Faustino Mayo

WORK HISTORY

EDUCATION

SKILLS

ABOUT FAUSTINO MAYO

Accomplished professional with 25+ years of leadership experience in regulatory compliance and managed care operations of Fortune 200 companies keenly adept at applying a comprehensive knowledge and understanding of regulations, industry trends, and best practices to focus on compliance, quality, and efficiency – creating best in class operations. Collaborative communicator able to build mutually beneficial relationships across matrixed environments that contribute to the organization’s success. Recognized for sound decision-making skills and driving innovation in fast-paced, and rapidly changing environments. Master at turning crises into opportunities. Innovative individual focused on improving the consumer experience. Driven and dedicated leader eager to impact team success through hard work and innovation. Recognized for inspiring team members to excel and encouraging creative work environments resulting in high-performing associates. Executive Competencies:Leadership: Team Development | Multi-site enterprise-wide operations | Project Management (idea to implementation)| Process Improvement | Strategic PlanningOperations: Appeals, & Grievances | Marketing | Enrollment | Customer Service | Billing | Vendor Management | UM | Claims, Coding, and Payment IntegrityCompliance: Compliance/Regulatory Requirements | Internal Audit, Audit Planning, Testing & Validation | Risk AssessmentsManaged Care: Extensive experience with Medicaid/Medicare | ACA | Physical and Behavioral Health | Medicare STAR measures and Medicaid quality measuresResults:>Increased savings by $23M+ for the Emergency Room Coding initiative and by $7M+ for DRG Coding and Clinical Claim Reviews.>Analyzed data and workflows to develop business initiatives that improved Medicare STAR ratings with 95% of contracts achieving ≥ 4 STARS in the measures of timeliness and fairness of appeals and improved Medicaid timeliness from 95% to 98% to avoid contract withholds.>Reduced outstanding inventory of reviews by 80% and trimmed average TAT by 60% avoiding focused audits and sanctions.>Spearheaded improvements, in partnership with other matrixed units, that slashed disputes by 5% within 6 months by focusing on interdepartmental consistency which enhanced the efficiency and efficacy of operations.>Cultivated professional, mutually beneficial relationships with representatives from the Centers for Medicare & Medicaid Services (CMS), Medicaid agencies, and licensing entities.