Project Management Business Operations

Eric M Rosenblum

*** **** ***** ****: 941-***-****

Huntingdon Valley, PA 19006 Cell: 941-***-****

***************@*****.***

http://www.linkedin.com/pub/eric-rosenblum/47/1a5/111

Professional Summary

Motivated, goal oriented individual seeking a challenging position which will utilize skills and experience gained in the healthcare industry in the areas of claims data analysis, auditing, provider and member communication and problem solving with a proven ability to prioritize in fast paced environment both independently and in a team environment to accomplish tasks in a timely and efficient manner. Key strengths include:

SQL/HQL Certified

Staff Management

Project Management

Innovation

Facilitator and Mentor

Research and analysis

Creative Problem Solver

Professional Experience

Aetna Healthcare

BlueBell, Pennsylvania 10/21 – Present

Manager, Project Management

Develop and provide information and analysis to drive the decision-making process and support business operations for internal and external customers

Oversees the implementation of information strategy and development of information products to ensure operational objectives and other strategic business initiatives are met

Responsible for exception monitoring ensuring problem resolution exists

Works with advisers from key functional areas to understand potential project impact on the organization, align project work, and execute activities accordingly

Influence change or enhancements to business processes, policies, and system infrastructure to improve information quality, availability, and access

Aetna Healthcare 11/17 – 10/21

BlueBell, Pennsylvania

Senior Consultant

Define, develop and provide information and analysis to drive the decision-making process and support business operations for internal and external customers.

Provides consultation on the design, testing and enhancement of information product including technical assistance and product development support to external and internal customers.

Researches, manipulates and prepares complex data to document program activities and reports on its results.

Provides oversight to data quality and provides feedback to various areas in order to improve service delivery and enhancement to design efforts.

Develops a consultative relationship with internal and external customers.

Aetna Healthcare 06/17 – 11/17

BlueBell, Pennsylvania

Informatics Consultant Lead

■Develop rules and queries and determines analytical approaches to evaluate scenarios and potential overpayment identification methods.

■Collaborates with business partners to understand their problems and goals, develop statistical analysis, data reports and performance metrics.

■Develops and participates in presentations and consultations to existing and prospective constituents on analytics results and solutions.

■Interacts with internal and external peers and managers to exchange complex information related to areas of specialization.

■Use strong programming skills to explore, examine and interpret large volumes of data in various forms.

■Demonstrates strong ability to communicate technical concepts and implications to business partners.

AmeriHealth Caritas 09/14 - 06/17

Philadelphia, Pennsylvania

Cost Containment Analysis 09/14

■Provide analytical support to all appropriate lines of business to identify provider overpayment's prospectively and retrospectively.

■Performs the role of data source expert to support corporate cost containment initiatives.

■Able to translate business rules and provider contracts into cost containment projects through report development through research of internal and state systems.

■Identifies root cause issues and communicate issues to appropriate functional areas to resolve system with the intent to resolve.

■Independently manages multiple projects, including meeting with appropriate service team and answer provider questions.

■Responsible for assuring the accuracy and validity of data, while interpreting results into recommendations.

■Analyze claims payment aberrations and provide explanation for projects and recommended changes.

■Validate results and report root cause to cross functional departments and management.

Connolly Healthcare 08/11 - 09/14

Auditor I

Medicaid Division

Review and investigate health insurance claims data and related documents to identify client payment errors.

Develop new concept reports and create projects based upon the identified trending.

Analyze and validate audit results according to client policy, processing guidelines, provider contracts and state/federal regulations.

Handle specialized team and client projects when assigned.

Research and develop new audit opportunities.

Work with IT staff to develop and implement technology improvements to support the audit process.

Address policy and other issues with a long term view of the client relationship

Assist in developing the team’s long term audit plans.

Identify and recommend corrective action plans to avoid future losses.

Train and mentor new employees

Assist manager with client strategy implementation.

Junior Auditor 08/2011- 04/2014

Medicaid Division

Investigate and audit medical claims data including Coordination of Benefits to identify client payment errors.

Handle and complete reports as assigned.

Validate all audit findings based upon client, state and federal regulations.

Work with all areas of other patient liability including but not limited to Medicare.

Assist team and management with the development of new reports and improvements to the auditing process.

Collaborate with colleagues across all audits sharing experience, ideas, techniques and knowledge in order to strengthen each team as well as to optimize audit results.

Work with IT staff to develop and implement technological improvements to support the audit process.

Address policy and other issues with a long term view of the client relationship.

Assist in implementing the team’s strategic audit plan.

Identify and recommend corrective action plans for the client.

Florida Blue 2010 - 2012

Tampa, Florida

Auditor II

Prepared and reviewed cost reports required to conform with CMS standard to address forty legal entities.

Performed audits on hospital who had participated in the Medicaid program to ensure appropriate reimbursement for services provided to Medicaid beneficiaries.

Performed Disproportionate Share Reviews (DSR) for the State of Florida as part of the hospital audit contract.

Communicated with hospital administrations for supporting documentation relevant to the audit examinations.

Responsible for leading team of auditors during the review process and assuring timely and quality results.

Improved productivity and morale by initiating systems for accountability and instituting effective training programs.

Walgreen's Pharmacy 2005 -2010

Tampa, Florida

Executive Manager

Accountable for budgeting, cost control, payroll, full profit and loss and general accounting.

Supervised staff of ten employees.

Responsible for training, scheduling, prioritization of tasks, monitoring and evaluations.

Effective problem solving skills to resolve client issues in a managerial environment.

Review cash register transaction and reconcile receipt to bank deposit submission.

Educational Summary

Nova Southeastern University

Tampa, Florida

Master of Business Administration, Accounting 2008

University of Tampa

Tampa, Florida

Bachelor of Business Administration 2004

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