GEORGE HARALABIDIS

**** ******* *****

Cell: 770-***-****

Marietta, Georgia 30068

ad1vv5@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

Accomplished health care professional with extensive experience in financial planning, project management and health care operations. A track record of success in managed care. A leader in financial and health care analytical reporting with over 25 years (since 1998) of Clarity experience using the EPIC suite: ADT/Scheduling, Cadence, Resolute (Hospital and Ambulatory), Tapestry (Claims, Referral, Capitation, CRM). Areas of expertise include:

Strategic Planning

Data Warehouse

Operations Management

Project management

Managed Care

Medical Management

Financial Planning

Systems Implementation

Forecasting

WORK EXPERIENCE

KAISER PERMANENTE

February 2008 – December 2023

Medical Group Consultant / Health Plan Clarity Consultant (Tapestry, Resolute HB/PB, Cadence, EpicCare)

Currently working on evaluating Medical Group initiatives from controlling outside costs, hospital utilization and internalization projects. Responsible for the 2018-2025 budgets and setting up the parameters needed to rollforward with a five year plan. Working on report redesign to Oracle.

Revamped the GL reconciliations to the claims data and the IBNR processes to enable KP to pass outside audits. Redesigned a number of existing reports and data points to explain cost structures and potential issues by pools (products), service areas and customer types. Worked with new autocoder programming codes to accommodate ICD10 changes and a new national GL implementation.

Responsible for coordinating the efforts of the analytical teams during the Epic Tapestry implementation (UM, CRM and Claims). Developed all data mappings and wrote Kaiser Permanente extracts to outside customers, using Teradata SQL. Data testing for the Referrals and Claims module of Tapestry. Part of the report writing team using Paradox, Teradata SQL, Cognos and Crystal XI. Project managing the transition of all existing homegrown applications. Support all accounting reports, processes and extracts needed for the transition to Tapestry. Responsible for the refunds and recovery work and reconciliation of accounting systems. Revamped the month-end close process as they relate to accruals methodologies and IBNR accruals. Created over 100 AP Claims and Referrals reports. Vendor, provider, internal physician reconciliations and validation. Audit and external customers design of reporting YE Tapestry data

TRINITY HEALTH, CT

February 2017 – May 2018

Clarity Consultant – (Tapestry)

Working predominantly for St Francis Hospital & Medical Center in Hartford, CT. They were part of Trinity Health who was in the process of converting to Tapestry also. Need help with Hospital billing reporting issues and understanding the impact of the new Tapestry claims system to their financials. Worked mostly with the Claims Manager and Finance Director to try to create the right set of reports for financial analysis and audit reasons. Creating month0-end package for both internal and external claims, and referrals-based accruing. Adjustments made to bad debt, aging and other financial reports. Reviewed and set up reports for outstanding Capitation and Referral gaps. Created the OCHA Medicare filings for both St Francis and Johnson Memorial Hospitals.

MEMORIAL HEALTH, CA

February 2013 –June 2017

January 2018 – June 2018

Clarity Consultant – (Tapestry / Resolute HB/PB)

Assisting with reports in Tapestry and Resolute Professional Billing. The client went live last year and experienced a reporting backlog. Created over 100 Tapestry reports using Crystal 2008 (moving to 2011) and Oracle Toad. In the process of reviewing and reworking around 50 Resolute reports. Helping with the referral strategy as it relates to the cost strategy of the affiliated networks. Working with the Finance department and building their IBNR models. Working on CRM flowsheets, PDR reports, calls received and a variety of other Customer Service datapoints. Creating a number of extracts and reconciliations with the Contracts department to be able to evaluate contract performance against the Medicare schedules and year over year increases. Working on multiple go-live locations and multiple Tapestry instances (GNP, Edinger, UCI, Cedars and Nautilus). Translating the old claims processes (from QNXT, MC400 and EZCap) to Epic reports and metrics, such as claims accuracy, IBNR detail and summary, ME GL close reports, Claims Timeliness filings to Medicare, claims production and productivity, bed days census reports, referrals productivity and exception reporting. Revising extracts and universes that are needed to support a common approach to reporting to avoid the “dueling reporting” syndrome.

MERCY HEALTH, OH

June 2014 – June 2015

Clarity Consultant – (Tapestry)

Hired to assist with the reporting requirements and gap analysis of a short Tapestry built. January go-live was additionally challenging since part of the membership was recently acquired from an HMO that stopped supplying IT support, and had to quickly review and fulfill critical needs. Responsible for Claims, Membership and Refunds and Recoveries reporting. Development in MS SQL with Crystal / Infoview front-end tools.

MEMORIAL HEALTHCARE, FL

December 2010 – August 2011

April 2014 – July 2014

March 2015 – August 2015

Clarity Consultant – (Tapestry, Resolute HB and PB)

Developed and created over 40 reports by consolidating over 150 old reports and extracts out of EZCap. Created several data mappings and data marts for all Tapestry modules: Claims, Eligibility, Capitation and Referrals. Reports were created in both MS SQL and Crystal 2008. Streamlined financial month-end with Corporate Finance and redesigned audit reports. Developed new accrual reports for hospitalization and outside medical expenses. Worked on CM/DM reports and CRM productivity extracts. Special database design for Refunds and Recoveries out of the Tapestry Claims module; Recreated aging reports for GL subledger setup; IBNR calculations to prepare for Financial Planning estimates, audit reports and calculation of bed days methodology for use in lag triangles.

