Experts in Plan consulting to identify potential opportunities for benefit.
• Work with clinical leaders in HEDIS improvement, and clinical excellence through the development and implementation of benefit cost containment strategies through effective network strategies and by providing.

Oakland, California, US

• Lead multiple teams responsible for multiple areas of health plan operations including regulatory compliance and reporting, quality and auditing, KPI dashboards, executive presentations, and provider data management.
• Lead a team of analysts in designing & automating over 50 reports that support daily operations.
• Implemented Tableau and created an internal quality program with audit tools
• Recruit high performing contributors to rebuild human capital infrastructure.
• Participate in key committees with medical groups and executive leadership
• Provider support to individual contributors, managers and senior leadership in the form of regularly written and numerical reports and presentations.

US

• Management
• Lead a team of reporting analysts and/or senior reporting analysts
• Initiated new projects that benefit the goals of the company
• Managed the case investigation tracking system and oversee timelines to completion for vendor activities
• Oversaw that all requests for their area are completed timely, accurately, following department policies and procedures
• Ownership of a large-scale, ongoing project and/or area that may contain multiple reports, analysis, and representationsAnalysis & Reporting

Bowie, MD, US

• Provide detailed analysis and summary to the Executive Leadership Team, including company CEO, on an ad-hoc basis regarding the financial and operational performance of company’s core products which account for over.
• Built ELT Report that is used as a key resource for contract negotiations at the highest level of the organization.
• Mentors group of Sr. Business Analysts to recognize opportunities for process improvement, constant collaborative decision making, and purposeful documentation.
• Prepares and present monthly reporting packages that includes analysis of key business trends and actual versus plan variances, including comprehensive explanations of differences.
• Oversee modifications and updates to standard operating procedures and processes, and drive performance of Medicare, Medicaid and Commercial lines of business.

Indianapolis, Indiana, US

• Lead consultant and subject matter expert managing all professional, institutional, contractual, and legacy system issues impacting the overall performance and P&L accountability for two Medicaid State clients..
• Led team of Sr. Analysts on improving performance and drove multiple projects to reduce costs.
• Participated in on-sight client visits to triage revenue cycle and system related issues with hospital executives and state government agencies. Led the resolution of all financial impacting challenges.
• Drafted appropriate documentation (i.e., policies, standards, procedures, and guidelines) pertinent to areas of accountability and conduct training and presentations across various departments.
• Effectively led Provider Field Reps on how to immediately triage institutional reimbursement and Medicaid compliancy inquiries from large hospital networks.

US

• Project leader and facilitator active in high visibility projects such as the New Provider Reimbursement Model, HIPAA 5010, HEDIS, Electronic Payment System Enhancement, and Prompt Pay. Focused frontrunner of company.
• Led enterprise level projects with high visibility.
• Directed bi-weekly B2B conference calls with the largest book of business clients.
• Authored companywide policies and procedures and create business requirements.
• Managed in handling EDI (HIPAA) transaction provider set up and issue resolution, 4010 vs. 5010 transition, National Prompt Pay (claim interest) system development, EPS Enhancement, high volume impacting claim.

Master Of Business Administration - Mba, Finance, General

Master Of Science - Ms, Management Information Systems And Services

Bachelor Of Science - Bs