Healthcare & Managed Care Finance Expert #01013
This Healthcare Finance Expert is a specialist in the Managed Care Industry who has worked on several large M&A transactions, large scale contracting efforts and product deployments in Oklahoma over the last 30 years. With strengths in Finance, market analysis, root cause analysis, claims configuration, process improvement, provider contracting and CMS regulations. This Healthcare Finance Expert has the ability to lead and/or partner with Claims Operations, Medical Management, Medical Economics, Legal and Regulatory, Claims Configuration, Network Management and Actuarial to establish best market practices that will lead to profitable growth in Commercial, Medicare and Medicaid lines of business. Robin has effectively developed and aligned incentives with Key Performance Indicators that link strategies to successful market performance.
- 30+ years of experience
- Certified Public Accountant
- Led the M&A activity for Healthcare Economics group at the state level
- Broad Managed Care Industry Experience
- Skilled Finance Executive
- Deep Market Knowledge in Oklahoma, Texas, Missouri and Illinois
- Developed strategy and rates for mass physician and hospital contracting efforts in PPO product line for the entire Oklahoma market and Cook and DeKalb counties in Illinois.
- Acted as internal auditor for the network configuration of physician and hospital contracts during PacifiCare of Oklahoma tenure.
- Maintained a database of all Oklahoma hospitals and tracked their annual chargemaster increases and recommended changes to contracted rates to mitigate chargemaster increases during United Health Group tenure.
- Designed and implemented reports detailing monthly IBNR estimates with explanations of actuarial assumptions for senior executives.
- Implemented SAS reporting structure to drill down to employer group/member level to identify medical cost savings and pricing initiatives.
- Partnered with Medical Management to develop strategies to provide high cost members with more efficient care and better outcomes.
- Identified $16M in annualized savings in pharmacy costs in 2016 and assisted with claim configuration to prevent similar issues.
- Identified $150M in annualized savings opportunities with hospital based physicians.
- Estimated contractual synergies during M&A activities for Aetna, United Health Group and Coventry Health for the Oklahoma, Texas, Missouri and Illinois markets.