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Click here or scroll down to respond to this candidateEric O. Augustine RN, MBAStreet Address Tel: PHONE NUMBER AVAILABLE Email: EMAIL AVAILABLELINKEDIN LINK AVAILABLEExecutive Manager / Health Care Management/Accreditation GovernanceHighly accomplished healthcare professional and Executive Manager with a proven track record in business solutions, operation improvement, and information system product delivery. Experienced leader of Organization Governance, Business Analytics & Consumption with a focus on ambulatory system networks combining innovation and analytics to create predictive analytic solutions. Transformational leadership approach to creating business solutions and operation strategies. Highly motivated professional with years of experience anchored in creating standard processes and effective negotiations with business leaders. Experience communicator of change management solutions, innovative and predictive analytics for business operations aimed at aligning new paradigms business strategies. Able to smoothing translate solutions applying innovative technologies with changes in business law, regulations, healthcare coordination and payment models to champion change management and process improvements to achieve increase revenue on organizations bottom-line.FOCUS EXPERIENCEStrategic PlanningOperational ManagementAnalytic ConsumptionUtilization ManagementInitiativesBudget development and forecastingCost Containment and Risk ManagementProcess MappingLeadership & Team BuildingTraining & DevelopmentOrganization GovernanceQuality ManagementSignificant AccomplishmentsLed enterprise strategy for designing performance methodology and auditing designs for creating successful clinical and nonclinical operational process improvements; resulting in operation performance score improvements form 30% to 90% in 12 months.Led process improvement strategies reducing time to market from 3 months to 2 weeks.Led information system technology initiatives resulting in insourcing quality and performance audits resulting in creating strategies for improving technical mastery and reducing third party consultant annual cost by $6 Million.Created Standard Operational Procedures and Job Aids to lock in change management solutions.Coached and trained employees on new business processes and monitored staff training resulting in improved performance of direct reports.Created predictive analytic health care process mapping solutions to navigate health care needs from a population approach to align virtual needs of the populations of health care members across different geographic locations.Career ExperienceElevance health, Mason, OH July 2023 present Customer Service Representative IIProvide customer support to member for dual plans have Medicare and Medicaid benefits.Review plan benefits with customer for year-over-year plan changes.Find provider services and describe differences between in-network and out-of-network provider.Conduct quotes for member services and procedures for in-network and out-of-network services.Manage customer service needs applying updated Management Knowledge documents and processes.Manage Knowledge sharing via collaborative sharing tools and identify, curate, and develop need for improvements for information sharing among peers and customers.Blue Cross Blue Shield, Dallas, TX March 2017 Jan 2022 Senior Manager of Clinical Process ImprovementLed business analytic research to created vision and develop strategic plans for new business cost structure to support $1 billion new business initiatives.Led enterprise strategy for redesigning performance methodologies and quality review for managing 16M customers resulting in improvement of performance scores form 30% to 95%.Led information system technology business solutions and initiatives resulting in insourcing quality and performance reviews, reducing administrative work, meeting enterprise goals, and reducing imperatives costs by 25%.Led teams on innovation discussion to create hybrid neutral systematic approaches to population health care.Led and created process mapping analytic solutions to process improvement clinical operation needs and led internal audits of process improvements.Blue Cross Blue Shield, Dallas, TX Oct. 2015 July 2016 Manager, Manager Solution Delivery and Customer ManagementCreated a robust standard operations procedure for IT custom reporting resulting in meeting annual goals for compliance with state licensing requirements for business programs.Spearheaded operation redesign methodologies resulting in reducing IT custom reporting turn-around-timeline and reducing a six-month backlog to a two week turn-around-timeline for major business initiatives and improving cost structure and time to market.Led the development of Companys High Dollar tracking system, data consumption, and reporting for Operation departments allowing for improved visibility of data allowing management teams to identify and created robust financial strategies impacting high dollar risk