Roger Bauer Email & Phone Number

Kansas City, Mo, Us

Oakland, California, Us

Serve as Georgia Medicaid Line of Business, Operations, and PMO Leader. Responsible for GA Families’ contract implementation, de novo Medicaid MCO market entry with corresponding capability builds, and a $70M investment budget. Incremental 1st year revenue estimated to be $1.5 billion.o Lead the formation and governance of a project management office (PMO) to prioritize, initiate and solution projects; track progress; identify and mitigate risks; communicate with stakeholders; and resolve escalation issues that arise. Portfolios of work include Healthcare Services, Provider Network & Provider Services, Pharmacy, Line of Business, Other Support Functions, and Member Experience.o Led financial model assessment and business case development. Scope of case included market context, competitor performance, economic value drivers, financial scenarios, technology and operations investments, and risk mitigation strategies. Managed review of state pricing artifacts and assumptions used to build out income statement, enrollment, rates, administrative cost, medical cost, and risk-based capital impact of entry.o Oversaw Technology and Operations Readiness Assessment to review current state operating model, technology solutions and processes across 15 workstreams to assess ability to deliver RFP commitments and Medicaid model contract requirements within the timeline required by the state. o Oversee the development and delivery of people, process and technology capabilities required to effectively serve an additional 24,000 providers as part of a statewide expansion.

Oakland, California, Us

Led the startup of a multi-program portfolio to improve affordability with realized cost savings of $220M by making processes more efficient, reducing waste, increasing quality, improving performance, and driving out unwarranted practice pattern variation.Programs include the following: internalization of services, prescription conversion, site of service optimization, claims and utilization management, network vendor management, payment integrity, revenue optimization, care transformation, profitable growth, and access and member experience.Select accomplishments:o Managed up to 60 consultants and three external vendors with an annual budget of $25 million. o Hired and onboarded a leadership team and organization of 37 to successfully transition external consultant support. Functions included data science & analytics, consulting services, business case development and project management.o Launch of Outside Medical program to develop clinically validated and actionable network leakage opportunities. Successful execution of low-capital internalizations, vendor steerage and place of service optimization projects. o Delivery of Revenue cycle optimization projects to lower denial rate for Medicaid and Medicare FFS billing and to increase revenue by offering financing for non-covered services through Care Credit.o Optimization of target review (pre-cert) list and level of review.o Launch of Payment Integrity interventions such as Emergency Department Claims (EDC) Analyzer, Itemized Bill Review, Fraud Waste and Abuse (FWA) partnership with Cotiviti, Inappropriate Unbundling of services, and DRG upcoding.o Launched program team to implement Milliman MedInsight Guideline Analytics and Health Waste Calculator analytic tools and execute identified interventions.o Oversaw the build out of an Episode Treatment Grouper (ETG) analysis capability in partnership with Medical Group that identified $14 million in actionable savings for the region.

Oakland, California, Us

Reporting to the regional chief actuary, responsible for value demonstration and rate increase defense to employer groups and their consultants; employer group reporting product strategy and execution; P&L analytics for all lines of business, product lines and funding mechanisms; P&L forecasting and pricing strategy; and decision support cost accounting and analytics.Select accomplishments:o Responsible for timely and accurate Premium, Internal Member Cost Sharing, and Self-Funded revenue projections for all market segments and product lines. Forecasts were more than $2.0 billion annually. Forecast accuracy was within 0.5% of target.o Managed the development and performed final review of P&L package of reports and narrative that analyzed and explained drivers behind results, variances to plan, and comparisons to Milliman HCG benchmarks.o Developed and received funding for a $1.5 million business case to partner with MedeAnalytics to create a web-based analytics platform to enable self-service for large group customer analytics and reporting requests related to financial, clinical or wellness domains.o Created cross-functional team of Medical Group and Health Plan employees to create and present recurring “White Papers” for Top 10 largest employer group accounts and those most at risk for termination to demonstrate value proposition and defend renewal rate increases.

Oakland, California, Us

Led team in the areas of broker relations, sales training, MSBD compliance and communications, scorecard metrics, broker/sales compensation and sales systems.Select accomplishments:o Successfully led effort to remediate substantial compliance deficiencies identified by the National Compliance Office. Areas of focus included Licensing and Appointment, 5500 Disclosure Reporting, Broker Commission Financial Controls, and Marketing and Sales of Products. No findings reported in follow-up audit.o Led Mid-Market Underwriting and Sales New Business Quote Process migration into Salesforce.com CRM to reduce overall turnaround time by three business days.

Oakland, California, Us

Managed the Federal Government (FEHBP) annual financial proposal ($110 million), retrospective bid reconciliation, compliance documentation, and 2 OIG audits. Oversaw the rating calculations for the ten largest groups (SSSGs), accounting for $300 million in revenue.

Arlington, Va, Us

Led creation and communication of Evolent’s pro-forma financial modeling efforts for five hospital delivery systems to determine financial feasibility of starting a health insurance plan.* Left Kaiser for 8 months to pursue consulting opportunity at start-up

New Orleans, Louisiana, Us

Mba, Finance

Wharton Executive Education, Business Strategy And Competitive Advantage

B.S., Management