John Haffey

John Haffey

Government Programs

  • Facilitated a County Operated Health System in California to develop a strategic roadmap and define a strategy for reorganizing their administrative services model
  • Led a large national ancillary payer through an enterprise-wide Medicare compliance initiative
  • Enabled the operations department of a managed care organization to improve provider data capture, storage, and management for 5,000+ providers to address critical claims payment issues and provider complaints
  • Drove process improvements to address backlog of 50,000+ non-compliant provider disputes to improve intake, classification, tracking, and resolution procedures for increased transparency and accuracy for a Medi-Cal plan

Health Insurance Exchanges

  • Led requirements gathering efforts across 8 separate projects as part of a $40 million Affordable Care Act Mandate Implementation Program for a leading regional health plan
  • Identified non-compliant health care products filed (on and off exchange) by a regional health plan, and planned and executed remediation activities to update contract language, rate and benefit filings, and member communication and marketing materials
  • Led a market evaluation of available private exchange solution vendors for a regional payer with approximately 750,000 lives

Business Process and Technical Consulting

  • Managed a team to develop a cloud based scope and requirements tracking process to improve scope management and develop and deploy a scope change request process for a $40 million dollar Affordable Care Act Mandate Implementation Program for a leading regional managed care provider
  • Led the business requirements gathering process for a behavioral health utilization management system migration from a legacy mainframe system to a browser based solution
  • Led the implementation of business process and information technology upgrades to conform with the requirements of the Affordable Care Act for a large regional health plan
  • Assessed the end-to-end claims process across multiple vendors for a large government agency and provided improvement opportunities across staffing, processes, and technology platforms
  • Provided interim Chief Technology Officer services to a large pharmacy benefits manager interested in improving data stewardship, increasing new technology adoption, and developing a technical roadmap to include immediate improvements and long-term system upgrades
  • Provided market evaluation and business process outsourcing recommendations for a multi-state provider interested in entering the Medicare market through either internal development, alignment, or acquisition
  • Audited an internal healthcare IT disaster recovery system and process designed to meet parallel production criteria for a large multi-state provider