Daniel Genovese

Lead a team of Risk Adjustment consulting managers and healthcare experts who partner with Providers to supply data-driven analysis, workflow optimization tools, and executive level reporting that enabled each entity through the complex CMS Risk Adjustment that maximized each Providers ability to give the highest care to of our 300,000+ members.

• Facilitate a member centric prospective risk adjustment model that resulted in 5% increase in Risk Adjustment Scores in 6 months
• Mange provider enablement workflow optimization strategies, embedded practice vendors, and enhanced EMR/EHR integrated technologies to optimize risk coding by 10% and reduce provider abrasion by 25%
• Foster an environment of collaboration among diverse talents and perspectives of matrix partners to deliver the highest quality experience for provider and members

Led a team of Engagement Managers and healthcare experts who partner with Providers to supply data-driven analysis that guides Entities through CMS's complex Risk Adjustment process and provides valuable insights that enable Providers to give the best care to members.

• Aligned Risk Adjustment program offerings with all Value Base Reimbursement arrangements to simplify provider engagement and optimize provider workflow improvement efforts
• Created Senior Leadership reporting and review forums to ensure transparency of program performance and to contextualize complex program metrics results to departmental and company strategic initiatives
• Optimized Risk Adjustment Operating Model across Production, HCC Coding, Implementation, and Reporting to ensure efficiency and speed to market with new program pilot and critical spending levers

Led a team of consultants and healthcare experts to identify and scope projects designed to help grow top-line revenue through entering new markets, and promote operational efficiency through business process design initiatives.

• Reduced cycle time by 50% on Healthcare Effectiveness Data and Information Set extract process through improved automation, activity scheduling, and resource cross-training
• Aligned business leaders on a three-month risk remediation plan to stabilize critical process for Government Programs Value-Based Care arrangements
• Implemented a solution for Medicare Stars and risk adjustments hosted members that generates $1 million annually

Led and managed a team of consultants in providing project management services to implement strategic projects for the Medicare line of business.

• Lead the system and operational migration of 1 million members to a vended solution
• Lead the product filing and system configuration of new Medigap plans for five state markets

Provided management consulting services to internal clients in the areas of business process (re)design, operating model development, identify strategic alternatives, and workshop facilitation. Utilized working knowledge of health insurer operations and Medicare products.

• Created an operating model for delegation oversight of all Government Program vendors from intake through termination
• Lead an assessment of the Medicare and Medicaid appeals and grievance processes that resulted in the elimination of 3,000+ backlog of appeals

Lead team of consultants and healthcare experts to develop remediation plans for operational, contractual, and regulatory failures.

• Improved each contractual and operational metric year over year performance by an average of 5%
• Reduced repeat occurrences of failures by 50%

Managed day-to-day operations of reporting and communicating 700+ contractual and regulatory metrics with internal and external leadership teams.

• Centralized desperate metric measurement and reporting under a single team structure
• Implemented reporting solutions tools that reduced cycle time by 50%
• Implemented automation that reduced the staff error rate by an average of 60%

Responsible for strategy development and solution execution of analytics tools and operational process improvement

• Optimized investment strategies, and user processes resulting in a 60% increase of application usage
• Supported sales team by closing five trial clients generating $10 million annually