Thomas Harter, PMP
Rochester,NY
Summary
Dynamic leader with extensive experience at Excellus Blue Cross and Blue Shield, specializing in Quality Improvement, Vendor Management and Project Management. Demonstrated success in leading health plan accreditation, regulatory programs, and departmental vendor oversight/ management. Skilled in strategic planning, team leadership, and executing supplier solution contracts. Vendor Management skills include partnering with Supplier Sourcing, creating Requests for Proposals (RFP), RFP Scoring, designing vendor service level agreements (SLA's), designing performance metrics for vendor engagements, and ongoing management of vendor performance.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Compliance and Risk Manager
University of Rochester
07.2024 - Current
- Responsible for overseeing compliance with NYS Insurance Law for the University's Self-Funded Student Health Insurance Plan
- Coordinated university response and readiness for the New York State Department of Financial Services Finance and Market Conduct Exams
- Responsible for managing the vendor relationship for Third Party Administrator (TPA) Aetna
- Accountable for tracking vendor performance of Aetna, the university's external financial auditor, and the university's stop-loss insurer.
- Created departmental tracking tools for compliance, Visio process maps, as well as Visio Timelines and Roadmaps
- Deployed project management framework for managing and monitoring compliance with NYS requirements.
Manager- Accreditation, Quality, and Regulatory Programs
Excellus Blue Cross and Blue Shield
12.2020 - 04.2024
- Accountable for the Health Plan's successful delivery of NYS PIP projects, NYS QARR Action Plans, and NCQA Health Plan and NCQA Health Equity Accreditation.
- Develop strategy to ensure successful completion of audits supporting quality regulatory requirements.
- Report progress and potential risk to senior management of all Accreditation and Regulatory project initiatives.
- Coordinated divisional security risk assessments for contracted vendors, facilitated RFP process for procurement/selection of vendor, and was lead oversight on departmental vendors SLA's (Service Level Agreements).
- Provide supervision to a team of six (6) Clinical Quality Administrators responsible for day to day deliverables supporting Accreditation and Regulatory project initiatives.
Senior Project Manager
Excellus Blue Cross and Blue Shield
12.2017 - 12.2020
- Project Manager of the Health Plan's NYS regulatory projects, PIPs, QARR Action Plans, and NCQA accreditation.
- Accountable for vendor management of NCQA Consultant contract, CAHPS vendor contract, completing Sole Source Justification forms when necessary, and tracking monies owed from vendor when performance metrics not met.
- Collaborate with Quality stakeholders, Data Analysts, Clinical Operations, Quality Improvement teams, and other business areas.
- Design work plans, timelines, and roadmaps to successfully guide work.
- Risk assessment and risk socialization to leaders (if applicable).
- Report on project/initiative status.
- PDSA experience with QI initiatives, pivoting when desired outcome at risk, assist in qualitative and quantitative analysis.
- Serve as a Project Management mentor to individuals in both Clinical Operations and Quality teams.
Project Manager II
Excellus Blue Cross and Blue Shield
11.2011 - 12.2017
- Project Managed Quality and Operations initiatives.
- Lead multiple cross- functional teams through project life cycle.
- Re-engineered the corporate wide medical record process and solutions.
- Led community focused medication adherence initiatives.
Project Manager I
Excellus Blue Cross and Blue Shield
11.2007 - 11.2011
- Lead small to medium projects in the Medical Services department.
- Projects included process re-engineering, process map/workflow development, alignment with NYS mandates on Enteral formula and Timothy's Law for Behavioral Health parity.
Behavioral Health Utilization Manager
Excellus Blue Cross and Blue Shield
09.2001 - 11.2007
- Performed clinical reviews on requests for Behavioral Health admissions, Partial Hospitalization admissions, Chemical Dependency detoxification admissions and requests for extra contractual benefits.
- Worked directly with Excellus Medical Directors on case reviews, clinical rationale, and coordinating alternative benefit utilization.
Education
BA - Psychology
SUNY Polytechnic Institute
Utica, NYCertification
PMP Project Management Institute October 2011
PMP Certification #1469636
Health Equity- Reducing Racial Disparities Harvard Business School March 2024
Timeline
Compliance and Risk Manager
University of Rochester
07.2024 - Current
Manager- Accreditation, Quality, and Regulatory Programs
Excellus Blue Cross and Blue Shield
12.2020 - 04.2024
Senior Project Manager
Excellus Blue Cross and Blue Shield
12.2017 - 12.2020
Project Manager II
Excellus Blue Cross and Blue Shield
11.2011 - 12.2017
Project Manager I
Excellus Blue Cross and Blue Shield
11.2007 - 11.2011
Behavioral Health Utilization Manager
Excellus Blue Cross and Blue Shield
09.2001 - 11.2007
BA - Psychology
SUNY Polytechnic Institute
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