Expert Details
Healthcare, Medicare, Medicaid, Risk Adjustment, Quality Improvement, and Value-Based Care
ID: 739673
California, USA
VP of Business Development: Revenue and quality control for health plans, provider groups, and risk-bearing entities. Solutions for Medicare, Commercial, and Medicaid populations. Risk Adjustment, Quality Improvement (HEDIS/STARS), and ACO programs through software and service solutions. Strategy development; member and provider engagement; and care coordination to improve member outcomes and achieve health plan HEDIS/STAR rating goals.
SVP of Strategy and GrowthRisk Adjustment and Quality Improvement for managed care organizations. Providing cutting-edge technologies -- Artificial Intelligence (AI), Natural Language Processing (NLP), Machine Learning (ML), and Robotic Processing Automation (RPA).
VP of Sales: Sales solutions to simplify healthcare; informing decisionmaking; improving patient outcomes; comprehensive care coordination; prior authorization and eligibility and benefits software databases; payer-provider collaboration solutions; and successful savings and enhanced communications across the healthcare ecosystem.
Expert has positively changed the healthcare landscape to empower healthcare clients to improve revenue accuracy and payment integrity, while ensuring that provider and member engagement is strengthened.
Education
| Year | Degree | Subject | Institution |
|---|---|---|---|
| Year: 2013 | Degree: MBA | Subject: Business | Institution: University of Wisconsin, Eau Claire |
| Year: 2005 | Degree: Bachelors of Arts | Subject: English | Institution: Kent State University |
Work History
| Years | Employer | Title | Department |
|---|---|---|---|
| Years: 2023 to Present | Employer: Undisclosed | Title: VP, Payor Innovations | Department: |
Responsibilities:For over 20 years' industry leadership, Expert's organization has pioneered in healthcare navigation and care coordination, offering unparalleled employee engagement and positive health outcomes.Expert is VP of Payor Innovations. The company serves millions of members with human-centered, technology-enabled services. The organization excels in creating single points of contact, simplifying the healthcare journey and increasing benefits utilization through AI-powered care coordinators. Often months before the first claim, the organization's proactive approach influences outcomes and costs alike. They offer end-to-end support for critical conditions like cancer, ensuring both clinical and emotional well-being while achieving cost savings. The company is committed to delivering remarkable results and seamlessly combines advocacy, support, and advanced technology to guide members and their providers in a cost-effective healthcare experience with high quality of care. |
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| Years | Employer | Title | Department |
| Years: 2021 to 2023 | Employer: NantHealth | Title: VP, Global Sales | Department: |
Responsibilities:Expert served as VP of Global Sales at this healthcare industry software solutions company.In this role, he enabled payers and providers to make more confident decisions and improve patient outcomes. Methods included comprehensive care coordination solutions: Prior authorization and eligibility and benefits software databases. By specializing in payer-provider collaboration solutions, this company has unlocked savings and enhanced communications across the healthcare ecosystem. |
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| Years | Employer | Title | Department |
| Years: 2019 to 2021 | Employer: Reveleer | Title: SVP, Strategy & Growth | Department: |
Responsibilities:Expert spent two years as SVP of Strategy and Growth at this risk adjustment firm serving healthcare organizations. In this capacity, he was instrumental in empowering managed care organizations to take control of quality improvement initiatives.Expert and his cohort provided transparent tools and marshaled cutting-edge technologies -- e.g., Artificial Intelligence (AI), Natural Language Processing (NLP), Machine Learning (ML), and Robotic Processing Automation (RPA). Throughout this time, Expert led the way in transforming the healthcare landscape to empower healthcare clients to improve revenue accuracy and payment integrity, while strengthening and ensuring mutual provider and member engagement. |
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| Years | Employer | Title | Department |
| Years: 2012 to 2019 | Employer: AdvantMed | Title: VP, Business Development | Department: |
Responsibilities:In his role as VP of Business Development, Expert held pivotal leadership responsibilities in improving and delivering services for health plans, provider groups, and risk-bearing entities. He achieved the goal of optimizing revenue and improving quality outcomes.Expert routinely implemented integrated prospective and retrospective solutions for Medicare, Commercial, and Medicaid populations. He showcased and leveraged expertise in improving Risk Adjustment, Quality Improvement (HEDIS/STARS), and ACO programs through software and service solutions. Expert's work also involved comprehensive strategies for improving member and provider engagement, ensuring effective care coordination to improve member outcomes and achieve health plan HEDIS/STAR rating goals. |
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