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Category Archives: Health Insurance

HealthCare Operations Director – Apps, Change Management & Delivery

Posted on August 8, 2016 | Categories: Health Exchange, Health Insurance, Health System, HealthCare, HealthCare IT, Program and Project Management | Posted by: admin

HealthCare Operations Director – Apps, Change Management & Delivery 

 

  • Self-starter with an entrepreneurial spirit and healthcare hands-on domain expert on Payer, Providers and Tech Applications (Implementation, Configuration, Interfaces, Upgrades, Enhancements and Delivery)
  • Accountable for day-to-day progress of Agile, Waterfall & Hybrid based development project(s) and release initiatives with regard to time, budget, scope and quality
  • Collaborates with Leadership, Product, Infrastructure &Security teams to configure solutions and deliver value to customers. Responsible for identifying and solving business / systems issues
  • Contribute to the delivery and execution of complex, large scale, multi-year (high cost, high complexity and/or high risk) client enterprise transformation programs
  • Deliverables include leading major work streams and projects, supporting pre-sales and sales activities, owning deliverables, building key customer relationships, building and sharing institutional knowledge, and developing junior professionals
  • Exceptional listening, communication, documentation and presentation skills
  • Experience managing at least 10 direct reports
  • Follow and implement HIPAA, CMS and PHI compliance & regulations and maintain center operations
  • Implement company goals and objectives including Change Management
  • Negotiate and manage contracting
  • Oversee and manage Quality Assurance for Business & IT Projects
  • Participate in budget creation and maintenance with help of Finance Team
  • Participate in Infrastructure upgrade, procurement and management with help of Infrastructure Team
  • Participate in Recruiting, Hiring & Training of Key Personnel with help of HR & Training Team
  • Responsible for ensuring the delivery of quality patient care while efficiently utilizing resources and maximizing returns
  • Responsible for Voice of Customer (VOC), Statement of Work (SOW) and C-Sat (Customer Satisfaction) Score
  • Strong physician relationships- dynamic- positive- outgoing- flexible- able to work with boards, committees, regulatory agencies, third party, vendors, patients and all levels of personnel
  • Successfully managed and delivered Multi-million dollar HealthCare Transformational Projects i.e. ePrescribe, EMR, Medicare (MA), PBM, Specialty Pharmacy, Tele-Health, Claims, BPO, RCM & MU (STAR)
  • Track record of success with staff development, coaching and employee performance management

 

Contact Manish for HealthCare Director – Solutions & Delivery at 646.644.3049 or manish@techcusp.com

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25 Largest Health Systems in America

Posted on August 5, 2016 | Categories: Health Insurance, Health System, HealthCare, HealthCare IT | Posted by: admin

25 Largest Health Systems in America

 

Here are the 25 largest integrated health systems, according to SK&A’s report.

 

  1. Community Health Systems (Franklin, Tenn.) — 2,224 total facilities
  2. Ascension Health (St. Louis) — 2,098
  3. HCA (Nashville, Tenn.) — 1,719
  4. Trinity Health (Livonia, Mich.) — 1,705
  5. Tenet Healthcare (Dallas) — 1,061
  6. Kaiser Permanente (Oakland, Calif.) — 1,045
  7. Carolinas Healthcare System (Charlotte, N.C.) — 936
  8. UPMC (Pittsburgh) — 859
  9. Partners HealthCare System (Boston) — 788
  10. NewYork-Presbyterian Healthcare (New York City) — 732
  11. Catholic Health Initiatives (Englewood, Colo.) — 719
  12. Mercy Health System (Chesterfield, Mo.) — 706
  13. Baylor Scott & White Health (Dallas) — 683
  14. Northwell Health (New Hyde Park, N.Y.) — 670
  15. Adventist Health System (Altamonte Springs, Fla.) — 636
  16. Sutter Health (Sacramento, Calif.) — 622
  17. Providence Health & Services (Renton, Wash.) — 579
  18. Universal Health Services (King of Prussia, Pa.) — 571
  19. University of Texas Health System (Austin) — 551
  20. LifePoint Health (Brentwood, Tenn.) — 544
  21. Mount Sinai Health System (New York City) — 535
  22. Cleveland Clinic Health System — 525
  23. Indiana University Health (Indianapolis) — 492
  24. Novant Health (Winston-Salem, N.C.) — 492
  25. Advocate Health Care (Downers Grove, Ill.) — 483