to the organizations with results that improve customer experience and satisfaction scores.Led the development of customized reporting and self-service applications for elite customers allowing key business owners to pivot into business solutions aimed at reducing overall health care cost and optimize technological business solutions.Created hybrid system solutions to mind data for predictive analytics to evaluate cost risk and create cost containment solutions for population health and disparities across geographic locations.Blue Cross Blue Shield, Dallas, TX Sept. 2013 Oct. 2015Senior Analytic ConsultantSpearheaded analytic transformational strategic changes resulting in redesign of Plan Solutions and Market Delivery reducing operational costs and alignment of the customers demand with the companys products.Implemented analytic research supporting cost containment to decrease overutilization of dialysis services, which resulted in $5 million annual cost savings and contributed to cost management and revenue enhancement strategies.Implementing a system-wide assessment of Medicare Payment applications, resulting in resolving identified overpayments of greater than $60M dollars.Spearheaded analytic research providing the chief executive officer and management teams with business insights for improving business outcomes and reposition customer utilization resulting in case management services improvements supporting sustained cost-effective organizational imperatives.North Central Surgical Center Hospital, Dallas, TX Oct. 2012 Sept. 2013Case ManagerNorth Central Surgical Center Hospital is a twenty-four (24) bed hospital and a joint venture between Baylor Scott & White Health and United Surgical Partners International, Inc. located in Dallas, TX.Developed a Utilization Review Committee that improved cost structure and contributed to an average of $5M dollars of profits per quarter.Led a review of Medicare reimbursement processes associated with inpatient readmissions, Medicare reimbursement, and appeals resulting in an 80 percent recovery of denial claims revenue of $20M.Led organizational process enhancements for emergency department, inpatient, outpatient, ambulatory surgery to improve length of stay and continuation of care transitioning of patients to lower levels of care.Developed innovative discharge strategy geared towards integrating community resources and health care vendors to address health disparity that might otherwise become barriers to discharge; resulting in reduce inpatient hospitalization and reduction in readmissions within 31 days of hospitalization.TrailBlazer Health Enterprises, LLC, Dallas, TX Jan. 2006 - Oct 2012Senior Provider Education ConsultantTrailBlazer Health Enterprises, LLC was an affiliate of Blue Cross Blue Shield of South Carolina and a Medicare Administrative Contractor of Medicare Part A and Medicare Part B fee-for service benefit claims.Provided consultation services as the legal liaison to healthcare providers, the office of the Attorney General, and CMS leaders via communicated commitment and set expectations for clinical review, appeals, and fraud and abuse processes. Provided education to medical staff on CMS regulations as it pertained to documentation. Manage claim reviews for multiple state contracts ranging from $156M-$365M per contract.Medical System Coordinator oversight of 3M, MCG, InterQual, Cerner, SharePoint, FISS system, and Provider Tracking System. Consultant to Chief Executive Office and healthcare providers regarding billing and compliance with Medicare regulations. Created department annual Enterprise Resource Planning (ERP) objectives. Consult specialized workgroups and provided professional guidance to health care providers as Trailblazers legal liaison for fraud and abuse occurrences resulting in a cost saving of $99M.Earlier Career ExperienceRichardson Regional Hospital, Richardson, TXStaff Registered Nurse, Oct. 2003 Jan. 2006TradeWinds Core Health Services, LLC, Plano, TXChief Executive Officer and President, Sept. 2005 Dec. 2011EducationDoctorate in Management / IST Projected graduation: Dec 2023University of Phoenix, Phoenix, AZMaster of Business Administration-Healthcare Management, 2011University of Phoenix, Phoenix, AZMaster of Business Administration- Global International Business Management, 2011University of Phoenix, Phoenix, AZBachelor of Science in Business Administration, 2009University of Phoenix, Phoenix, AZAssociate R.N. Degree in Nursing, 1997 Louisiana State University at Alexandria, Alexandria, LALicensed Practical Nurse, 1994 Alexandria Regional Technical Institute, Alexandria, LALegal Specialist, 1990United States Army and Louisiana National GuardProfessional Accomplishments & Awards President of Business Resource Group BCBSTX Owner and President of TradeWinds Core Health Services, LLC Delta Mu Honor Society (Outstanding Business Leader) Nominated for Association of Collegiate Business Schools and Programs Student Leadership Award Department of Armed ServicesOut Standing Solider and Leadership Award |
