Manager Management
Resume:
Richard Licerio
Email: *********@********.***
Address: **** ********* **.
City: Trophy Club
State: TX
Zip: 76262
Country: USA
Phone: 714-***-****
Skill Level: Director
Salary Range: $100,000
Willing to Relocate
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
Richard Licerio
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Richard Licerio
aa Trophy Club, Texas aa 682-***-**** aa *********@********.***** http://www.linkedin.com/pub/richard-licerio/28/77/86
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CCOMPLISHED SENIOR LEADER with extensive experience in Claim & Call Center Operations, Compliance, Global Outsourcing Management and Provider Network Administration. Directed six services centers (domestic and offshore) with ~ 1,000 FTE processing high volume calls/claims. Developed talent and built loyal and high performing teams. Successfully communicated vision, mission and strategy to diverse national and global organizations; achieved rapid results in a fast paced in changing and challenging environments.
Key Skills
aa Insurance Management
aa Global Outsourcing Operations
aa Team Building
aa Claims Management
aa Vendor Negotiations
aa Call Center Management
aa Health Plan Management
aa Provider Network Operations & Administration
aa Performance Management
aa Strategic Planning
Professional Experience
MOLINA HEALTHCARE OF TEXAS aaa Irving, TX
Director, Provider Network Administration, 2012 to Present
Regional leader with oversight accountability for administration and implementation of provider contracts, fee schedule updates and benefit configuration. Oversee the development of new reimbursement models. Contribute as a key member of the Senior Leadership Team and other committees in developing strategic goals of the department and organization.
Key Results:
aa Resolved backlog in provider contract implementation and restored order and organization through development and implementation of workflows and policies and procedures.
aa Attracted top talent and built a high performance team.
aa Composed effective ad-hoc reports summarizing data issues and focusing on root cause analysis.
MOLINA HEALTHCARE, INC. aaa Long Beach, CA
Associate Vice President, 2005 to 2012
National role responsible for 6 claim service centers (domestic and offshore) and a $40 million dollar budget. Directed staff consisting of ~ 1,000 associates processing high volume of claims. National projects focused on improving customer experience and ease of doing business with Molina Healthcare, Inc. Created and managed yearly budget, staffing analysis to determine/balance capacity, oversight of day to day administration management of operations, continuous process improvement and staff development activities.
Key Results:
aa Improved operation results in key areas.
o Turnaround Times - Improved claim average turnaround time from 25 to 5 business days, day received on hand from 15 to 3 and claims processed within 30 days from 80% to 99%.
o Cost - Reduced operating costs $2 million annually by negotiating multi-million dollar contracts with multiple vendors both domestic and offshore.
o Quality - Improved financial dollar accuracy from 92% to 99.5% through root cause analysis and implementation of several projects.
o Auto Adjudication aaa Improved auto adjudication from 35% to 70% in focusing on root cause analysis, provider match logic, claim edits and SQL scripting.
aa Successfully merged claim operations of two companies to reduce costs.
Professional Experience (continued)
aa Conducted due diligence and operational review of Health Information Management (Unisys) acquisition. Worked with Executive Leadership to conduct business assessment after acquisition and provided recommendation for a seamless merger.
aa Developed and implemented robust key performance indicator report that was used throughout the enterprise for performance management purposes.
aa Attracted and developed high performance management team.
SMILECARE aaa Santa Ana, CA
Reimbursement Manager, 2004 to 2005
Oversight and direction of day-to-day operations of Claims Reimbursement Department servicing nearly 300,000 patients enrolled in various managed care programs.
Key Results:
aa Assumed expanded responsibilities (concurrent with claims reimbursement) overseeing Call Center Operations.
aa Reduced operating costs by outsourcing transactional claims activity offshore.
aa Increased revenue in meeting with multiple health plans and reviewing outstanding A/R. Rebuilt trust with health plans and repairing damaged relationships by ensuring timely, correct billing for services to our patients.
UNITED HEALTHCARE, INC. aaa Cypress, CA
National Operations Manager, 2002 to 2004
National Service Center manager with accountability for Claims, Call Center, Broker Relations and Membership Accounting Departments servicing 300,000 members enrolled in individual PPO, Medicare Supplement and Commercial lines of business.
Key Results:
aa Developed and managed a broker relations team dedicated to serving our individual PPO product line. Worked with individual and large broker agencies to ensure accurate and timely processing of commissions.
aa Improved auto adjudication by 15% by focusing on provider match logic.
aa Developed and implemented workflows, policies & procedures and process improvement initiatives.
MAXICARE aaa Los Angeles, CA
Director of Operations, 2001 to 2002
Responsible for all operations including oversight of Claim, Call Center, Enrollment and Compliance Departments. Staff and budgeting responsibility for over 140 associates serving nearly 300,000 members in all managed care lines of business (Commercial HMO, PPO, Medicaid, Medicare).
Key Results:
aa Improved abandonment rate from 17% to 1.9% by implementing protocols during peak hours.
aa Worked with technical teams to build system macros to improve efficiency and quality of call documentation of customer services associates.
aa Improved average claims turnaround times from 45 to 15 days.
aa Implemented Compliance onsite monitoring for delegated groups that were not meeting health plan minimum standards.
aa Project managed bankruptcy proceedings, including negotiating multi-million dollar claim settlements.
Other Relevant Experience
aa Claims Manager
aa Senior Compliance Auditor
aa Senior Claims Supervisor
aa Compliance Auditor
Affiliations
Managed Care Executives, 2010 to Present
Centers for Medicare & Medicaid Service Group Member, 2011 to Present
HealthCare Executives Network Group Member, 2012 to Present
Technology Summary
MS Office (Word, Excel, PowerPoint) aa QNXT aa QMACS aa NICE aa RIMS aa Blue Pumpkin aa Windows (all)
682-***-**** aa *********@********.***
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