Resume

Sign in

Management Medical

Location:
Albany, New York, United States
Salary:
165,000
Posted:
May 14, 2019

Contact this candidate

Resume:

Mikhael Voloshen BS, MBA

*** ******* **** *********** ** 12303 • 215-***-****• ac9dkc@r.postjobfree.com Healthcare Administration and Senior Technology Leadership professional: Delivering Innovation, Quality, and Tangible Results in all Operational Areas. Dynamic, emotionally-intelligent Healthcare leader who articulates a clear, compelling Program and technology vision that transforms all operational areas. Technically skilled Health Executive who develops Program and IT infrastructure that streamlines workflows, grows security and stability, and enhances disaster recovery and business continuity capabilities. Strategic thinker who leverages emerging and traditional solutions to address a rapidly evolving Program Management and IT landscape. Financially skilled Health Executive who develops complex budgets, negotiates contracts, lead the day to day management of large-scale projects to develop and implement programs that integrate Medicare and Medicaid coverage for persons dually eligible for Medicare and Medicaid. Deadline driven program manager who executes large-scale initiatives with little to no disruption. Collaborative professional who works with multiple constituencies to build consensus. Outstanding communicator who expresses complex program management and technology concepts in a clear, concise, and consistent manner. Customer focused leader who builds a relationship of trust between Program and IT and business users. Motivational team builder who mentors and develops technical talent. Demonstrated success in the areas of:

• Day to day management of a large-scale project to develop and implement programs that integrate Medicare and Medicaid coverage.

• Expert knowledge of Medicare managed care eligibility, benefits and premium development rules and processes.

• Information Security - At NY DOH Lead and coordinate day to day data security risk assessments, gap analysis & documentation, remediation planning and corrective action implementation. Health Insurance Portability and Accountability Act (HIPAA). Health Information Technology for Economic and Clinical Health Act (HITECH), and CMS MARS-E 2.0

• Development, review, approval and implementation of policies and procedures- At NY DOH Develop and deliver policies and procedures in accordance with the federal regulations and options available for integrating Medicare and Medicaid for to dual eligible persons including but not limited to Medicare.

• Business Process Improvements - Practiced in clarifying and implementing business and regulatory requirements for various State and Government Organizations and Provider settings, designing process and system improvements to increase productivity, streamline operational processes, and reducing operating costs.

• Building High Performing Teams - Drove improvements in 150+ team members, employing project management, improving turnaround times, leveraging iterative deliverable approach, improving customer satisfaction and team morale. Healthcare Program and IT Leadership Competencies that Drive and Sustain Growth

• Learning Agility

• Strategy, Vision, Mission Planning

• Business and Technology Alignment

• Technology Lifecycle Management

• Vendor Management and Negotiations

• P/L Management

• Information Security & Governance

• Project Planning, Budgeting, and Timelines

• Health Plan Program Design and Implementation

• eDiscovery

• Data Analytics & Security

• IT Infrastructure /Business Systems Integration

• Solution Development and Implementation

• Stakeholder Relations & Communications

• Contract Negotiations and Strategic Alliances

• Human Resource Management/Staff Development

• Building High Performance Teams/Improving Morale

• Medicaid / Medicare Program Analysis & Management.

• Healthcare Marketing & Promotions, Relationship Management.

• Key Partnership Development, Organizational Restructuring.

• Web, Database, Systems Application Development

Track Record of Healthcare Administration and Senior Technology Leadership. Medicaid Program Director (New York State Department of Health/PCG) January 2016-Present Bureau of Managed Long-Term Care, Division of Long-term Care New York State Department of Health, Office of Health Insurance Programs Medicaid Program Management and Health Plan Administration. Medicaid and Medicare Data and Policy management and implementation. Medicaid and Medicare long term community-based program management; quality assurance/quality improvement processes; legislative, regulatory and policy development related to home and community-based programs for Medicare and Medicaid dually eligible members. Work with DOH Senior leadership developing and designing policy features and recommendations on Medicaid and Medicare recipients based on fiscal and enrollment projections and present findings to stakeholders. Analyze critical systems and support gaps. Develop robust, foundational strategic technology plan and roadmap. Grow maturity and consolidate Program and IT enterprise. Develop and implement comprehensive, structured, and scalable approach to Health Plans and technology management of Managed Care eligibility, benefits and coverage rules and processes. Identify and resolve schedule, resource and dependency conflicts and maintaining high levels of communication with the Managed Care Plans, internal and external stakeholders project team and sponsors. Management of long-term care, home and community based and other services to frail elderly, disabled and special populations D- SNPs, FIDE SNPS, HIDE SNPS and PACE. Expert knowledge of Medicare managed care eligibility, benefits and premium development rules and processes and policy gained through thorough training and experience in MLTC. Trained and researched federal and state regulations affecting LTC integrated services for dual eligible, FIDA, SNPS, and PACE New York State Department of Health, Office of Health Insurance Programs implementing, monitoring and evaluating health reform initiatives with a specific focus on Health Plan administration and management of Medicaid Encounter Data (MEDS) and Provider Network Data System (PNDS) reporting.