UTAH MEDICAL SERVICES, UT

September 2010 – January 2011

Clarity Consultant – (Tapestry / Enrollment)

Developed over 50 reports using Oracle toad. Reports were mainly CRM and Claims using the Tapestry module; both as extracts to outside vendors and internal daily and weekly datasets exportable to MS products. Data tested for the Referrals and Claims module of Tapestry. Project managing the data modeling of all existing homegrown applications. Supported all accounting reports, processes and extracts needed for the transition to Tapestry.

UNIVERSITY OF TEXAS MEDICINE

August 2007 – February 2008

Clarity Consultant (Resolute PB/HB)

Responsible for coordinating the efforts of the analytical team during the Epic implementation. In charge of all Clarity reports for the ambulatory implementation of 20 locations and over 25 specialties. Leading the data mapping efforts, assisting in Clarity training, and developing reports (Resolute, Cadence, Epiccare) using Crystal and SQL Server Enterprise Manager. Coordinating the efforts of a universe building model for secondary reporting and ad-hoc analysis

CHILDREN’S HOSPITAL OF PHILADELPHIA

October 2006 – July 2007

Clarity Consultant (Resolute PB/HB)

Responsible for coordinating the efforts of the analytical team during the Epic implementation. In charge of all Clarity reports for the ambulatory implementation of 20 locations and over 25 specialties. Leading the data mapping efforts, assisting in Clarity training, and developing reports (Resolute, Cadence, Epiccare) using Crystal and SQL Server Enterprise Manager. Coordinating the efforts of a universe building model for secondary reporting and ad-hoc analysis

KAISER PERMANENTE

October 1990 – October 2006

Director of Analytical Services & Web Development Group (1998 – 2006)

Responsible for the Internal Reporting, Utilization Reporting, Group Reporting, RFPs Support, HEDIS, Pharmacy, Medicare Finance, Marketing, Pricing Support and Data Warehouse functions, EPIC implementation.

Developed company intranet site; using the COGNOS enterprise server and web portal; Responsible for teaching senior management and Medical Group staff multidimensional cubes and information solutions using the Data Warehouse COGNOS tool, Business Objects and Crystal reports;

Responsible for a company-wide web implementation of the report registry on the company Intranet;

Responsible for the creation of standard group reports and the ability to price group-specific reports for external purchasing groups and consulting groups.;

Responsible for creating member-level P&Ls and time-sensitive pool reporting;

IT Steering committee member overlooking the transition to a new software system and its implications on data reporting and day-to-day business processes;

Authored Diabetic Cost Study that resulted in savings of 10 inpatient days per thousand and several millions in costs;

Identified $4.5M in hospital overcharges that were collected from our vendor;

Managed the transition to the Broker 5500 reports and created a web data-entry portal and a new broker interface, that will result in accurate reporting;

Led the Clarity reporting team during the Epic implementation; Appointments and Resolute ambulatory billing; created a number of reports and data metrics using Paradox, Cognos, Crystal, Sybase, Teradata;

Director of Financial Planning and Strategic Initiatives – SE Division (1996-1998)

Responsible for the Financial Planning, Cost Management Information System, Strategic Initiatives and Mergers and Acquisitions functions for the Southeastern Division: Atlanta, Charlotte and Triangle markets.

Led the Refunds & Recovery Project Team; responsible for collecting $7.1M (target of $3.5M);

Responsible for the reporting functions of the three markets; the consolidation of the data resulted in savings of 5 FTE and a much improved reporting environment;

Oversaw an operating budget of over $1B;

Implemented an on-line budgeting system for operations;

Participated in the rate setting process and created a 10 year forecasting model;

Responsible for the divisional Capital Budgets;

Implemented a CMIS system in a home-grown application (from the T1 system) that resulted to over $1M in savings;

Team leader of the conversion to MHC from the Comtec system, that resulted in paying claims accurately and timely within the 15 days allowed by the DOI;

Responsible for converting all financial DOS and Windows 3.1 applications to Windows 95 software.

Senior Financial Analyst (1990-1996)

Designed user-friendly menus and reports to help accounting staff with their monthly reconciliation processes. Trained internal staff and management on software and custom-built applications; SQL training for corporate data in Sybase. Authored Data Warehouse training manuals and taught database logic, data catalogs and multidimensional database using COGNOS.

SELF EMPLOYED

February 1990 – September 1990

Research Consultant

Analyze financial data to help businesses evaluate performance and formulate strategic plans. Offer advice on computer software packages and systems designs to run companies more efficiently. Clients: Active Parenting Publishers, Floor Coverings International, Integratec, Kaiser Permanente.

UNIVERSITY OF MARYLAND – COLLEGE PARK

June 1989 – January 1990

Coordinator of Research & Statistics

Responsible for calculating and reporting institutional data. Performed studies on student attrition, course scheduling, student satisfaction and strategic planning for the Graduate School. Taught graduate business simulation classes for after hours military MBA classes.

EDUCATION

MARYMOUNT UNIVERSITY - Arlington, Virginia

M.B.A. in Finance (1989)

Delta Epsilon Sigma Honors Society

UNIVERSITY OF KENT – Canterbury, England

B.S. with Honors in Computing, Operations Research and Statistics (1986)

KAVALA TECHNICAL INSTITUTE – Kavala, Greece

HND in Mechanical Engineering (1983)

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