Steven Shain Email & Phone Number

Louisville, Kentucky, United States

Implemented and managed claim code edit vendor program for Author by Humana (start-up customer-centric Medicare health insurance). • Designed and developed editing program, using vendor rule sets to align with payment objectives on a new claim adjudication platform. • Established and strengthened partnerships with code edit vendors, leveraging relationships to fine tune go-live rule set and facilitate future updates and new policies. • Designed and developed program, reviewing and approving editing rules, policies, updates, and changes to comply with internal and CMS guidance and policies to prevent improper editing and escalated complaints. • Provided coding guidance to ensure CMS and Humana claim payment policy adherence. • Coached associates via weekly and monthly 1x1 meetings, developing skills and improving job performance.

Louisville, Kentucky, United States

Managed the operations of four vendor code edit programs which annually delivered several hundred million dollars in savings. Led and directed a team of ten responsible for day-to-day operations, implementation of rule updates and new policies and resolution of issues resulting from code editing. Coordinated with other leaders within the organization, and interacted with vendor managers and client support staff.

Louisville, Kentucky, United States

In this role I was responsible for one of four vendor code edit programs. Led and coached a team of four in managing all aspects of the program including implementation and operation of rule sets, evaluation of proposed updates and new rules, and responding to internal and external inquiries. Partnered with other Humana teams to determine appropriateness of rules given existing claims policy.

Louisville, Kentucky, United States

Provided guidance and support to operational teams within Claims Cost Management. Efforts included implementation of a new vendor for third level claim disputes that led to significant administrative savings. Identified opportunities for medical cost savings and lower administrative costs. Evaluated vendors and analyzed proposed solutions and provided recommendations to leaders.

Louisville, Kentucky, United States

Guided IT development team using agile methodology for an enterprise-wide initiative. Led team to appropriately source, staff, commit and deliver business requirements for consistent compensation logic for internal and external sales agents resulting in program savings. Completed upgrade of hardware and software used in sales incentive compensation calculations, resulting in reduced processing time. Provided consultative guidance for sales incentive associate experience issues, retroactivity, and exception processing. Created process improvement related to associate experiences with sales incentive compensation process, resulting in more timely response to inquiries and improved tracking and trending of problems reported.

Louisville, Kentucky, United States

Led and coached teams of up to fifteen associates within call center, premium billing, terminated accounts, and cash management environments. Managed aging and collection of AR balances, and resolution of escalated customer issues. Recognized for process improvements resulting in lower inventory and increased quality. Developed associates for roles with increased responsibility within organization.

Louisville, Kentucky, United States