Case Studies

Government TPL Project Management for 15 State Medicaid Agencies

  • Primary technical and budgetary responsibility for auditing several state Medicaid programs
  • Developed specifications for new TPL projects and oversaw the technical execution and implementation of these projects from beginning to end
  • Served as liaison between state agencies/fiscal intermediaries and vendor operations staff to ensure accurate and timely production of contract deliverables
  • Ensured that project operations/programs were performed in accordance with current CMS and Medicaid regulations
  • Served as project manager, maintaining effective communication with clients regarding project status, issues and new projects through regular face-to-face meetings, project reports and correspondence
  • Developed an innovative methodology for associating absent parents with dependents, enabling Medicaid agencies to enforce financial and medical support orders
  • Initiated third-party liability recovery program for two Medicaid managed care organizations

 

Office Set Up for Estate Recovery Project in the State of Colorado

  • Assumed full responsibility for project, with fewer than 60 days notice
  • Secured office space and equipment, hired staff, ensured client satisfaction and managed a difficult separation from a hostile subcontractor

Government & Private Provider Billing & Collections at a Leading Health Care Collection Company

  • Reported to the Chief Executive Officer
  • Functioned as liaison between regional offices, clients and outsourced data processing staff, including prioritization of data processing budget/agenda
  • Developed standards for data transfer between client’s and health care collection company’s proprietary applications system (coincidentally, the same system currently used for FDNY billing and collections)
  • Assisted sales, accounting and operations units in development of profit and loss standards to determine viability of client project requests
  • Generated ad hoc reports, hospital system transaction files and profiled hospital data files using SAS