 

Source: SK&A’s report, 2016

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Principal Consultant & Delivery Manager – HealthCare (Payers & Providers)

Posted on July 29, 2016 | Categories: ACOs, Analytics, Apps, Big Data, Care Management, Claims, Clinical Services, Clinical Trials, Consulting, Data Analytics, Health Exchange, Health Insurance, HealthCare | Posted by: admin

Principal Consultant & Delivery Manager – HealthCare (Payers & Providers)

 

  • The Principal Consultant & Delivery Manager (PCDM) leverages combined people, process, analytics and technology competencies to support large-scale, complex customer engagements
  • The Principal Consultant & Delivery Manager (PCDM) is responsible for driving customer value through client facing advisory and delivery services. A subject matter expert and trusted advisor for Payers, Providers, Clients & Program Management Team and works closely with engagement and technology team to define strategic and tactical direction
  • Collaborates with Leadership, Product, Infrastructure &Security teams to configure solutions and deliver value to customers. Responsible for identifying and solving business / systems issues
  • Contribute to the delivery and execution of complex, large scale, multi-year (high cost, high complexity and/or high risk) client enterprise transformation programs
  • Deliverables include leading major work streams and projects, supporting pre-sales and sales activities, owning deliverables, building key customer relationships, building and sharing institutional knowledge, and developing junior professionals
  • Build, share, and maintain expertise in both practice area and client environment, regularly interface with Product, Infrastructure, and Security teams to deliver on customer commitments
  • Contribute to operational readiness, organizational change management, solution capability, packaging, and estimating, planning and delivery management
  • Contribute to pre-sales and sales activities for revenue growth
  • Lead major engagement work streams and projects to meet milestones on time, and to deliver with high quality and within agreed to budgets
  • Plan, organize, staff, direct and control the operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority
  • Use Data Analytics & information sets for analysis, creating hypotheses and presenting recommendations to team; developing client specific requirements, standard operating procedures (SOP), functional roles & responsibilities, process flow and user guide per SOW

 

Contact Manish for Sr HealthCare Consultant @ 646.644.3049 or manish@techcusp.com

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Delivery Director – HealthCare IT

Posted on July 27, 2016 | Categories: Account Manager, Claims, Consulting, Health Insurance, HealthCare, HealthCare IT, Program Manager, RCM, Senior Consultants | Posted by: admin

Delivery Director – HealthCare IT

 

 

  • Manage & Lead Project Initiations, Estimates, SOWs, Budgets, Charter, Scheduling, Plan, Risks etc in support of on-going client needs and new opportunities
  • Managing complex plans to resolve client production incidents and service requests through understanding of client priorities and internal processes. Tracking to plan and working across the organization to effectively meet the client’s business needs. Establishing positive relationships with clients and program resources through effective communication and on-time delivery of commitments
  • Responsible for Client Relationship Management (CRM), Voice of Customers (VOC), Solutions and Escalations that demand a high degree of diplomacy, discretion, insight, and judgment
  • Managing SOW / contract scope to include establishing agreed upon contract deliverables, roles, responsibilities and budget
  • Lead and directly manage a team of resources, in particular as it relates to the delivery of project-based activities
  • Participate and contribute thought leadership to help drive Professional Services & Business Development strategies
  • Acts as a liaison between various internal organizations (Marketing, Finance, Product Management, etc.)
  • Managing and developing agendas and action logs for all client meetings. Tracking open items in action log and ensuring timely delivery across the organization
  • Managing and facilitating weekly and monthly client meetings and reporting on projects at a line level up to senior executive level
  • Managing multiple operational projects on time, budget, and quality while accommodating competing priorities
  • Managing multiple project teams to completion in parallel within time and budget and completing all project close-out activities.
  • Managing project environments through the product lifecycle including procurement, build and configuration, network and security configuration, and coordinate and schedule resources
  • Proactively identifying gaps in internal change, incident, service request, batch and problem management plans and external expectations; and managing client expectations regarding risks and issues mitigation
  • Provide delivery engagement for existing & client portfolio. Manage client level P&L
  • Strong presentation skills with ability to effectively communicate through written or verbal forums and strong interpersonal skills
  • Working with Communication Team and Project Managers / Program Manager to disseminate project status, information, and expectations to internal and external client resources and stakeholders and reporting on projects at the executive level.
  • Working with technical leadership to ensure their client program is properly resourced based on scope, skillset and timeframe for delivery. Escalating production issues quickly and driving resolution while communicating status and resolution path to client. Proactively escalating to resource teams to avoid risk of missing client deliverables.

