Olaf Reyes

Experience

Olaf has extensive experience in leading large systems integrations teams in the implementation of enrollment and claims transaction audit and control solutions, and in developing end-to-end solutions for web enrollment, billing, and sales automation. He has functional expertise in Enrollment and Eligibility, Claims Pricing and Adjudication, Business Process Reengineering, and Process Improvement.

Developed and implemented Claims Accuracy programs for multiple health plans

  • Led and implemented the claims accuracy program for a managed Medicaid plan identifying over $20M in claims inaccuracies and $16M in recoverable findings across the plan’s institutional and professional providers
  • Developed and implemented a Payment Accuracy Center of Excellence for a national Managed Medicaid insurer that identified over $6M in claim inaccuracies and rolled out people, process, and technology initiatives to address underlying root cause
  • Developed a contract modeling and simulation analytics application for a managed Medicaid plan to assess the financial impact of state mandated payment methodology and provider network changes to assist the plan in developing new provider contracts

Re-engineered and re-platform electronic enrollment system

  • Lead business team in defining functional, business rules, operational reports, and dashboards requirements to re-engineer a regional Blue Cross Blue Shield plan’s electronic enrollment system doubling transaction capacity and providing near-real time processing capabilities
  • Implemented SaaS solution to augment electronic enrollment system’s intake capabilities expanding a regional health plan’s ability to connect with its brokers, employer groups, and members
  • Mobilized and directed client’s External Trading Partners to adopt new automated enrollment solution

Developed and rolled out reporting and dashboard architecture

  • Developed enterprise dashboard and reporting architecture to support monitoring and audit controls for a Managed Medicaid plan’s enrollment, provider, and claims workflows
  • Developed dashboard and reporting solution to monitor and track employer group migration to ACA compliant products as well as consumer direct subscriber retention and product selections

Implemented and rolled out new products for a large regional health plan

  • Managed cross functional teams to implement and deploy product enhancements in Maryland, DC, and Virginia
  • Coordinated with Legal and Contracting Team to develop and submit contracts and application forms to appropriate state regulatory board
  • Coordinated with Actuarial Team to submit product pricing to appropriate state regulatory board
  • Managed Configuration and Quality Assurance teams to implement and validate product configuration

Remediated integration of PBM CDH application

  • Provided technical leadership on analysis and requirements definition to remediate applications supporting CDH product for large health-plan
  • Developed and managed test environment setup and test execution plan on a NASCO and proprietary claims platform