Travis David Email & Phone Number

Indianapolis, Indiana, Us

• Monitors, analyzes, audits standard medical/pharmacy product benefit plans to determine strategy and client offering.• Providers research, analysis, and recommendations on the external environment as part of the strategic plan for thebusiness unit• Reviews competitors plans and consults with sales and underwriting to develop suitable benefit offerings, includingcustom plans.• Identifies and monitors changing patterns of competition, recommends changes while presenting to stake holders andclients.• Presents to Sales, account managers, underwriters, and stakeholders on custom benefit designs for RFP’s and renewals.• Coordinates with product, compliance, and actuarial to ensure the benefit plan is complaint.• Audits outgoing projects against CMS guidelines

Chicago, Il, Us

Lead the development, identification and root causing of payment accuracy opportunities through enhancing tactics and communicate/coordinate remediation with client counterpartsUtilize claims analytics to uncover payment accuracy opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS/OPPS), fee for service, Groupers, RUG, etc.Support the advancement of AArete’s Payment Intelligence initiatives to drive greater automation to claims paymentIdentify areas of opportunity for Payment Intelligence by staying up to date on current events, changes in regulatory requirements and market trendsPrepare deliverables for final review with engagement managerExercise excellent judgement and clear and direct communications in all aspects of your work

South Jordan, Ut, Us

Responsible for auditing and identifying complex claims projects, internal claim audits, and change auditing styles processes that improved revenue at $1M+.End to end project management including concept development, finding concepts that haven't been worked, and researching concepts that have been internalized by providers, to help find revenue, as well as researching CMS guidelines.Develop processes, frameworks, trainings, templates/forms, standard operating procedures, strategic plans, to assist with making sure the team hits monthly goals.Cross functionally collaborate via email, phone, and zoom with internal business analyst to ensure smooth implementation of innovative policies and practices.Facilitate front-line staff trainings to improve compliance, quality assurance, and performance metrics.Responsible for auditing and identifying overpayments for various client accounts that include (Tennessee, Nebraska, Idaho, and New Jersey (Commercial and Medicaid) within MediBlues+Collaborate with different auditing tools that resulted in 4 million dollars’ worth of revenueConduct research on various CPT and HCPCS codes in QNXT, Facets, and other client systems to identify changes in effective dates that may impact client payment policies affording potential overpayment opportunities.Proficiency in Facets, with ICD 9/10 knowledge, while also helping build SQL queries to identify trends.

Philadelphia, Pa, Us

Creates and conduct training sessions for associates transferring to new roles within the organization of the processes and procedures per the assigned State Medicaid & Plan and Provisions to ensure claims are processed accurately and meet Service Level Agreements. Educate Medical Plan stakeholders of claim policies, processes and procedures. Educate employees of new/revised plan implementations, provisions and guidelines. Provided training for associates in order to improve and exceed performance goals. Serve as Subject Matter Expert for multiple lines of business. Successfully works with various departments to implement work processes to adhere to both the specified medical plan and State policies and procedures. Successfully provide guidance of established On Line Help documentation for various processes and Lines of Business. Prepares weekly/ monthly reports for Enterprise Operations Management monitoring claims inventory, correspondence inventory, and claims processing error trends.