Compliance and outreach activities to ensure Managed Long-Term Care (MLTC) plans meet mandated program and compliance standards. Analysis and evaluation of data submitted by MLTC plans; Respond to ad hoc data analysis requests; Use plan financial, encounter, provider network and claims databases as analytical resources; Report, track and analyze expenditures. Provide technical assistance to MLTC plan and Department staff on MEDS/PNDS program policy, rules and regulations; communicate validation and compliance report findings to plans and work with to improve compliance. Project Manager June 2014- August 2015

Point Click Software Solutions

Prepared comprehensive project plans, technical requirements, solutions design, configuration control etc. Interacted and engage with all staff levels: business managers, project leaders and functional leads to discuss specific business needs and requirements.

Responsible for enhancing and supporting the business by continued delivery of data, metrics, dashboards, and reports. Facets Implementation.

Responsible for all phases of the software development lifecycle methodology. Medicaid and Medicare Policy Implementation

Gauged the complexities of business solutions that meet core business requirements, proactively supporting new business needs and delivering business benefits.

Utilized extensive knowledge of all facets of revenue cycle management and implemented in depth knowledge of Medicare billing/coding rules and regulations.

Applied experience in analysis and design of physician practice management systems and patient accounting systems. Business Consultant September 2012- May 2014

Helping Hand Hospice, Inc. Philadelphia, PA

Provided strategic planning and regulatory guidance for services provided to Medicare and Medicaid dual eligible patients. Implemented marketing goals, operational objectives, and industry projections. Facilitated customer retention and quality control measures. Managed and analyzed research derived data for use in quantification of client’s strategic goals. Budgeted and forecasted with monthly global financial reporting and approvals Facets Implementation.

Director of Operations September 2010-September 2012 Healthsource Rehabilitation, Inc. Philadelphia, PA

Managed daily operations with medical and support staff in a multi-specialty facility of doctors and physical therapists.

Oversaw insurance processes, including but not limited to: billing, coding, account follow-up, and claim progression.

Managed lifecycle diagnostic software development.

Managed membership, reimbursement, and financial data for physicians, through manipulation of raw, collected data and conversion of such data into usable formats for management decisions.

Prepared and conduct monthly physician and staff meetings.

Provided day to day management of the revenue cycle, including billing, cash posting, follow-up, collections, payer analysis, credit balance resolution, compliance, and staff training development.

Facilitated strategic planning process and continuous quality improvement projects.

Budgeting and forecasting with monthly global financial reporting and approvals.

Managed daily operations of twelve (12) primary physicians, six (6) specialists, six (6) physical/occupational therapists, and office medical staff providing medical services to Medicare and Medicaid dual eligible patients. Director of Operations February 2005-May 2010

Northeast Aqua & Physical Therapy, Inc. Philadelphia, PA

Managed all department operations, implemented policies for Medicare and Medicaid dual eligible, directed goals and objectives, and kept open channels of communication with various stakeholders and personnel.

Determined workforce requirements and utilization and recruited and trained top tier talent.

Oversaw billing, coding, account follow-up, and claim denials.

Oversaw and managed health care functions such as, pre-registration, insurance, verification, cash collection, financial counseling, registration, medical coding, medical records, billing, account follow-up and collections, customer service, and cash posting.

Managed lifecycle of software development.

Facilitated strategic planning process and continuous quality improvement projects, through implementation of various staffing models, utilization of appropriate cost drivers, and streamlining of operational practices.

Managed daily operations of four (4) primary physicians, three (3) specialists, three (3) physical/occupational therapists, and office medical staff.

Director of Operations February 1999-November 2004 Unique Healthcare, Inc. Philadelphia, PA

Developed financial statements, evaluated performance data accurately to measure productivity and goal success.

Assisted in new facility location search and ensured all licensing permits and credentials were obtained.

Oversaw billing, coding, account follow-up, and claim denials.

Served as a strategic improvement leader who can provide detailed analysis of existing processes to develop comprehensive written work-flow and guidelines to help centralize and standardize functions of the billing department.

Led efforts to diagnose and resolve root cause issues related to outstanding revenue collection problems.

Managed reimbursement and financial operations for physicians.

Facilitated strategic planning process and continuous quality improvement projects.

Managed daily operations of nine (9) primary physicians, four (4) specialists, and office medical staff. EDUCATION & CREDENTIALS

Medical Doctor Program Pediatrics Moscow State Medical Institute # 2 Moscow, Russia Master of Science Healthcare Administration Kennedy Western University, Cheyenne, WY.



Contact this candidate