Jim Colhour
Franklin,TN
Summary
Dynamic and results-oriented senior leader with a 16-year track record of success in the healthcare industry. Specializing in operational excellence, and strategic leadership, I have consistently driven significant improvements in organizational performance, compliance, and financial outcomes. Proven ability to lead cross-functional teams to implement large-scale risk adjustment initiatives that deliver tangible results. Adept at managing end-to-end program delivery, fostering strong partnerships with health plans, and ensuring strict adherence to CMS regulations. Skilled in leveraging data analytics and AI to optimize performance metrics, enhance coding accuracy, and drive data-driven decision-making. A hands-on leader with a passion for building and executing effective strategies. I thrive on collaborating closely with teams to identify opportunities, develop innovative solutions, and drive successful outcomes. My strategic thinking combined with my operational focus enables me to bridge the gap between planning and execution, ensuring that initiatives are effectively implemented and deliver maximum value.
Overview
21
21
years of professional experience
Work History
Vice President/General Manager, Risk Adjustment Solutions
Optum
01.2022 - Current
- As General Manager, I successfully led the process to integrate two recently acquired entities, leading cross-functional teams to develop innovative solutions that addressed external market pressures
- My strategic leadership and focus on operational excellence enabled us to maintain our position as a leading provider of risk adjustment solutions
- I lead a team that delivered scalable solutions that exceeded client expectations and solidified our market position
- Led a cross-functional team to successfully integrate risk adjustment coding platforms across two acquired entities and Optum, driving operational efficiencies and ensuring seamless integration
- Spearheaded the strategic direction and execution of risk adjustment operations for our largest client, increasing client value by 20% and decreasing operating costs by 15%
- Modernized coding product and go-to-market strategy to address market pricing pressures
- Leveraged artificial intelligence and machine learning to increase cost competitiveness and retain key clients, avoiding $30 million in revenue erosion
- Collaborated with Optum Growth Office and external partners to drive new business growth, developing custom solutions that consolidated Optum's market share leadership and positioned us as a pioneer in scalable, innovative risk adjustment solutions
Vice President, Risk Adjustment and Quality Operations
Optum
01.2019 - 01.2022
- As Leader of Risk Adjustment and Quality Operations, I successfully led a transformative period for our organization's risk adjustment operations from 2016 to 2022
- By partnering with Optum support areas, we overcame challenges posed by rapid growth and the COVID-19 pandemic, delivering significant results
- Expanded operations by 86% across the U.S., India, and The Philippines, increasing the team from 3,500 to 8,000 employees while maintaining a positive employee experience
- Achieved significant financial growth, delivering over $1.5 billion in revenue and $750 million in internal operating income
- Managed a massive increase in volume, retrieving 64% more charts and coding 174% more charts without compromising quality or efficiency
- Spearheaded a transformative modernization initiative, leveraging pioneering AI and machine learning technologies to achieve $100 million in savings over three years
- Drove a coder productivity program, improving productivity by 15% and achieving consistent performance targets
- Reduced risk adjustment discrepancies by 18%, implementing targeted training programs and process enhancements
- Negotiated favorable contracts with external vendors, achieving a 12% cost reduction while maintaining high service quality
- Streamlined data submission processes, increasing the efficiency, transparency, and accuracy of submissions
Sr. Director, Risk Adjustment and Quality Operations
Optum
01.2016 - 01.2019
- As Leader of Risk Adjustment and Quality Operations, I successfully led a transformative period for our organization's risk adjustment operations from 2016 to 2022
- By partnering with Optum support areas, we overcame challenges posed by rapid growth and the COVID-19 pandemic, delivering significant results
- Expanded operations by 86% across the U.S., India, and The Philippines, increasing the team from 3,500 to 8,000 employees while maintaining a positive employee experience
- Achieved significant financial growth, delivering over $1.5 billion in revenue and $750 million in internal operating income
- Managed a massive increase in volume, retrieving 64% more charts and coding 174% more charts without compromising quality or efficiency
- Spearheaded a transformative modernization initiative, leveraging pioneering AI and machine learning technologies to achieve $100 million in savings over three years
- Drove a coder productivity program, improving productivity by 15% and achieving consistent performance targets
- Reduced risk adjustment discrepancies by 18%, implementing targeted training programs and process enhancements
- Negotiated favorable contracts with external vendors, achieving a 12% cost reduction while maintaining high service quality
- Streamlined data submission processes, increasing the efficiency, transparency, and accuracy of submissions
Director Risk Adjustment and Quality Operations
Optum
01.2012 - 01.2016
- As Director of Risk Adjustment and Quality Operations, I successfully transitioned from finance to operations to lead a transformative insourcing initiative
- I oversaw the transition of 90% of coding operations from outsourced to insourced, growing the team from 150 to 2,200 and achieving $10 million in annual cost savings
- I established a robust governance framework to ensure operational efficiency, compliance, and risk mitigation
- My deep understanding of both finance and operations enabled me to effectively navigate this transition and drive successful outcomes
- Led a successful global coding insourcing initiative, transitioning 90% of coding operations from outsourced to insourced, growing the team from 150 to 2,200
- Contributed to the development of a proprietary coding and workflow application, providing a foundation for operational efficiency and long-term cost savings
- Established a robust governance framework, implementing operational management reporting packages to monitor production activities and identify mitigation strategies
- Improved integration with finance, creating operational financial planning and analysis processes to support corporate FP&A forecasting, budgeting, and monthly close
Finance Manager
UnitedHealthcare
01.2010 - 01.2012
Financial Consultant
Optum
01.2008 - 01.2010
Sr. Financial Analyst
Universal Hospital Services
01.2006 - 01.2008
Sales Analyst
Target Corporation
01.2005 - 01.2006
Personal Banker
Wells Fargo Bank
01.2004 - 01.2005
Education
Executive Development Program -
Stanford University Graduate School of Business
01.2018
Master of Business Administration -
Carlson School of Management, University of Minnesota
01.2008
Bachelor of Science - Business and Finance
G.R. Herberger College of Business, St. Cloud State University
01.2004
Skills
- Strategic Leadership
- Operational Excellence
- Data-Driven Decision Making
- Data Analytics
- AI/ML
- Cross-Functional Team Leadership
- Client Engagement
- Stakeholder Engagement
- HCC Risk Adjustment
- Compliance
- Risk Assessment
Timeline
Vice President/General Manager, Risk Adjustment Solutions
Optum
01.2022 - Current
Vice President, Risk Adjustment and Quality Operations
Optum
01.2019 - 01.2022
Sr. Director, Risk Adjustment and Quality Operations
Optum
01.2016 - 01.2019
Director Risk Adjustment and Quality Operations
Optum
01.2012 - 01.2016
Finance Manager
UnitedHealthcare
01.2010 - 01.2012
Financial Consultant
Optum
01.2008 - 01.2010
Sr. Financial Analyst
Universal Hospital Services
01.2006 - 01.2008
Sales Analyst
Target Corporation
01.2005 - 01.2006
Personal Banker
Wells Fargo Bank
01.2004 - 01.2005
Executive Development Program -
Stanford University Graduate School of Business
Master of Business Administration -
Carlson School of Management, University of Minnesota
Bachelor of Science - Business and Finance
G.R. Herberger College of Business, St. Cloud State University