Tim Blake Email & Phone Number

Work as a vital member of various project teams that address strategy and planning issues across all UPMC’s divisions. Provides research, reporting and analysis for various clinical initiatives, market share analysis and operational strategies.

Provided a leadership role in the qualitative analyses related to HEDIS, CMS Stars, PA Performance Measure, and Pay for Performance reporting. Investigated the causes of financial & clinical trends and anomalies. Responsible for the distribution of work assignments as well as workflow management within team. Served as a process expert and provide training.

Performed qualitative analyses related to HEDIS, CMS Stars, PA Performance Measure, and Pay for Performance reporting.

Greater Pittsburgh Area

Perform in-depth statistical and qualitative analyses related to the revenue cycle and business operations, particularly, patient/member access data and utilization.

Acting in the role of a Project Lead or high level individual contributor on complex projects, duties include: Analyzing complex processes to support Accounts Receivables area. Conduct impact analysis and interpret system documentation. Serve as a liaison between Highmark Medicare Services, the Federal Government, the Medicare Shared System Maintainers.

Developed various performance metrics and reports via SAS, SQL and other query tools. Forecast-ed annual targets and advised unit supervisors on correct staff allocation. Developed and administered the report intake process ensuring timeliness standards were met.

Served as a liaison for the Vendor Relations Team and conducted enhancement and regression system testing. Developed technical requirements and monitored project plans.

Reviewed and validated provider reimbursement for Inpatient, Outpatient and Skilled Nursing Facility prospective payments. Provided outreach and education on the Provider Statistical and Reimbursement system.

Processed file transactions impacting reimbursement and membership between Highmark and CMS accurately and timely. Functioned as a liaison between Highmark and EBDS the direct pay-billing vendor. Provided oversight of weekly premium refunding requested from Finance.

Delivered New Hire training to assist in the cross training of member service representatives on both the Medicare + Choice and Medigap lines of business. Provided monthly ad-hoc reporting on top Complaints for the Medicare + Choice products and top inquiry reasons for the Medigap products.

Serviced Medicare + Choice and Medigap telephonic and written inquiries regarding member's coverage, claims, and billing.

Responsible for supervising, training, and coordinating activities of officers. Monitor operations and fire-systems for multi-million dollar complex.

Evaluated Officer Candidates attending the Basic School. Responsible for coordinating the training efforts of a squad of Marines. Provided security for Haitian and Cuban migrant camps. Participated as a member of the strike force utilized to suppress riots.

Bachelor Of Science (Bs), Professional Communication & Information Systems

Associate, Liberal Arts And Science

Certificate, Lean Six Sigma Black Belt

Certificate, Excel I

Certificate, Excel Ii