 

Contact – Manish @ 646.644.3049 or manish@techcusp.com

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Cyber Security and Risk Management in HealthCare

Posted on July 26, 2016 | Categories: Health Exchange, Health Insurance, HealthCare, HealthCare IT | Posted by: admin

Cyber Security and Risk Management in HealthCare

 

Company’s exposure to fraud could happen due to

  • Complexity of IT infrastructure (e.g., more information or assets being stored/moved/processed digitally)
  • Complexity of products or services sold
  • Cost restraint over pay and remuneration
  • Entry to new, riskier markets
  • High staff turnover
  • Increased collaboration between firms (joint-ventures, partnerships etc.)
  • Increased outsourcing and offshoring
  • Increasing exposure to public digital touchpoints (e.g., employee’s social media use, personal computer use, etc.)
  • Lack of budget/resource for compliance infrastructure

 

Company’s adoption of anti-fraud measures

  • Assets (physical security systems, stock inventories, tagging, asset register)
  • Board of Director engagement in cyber security policies & procedures
  • Financial (financial controls, fraud detection, internal audit, external audit, anti-money laundering policies)
  • Information (IT security, technical countermeasures)
  • IP (intellectual property risk assessment and trademark monitoring program)
  • Management (management controls, incentives, external supervision such as audit committee)
  • Partners, clients and vendors (due diligence)
  • Reputation (media monitoring, compliance controls, legal review)
  • Risk (risk officer and risk management system)
  • Staff (background screening)
  • Staff (training, whistleblower hotline)

 

Types of Cyber-attack or Information loss

  • Alteration or change of customer data
  • Data breach resulting in loss of customer or employee data
  • Data breach resulting in loss of IP/trade secrets/R&D
  • Data deletion by malicious insider
  • Data deletion or corruption by malware or system issue
  • Data deletion or loss due to system issues
  • Denial of Service Attack
  • Email based Phishing attack
  • Insider theft of customer or employee data
  • Insider theft of IP/trade secrets/R&D
  • Lost equipment with sensitive data
  • Ransomware attack
  • Stolen equipment with sensitive data
  • Virus/ worm infestation
  • Wire transfer fraud

 

Company’s adoption of cyber security risk mitigation measures

  • An information security incident response plan that’s been updated in the last 12 months
  • Board of Director engagement in cyber security policies & procedures
  • Cyber insurance
  • Employee cyber security training
  • Employee restriction on installing software on company devices
  • Endpoint Threat Monitoring- Carbon Black, Tanium
  • Internal cyber security policies & procedures
  • Intrusion Detection System- network based
  • Intrusion detection system- device
  • Network Operations Center
  • Recruitment of in-house IT security specialists
  • Security assessments of data and IT infrastructure conducted by third parties (e.g. consultants)
  • Security assessments of data and IT infrastructure conducted in-house
  • Security Operations Center
  • SEIM or other Log Management system
  • Testing of an information security incident response plan at least every 6 months
  • Third party cyber security policies & procedures (e.g. for vendors/suppliers/intermediaries)
  • Threat intelligence system

 

Types of security incidents today

  • Environmental risk (including damage caused by natural disasters such as hurricanes, tornadoes, floods, earthquakes, etc.)
  • Geographic and political risk (i.e., operating in areas of conflict)
  • Terrorism, including domestic and international events
  • Theft or loss of intellectual property
  • Workplace violence

Company’s adoption of security risk mitigation measures

  • Conduct a threat and vulnerability assessment
  • Create a security master plan
  • Develop a plan for securing intellectual property
  • Develop and implement an information security plan
  • Develop physical security infrastructure (i.e., integrated security system development, implementation and training)
  • Develop security policies and procedures
  • Implement an executive protection plan
  • Implement business continuity plan (including crisis management and emergency response planning and training)
  • Implement threat management plans and procedures
  • Implement travel risk plans and procedures
  • Perform a security audit & security training

 

 

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