Richard Radomski Email & Phone Number

Hartford, Connecticut, Us

Responsible for government compliance(Medicaid and LTSS) for Aetna Better Health of Illinois. Monitor the Illinois Department of Health and Family Services(HFS) for any regulatory changes. Serve as a liaison between HFS and Aetna business units. Monitor the HFS inbox and assign regulatory items to appropriate business areas. Helped achieve ZERO missed state deliverables. Attend HFS meetings as needed. Research regulatory issues in the HFS contract. Coordinate external HFS audits with appropriate business units. Maintain updated database of contract language. Represent Aetna Better Health of Illinois Compliance in various meetings and committee's. Update iCAP's(Internal Corrective Action Plan) as needed. Also responsible for tracking and submission of all HFS Reporting.

Richard Radomski monitors state and federal contract compliance for Medicaid and CMS. He works closely with business owners to ensure updated policies and procedures. He issues corrective action plans when necessary. He reviews RFP’s for new business opportunites. He participates in meetings with state and federal regulatory agencies. He maintains the growth of Medicaid, increases business and customer satisfaction.Richard reviews health policies and procedures, Medicaid regulations, CMS regulations, RFP requirements and quality control to ensure coordinated and consistent responses to regulatory requirements an filings. He establishes and nurtures productive relationships with the key business unit leaders to further strategic goals and increased regulatory compliance. He designs and implements the strategy that fulfills the objectives, maximizes revenues, minimizes risk while streamlining overall operations pertaining to business development, and customer service.Achievements: - Designed and conducted an entire audit of the Pennsylvania Health choices Contract

Cincinnati, Ohio, Us

As a Workforce Analyst, Richard was responsible for monitoring calls with a high degree of accuracy, channel distribution, and application & service support. He generated command center reporting to senior managers and directors. He worked with health plan managers and supervisors to adjust schedules as needed. He made backend changes to skill routing and VDN’s as needed. He has tested new VDN for appropriate call routes. Richard established communication and rapport to improve customer service and brand loyalty resulting in increased product feedback. He designed and implemented the strategy that fulfills the objectives, maximizing revenues, profits, and market share of the company while streamlining overall operations pertaining to sales & marketing and business development. He learnt the workforce management and managed a large call center of around 10 in overseas.Richard conducted detailed market research and feasibility study to analyze the latest market trends and track the competitor’s activities thereby providing valuable inputs to streamline the call center strategies.

Richard reduced unscheduled absences by 50% in a six-month period. He ensured call center staff have tools to be successful. He worked with WFM to make sure that schedules are optimized. He ensured that SLA’s for 37 different plans are being met. He looked for new and innovative ways to promote workplace engagement. He understood how the organization worked and made sure that the data were accurate. He successfully developed a competitive business development and sales strategy, uncovering/creating new opportunities, identifying dynamic and flexible. Richard was responsible for increasing sales revenues, exceeding targeted goals, developing profitable & productive business relationships and building an extensive client base with the distinction of accomplishing multi-fold revenue increase. Richard worked well to improve the level of organization and ensured alignment of company goals, as set by senior management and ensured that the business growth strategies are met. He strategically planned & conceptualized creative, out-of-the-box strategies to enhance customer service; developed the rapport with regional Distributors and area Representatives for improved customer service.

Round Rock, Texas, Us

Richard successfully reduced unscheduled absences by 75% in a month period. He ensured staff providing world class health service to members. He helped to improve service levels and average speed of response. He monitored and analyzed the calls from the sales team and ensured all were responded in a proper and timely manner. He created vertical industry focus to significantly increase project pursuit and regional growth. Furthermore, he planned & conceptualized various strategies to achieve business goals aimed towards the growth in business volumes as well as profitability. He was involved in training and building the strong team of performers across different functional domains and implemented the best practice throughout the department

Tucson, Az, Us

He ensured that KPI’s specified in RFP were met. He was responsible for all staff performance issues and reporting of contract hours for entire staff. He met regularly with clients and ensured issues were immediately addressed. He collaborated effectively with internal departments to ensure that the members and providers were receiving a high level of customer service.He was responsible for the operation of 50 seat call center with three supervisors and three leads. He ensured high level of service being achieved. He exceeded the KPI’s and SLA’s. He helped the client to operate effectively. He stabilized the growth of organization.

Woonsocket, Ri, Us

He ensured case audits to be accurate and timely. He monitored work completion using available resources to complete daily audits. He re-audited staff cases as needed with highly accurate monitoring and reduction in errors. He engaged team with executing a value-add audit and quality assurance process. He improved quality and CMS audits. He monitored internal and external audits, oversaw responses and remediation necessary and improved member and client service with Smooth CMS audits and satisfied health plan clients. He collaborated effectively with internal and external auditors and business partners. He increased compliance with regulatory requirements.

Menlo Park, California, Us

He assured health plan compliance with CMS regulations regarding complaints/appeals/grievances. He increased compliance for Complaints/Grievances and Appeals. He provided feedback to health plan staff regarding case audits. He improved staff case audits and collaborated with other members of consulting team to ensure a seamless experience for the health plan staff and a positive CMS rating. He increased client satisfaction.

Pittsburgh, Pennsylvania, Us

He oversaw the daily operations of the complaints and grievance and provider appeal activities for UPMC health plan products. He assisted in meeting compliance requirements with the National Committee for Quality Assurance, Department of Health, Department of Public Welfare and the Centers for Medicare and Medicaid Services requirements for complaints, grievances and appeals. He assisted with the development of department training materials.He monitored staff compliance with regulatory case deadlines and created in-depth reports for department senior managers. He used for compliance reporting to CMS and the state department of insurance. He conducted case audits to ensure regulatory compliance results. He shared feedback with appropriate team members and department contact for regulatory agencies including CMS and DPW.

Mercer Island, Wa, Us

Us

• Managed the daily operational and business support activities of the high-volume national call center handling 10,000 or more calls per week. • Supervised, motivated, mentored, and evaluated employees and facilitated effective training programs• Planned and coordinated workflow to optimize efficiency and productivity throughout the department• Established and implemented strategic and tactical policy, workflow, and team performance standards• Worked closely with the grievance and appeals team to ensure member issues were handled appropriately •Trained new staff on grievance and appeals process Key Accomplishments and Contributions:• Developed a successful team. Consistently exceeded established goals for service levels, average speed of answer, quality and schedule adherence, and had the highest quality average. Result: Exceeded required metrics• Instrumental in the launch of several new products, including Healthy DC, a program which covered the uninsured in the DC area, resulting in enhanced competitiveness and market identity• Successfully reduced the team average handle time by over 30 seconds within a three week period

London, Gb

SERVICE OPERATIONS SUPERVISOR, Coventry Health Care, Cranberry Township, PA, 2004 to 2007• Managed, motivated, mentored, and coached a cross-functional team, consisting of claims processors and call center agents and facilitated effective training and orientation programs for new/existing staff• Participated in weekly meetings with IT groups to ensure portals were functioning at optimal efficiency• Instrumental in the launch of a state-of-the-art Provider Portal website and led teams to exceeding goals

Hartford, Connecticut, Us

CUSTOMER SERVICE TEAM LEADER AND SUPERVISOR, Aetna, Inc., Pittsburgh, PA, 1989 to 2003• Supervised, motivated, mentored and evaluated a team of 20 and facilitated effective training programs• Created staff schedules while staying on budget and ensuring proper staffing for the average volume• Developed an efficient paperless process where adjustments were routed via email instead of paper

Pittsburgh, Pennsylvania, Us