SETH B. HALL

ad36ps@r.postjobfree.com / https://www.linkedin.com/in/sethbhall/ / 1903 Foxboro Road, LaGrange, KY 40031 / 502-***-****

SUMMARY AND SKILLS

Highly analytical, innovative, and results-oriented leader with proven history of interpreting organizational mission, prioritizing goals, and developing strategic plans to streamline operations for smooth functionality. Demonstrated ability to successfully lead a large multi-location enterprise, effectively manage budgets, drive projects, formulate associates, improve quality, enhance productivity, and meet service level agreements. Adept negotiator seasoned in securing new and renewing existing contracts to build profitable partnerships and grow business. Capable of training and guiding staff for continuous business development and target achievement while complying with company standards.

Strategic Business Planning

Payment Integrity

Member & Provider Services

Contact Center Leadership

Education and Development

Project Management

Cost Containment

Workforce Mgt.

Product Implementation

Content Management

Budget Administration

Contract Negotiations

Staff Management

D&I Experience

Medicaid Reclamation

PROFESSIONAL EXPERIENCE

HMS a Gainwell Company, Irving, TX

Sr. Director Carrier Optimization Team

9/2020 to 2/2024

Motivated a team that managed/developed the relationships with 1,000 carriers building out eligibility interfaces and claim adjudication for recoveries for over $2.1 billion for state and federal programs.

Reorganized to achieve growth in recoveries of 20% year over year.

Increased the number or Carriers implementing EDI by 100%

Organized an Employer Group recovery strategy for Carrier denials that will increase the opportunity of recovery by 30%.

Developed Medicare Part D recovery strategy.

THE RAWLINGS COMPANY, La Grange, KY

Pharmacy Operations Director

7/2014 to 5/2020

Managed and supervised end-to-end operations, technology, and processes to improve identifications of overpayments and recoveries for commercial and government Pharmacy retrospective programs for the largest Healthcare payers. Efficaciously steered six direct reports for COB, Retro Terminations, Clinical, Compliance audits, and recovery team including Reversal and Payer to Payer recoveries while successfully leading the implementations of two Pharmacy Benefit Managers, PBM, and many large Healthcare payers.

Drafted and formulated 800 Payer recovery paths for Pharmacy claims to maximise company revenue and achieve Payment Integrity for our clients.

Devised and implemented business strategies to strengthen organization while optimizing company revenue to a new high from $24 million to $82 million in five years with only a 36% growth in staff.

Successfully governed to recruit, train, and build new staff and boosted recoveries with 222% increase over a period of 6 years.

Introduced and established a system of balance performance scorecards that help target education and best practices to drive over 20% revenue improvement each calendar year.

MEDASSIST, Louisville, KY

CIO & Chief Security Officer

1/2012 to 3/2014

Proficiently assisted the CEO and COO with devised strategy and decisions affecting all technologies and facilities while guiding organization during period of rapid growth in revenues, organizational structure, and operations efficiency. Monitored HIM, networks, cloud solutions, HIPAA security, telecommunications, helpdesk and other IT/communication activities. Collaborated development and conducted strategic business planning to establish and meet annual goals. Directed strategic healthcare reform projects, research, and implementation of enrolment programs.

Efficiently achieved 30% in network savings by transforming network infrastructure to Cloud and VOIP.

Upgraded and enhanced core system availability to 99.99% through the introduction of Six Sigma-based standards and architectural governance, and implementation of best practices for the core CRM.

Executed integrated scanning process for 24 million Medicaid applications.

Outsources AIX P7 series servers to enable the company to focus on growth and improving uptime to 99.99%.

Established capital and operating budget ($10 million in 2014) and monitored P & L.

Administered a global Shop with a team of 100 employees.

FIRSTSOURCE SOLUTIONS USA, Louisville, KY

Vice President of Strategy

1/2010 to 1/2012

Brainstormed innovative ideas to consult Chief Adviser to the CEO on global Healthcare strategy to come up with the better ideas in line with latest techniques. Efficiently crafted strategic planning for payer and provider markets in the United States and developed product offerings complementing healthcare reforms. Lead a team developing competitive analysis and cross mapping of product offerings by market.

Championed attainment of 30% savings a year through the evolution of clearing house strategy.

Remained successful in creating the EMPOWER Brand for MedAssist, a FirstSource Company – A Cloud Based Contact center technology for provider community.

Shaped proposal for State Medicaid plan.

MEDASSIST, Louisville, KY

Vice President of North America Service Group

7/2002 to 1/2010

Managed to lead a global HIM team, IBM mainframe team and establish a global Helpdesk team to assist US market of provider, payer, and banking businesses. Instituted a Center of Excellence in Mumbai, India to handle HIM activities for provider community and programming for core CRM solution. Introduced an outsourcing strategy for the Information Technology department incorporating the scope of help desk, programming, and support saving millions in human resource costs.

Crafted new outsourced consolidated data center allowing the provider group to have 100% uptime on data center while consolidating CRM solution to save $1 million a year.

AdminaStar, Indianapolis, IN

National Director of 1-800 Medicare

1998 to 2002

Effectively managed and supervised teams for completing assigned tasks and grabbed SOWs released by CMS as an encouragement for better performance while reporting directly to CMS and Operations Executive Director. Supervised and monitored a contract for 1600 staff members spanning over $100 million P&L yearly. Organized bid process resulting into Siebel CRM installation in the United States for Medicare for managing company’s interaction with current and potential clients. Steered and monitored company’s Business Intelligence Center from inception to completion and supervised complete operations in order to assist management and team members to come up with better and precise business decisions while cutting costs, identifying new business opportunities, and recognizing inefficient business processes.

Diligently worked as IDIQ Director for FAR contacts of CMS for Contact Center Product and Services while managing contracts worth of $500 million for a period of 5 years while exercising effective negotiation, communication, and project management skills.

Devised and executed a strategy to develop four contact centers for providing clients with efficient and effective timely support and assistance and recruited, trained, and coached a team of 1,000 members within 90 days.

Successfully achieved six successive superior ratings by CMS for contract for maximum 8% increase in bonus payment and exploring new revenue generating initiatives.

EDUCATION AND OTHER

Bachelor of Business Administration with minor in Economics & Political Science

University of Kentucky, Lexington, KY

University of Louisville School of Law, Louisville, KY

Certified Governance Enterprise IT, CGEIT

HIPAA

Rawlings University

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