Robin Tristan Mathew, Mba Email and Phone Number

• Formerly, a Project Manager for the Blue Chip C&S Integrated BH Initiatives (Process Improvement). This position’s scope is to support, enhance, and implement solutions and tools to improve the coordination and delivery of behavioral health (BH) services for 18 workstreams. This work has direct visibility to multiple health plan Executives including the President of UHG & COO, EVP UHC CEO, Regional Health Plan CEO’s, Regional Medical Officers, C&S BH and Optum BH VP’s along with many Senior Directors to support these initiatives. My responsibilities included: • Ensure each workstream runs smoothly by overseeing workflow, identifying next steps, supporting leadership with program design for each market, and reporting status to management.• Leads recurring team meetings, kick-off’s, deep dives, and workgroup sessions to support developing overall strategy, promote tactical planning, define processes, manage scheduling, as well as communicate procedural changes.• Develop Project Charters, Project Plans, Meeting Agendas, and Executive Steering Committee decks• Provide project updates on a consistent basis to various stakeholders about strategy, program design, and progress•Previously, with the California Covid Reporting System's Optum PMO reporting up to Optum Lead/Deputy Director on this engagement and working with many executive leaders assisting California Department of Public Health. Provided program oversight and management for the State of California's Covid Reporting System (CCRS) which is valued at over $80 million dollars. Additionally, partnered with California Department of Public Health (CDPH) Project Management Office (PMO) and Optum Senior Leadership to drive/lead program planning, risk, and deliverable management activities. Managed and coordinated training activities. Indirectly manage over 8 workstreams which consisted of multiple team members at all levels with the support of the Deputy Program Manager and Program Analyst.

Direct implementation of high-end payment integrity solutions aligned with client timelines and requirements including collaboration with C-level executives, team leadership, project task prioritization, timeline accountability, project planning, status updates, sales presentations, RFP contributions, contract and regulatory compliance, and communication strategy. At the core of it all as a dedicated Project Manager and Leader. • Facilitated meetings and presented results and updates to clients, project sponsors, and senior management. • Prepared implementation guides, system reference documents, and general correspondence for distribution to clients.• Advanced organizational goals by enhancing existing processes, sharing best practices, serving as a resource to team members, mentoring new hires, and providing post-implementation, transitional, and post go-live support to clients.• Recognized for outstanding performance on four initiatives across leadership, performance, collaboration and relationships.

Spearheaded core value project initiatives, supporting 30 leaders including two VPs of Pharmacy Operations, five Product Directors, and eight Operational Managers, with a team of Accountants focused on group purchasing (accounting and finance responsibilities) as well diversity and inclusion, collaboration events, and leadership development. Additionally, this entailed owning department month-end close, P&L review, and financial analysis. • Served as the Lead Event Planner for the companywide annual United Nation’s Day by securing speakers and planning logistics for booths, food, music, photographers, vendors, and partnerships with neighboring corporations including Fox 26, Mayor of Stafford, TX and Pro-Tem Mayor of Sugarland.• Developed technical financial indicators to support sales in key contract negotiations valued at $100M+.• Defined objectives and established metrics to measure progress, milestones, and key performance indicators.• Conducted analysis of financials by reviewing financial output, analyzing variances, creating budgets, and identifying impacts.• Partnered with IT and Analytics to make decisions using big data involving analysis for specialized customers.• Assessed protocol and program effectiveness to identify opportunities and implement enhanced cost controls.• Produced post-implementation reviews of pharmaceutical Group Purchasing Organization (GPO) contracts and financial statements to communicate profitability and risks.

Conducted activities ensuring regulatory compliance and adherence to company processes including monitoring Delegates and vendors, documenting activities, recommending and enforcing remediation plans, IT and policy risk control development, data and requirement gathering, promoting process improvement, and providing status updates. • Guided onsite audits ensuring compliance with HIPAA, Medicare, Medicaid, Anti-Kickback, F&A, FCA, and SOX controls.• Conducted analysis on data for STARS and HEDIS measures in order to help with quality improvement for ratings with CMS; this included providing recommendations for leadership based on the findings. • Established compliance training materials for Medicare staff and field auditors and assisted in the development and implementation of First Tier, Downstream and Related (FDR) entity process operations ensuring CMS compliance. • Monitored 50+ FDRs to measure compliance with regulatory and contractual compliance.• Report on delegated entity performance using web-based compliance tool, including performance metrics and remediation efforts when performance falls below acceptable standards.• Participate in planning meetings and communicate Delegation Oversight team and provider network delegate needs during development of new software platforms.• Develop new and maintain existing department reporting tools to insure reporting of performance and compliance with all NCQA, CMS, and applicable State standards.• Led event planning with mid-size team for company-wide compliance initiatives.

Perform detail-oriented financial claim analysis to calculate the financial impact and determine legal implications (if any) to clients, participants, pharmacies, and Caremark due to plan design or pricing errors. Investigative skills in validating analysis requests and to determine root cause for errors. Summarize results of the analysis into a standard report with the resulting financial impact and details for management. Work with various Caremark departments to resolve/identifying quality issues. Ensure that process requirements and improvements are in compliance with CMS. • Experience working with rebate invoicing, payments, reconciliations, or formulary research.• Knowledge of pharmaceutical industry, drug products, and manufacturer rebate contracts.• Ability to query data via SQL, AS400, RXClaim, BI, and other data analytic tools.