John Golimowski

About John Golimowski

Geisinger Health Plan relied on this professional\'s leadership as Director of Health Plan…

Experience

1. Director of Health Plan Operations - Claims

   Geisinger

   Jan 2020 — Present

   Provided day to day oversight of an over 120 FTE department. This transformative position is responsible for identifying and implementing changes to drive improved performance towards a “best in class” department. The position works with the COO and CFO to identify and implement short- and long -range goals, coordination of operations staff, enhancements of business development efforts and a continued focus on optimizations in areas of compliance, quality and reporting. The Claims Director is responsible for ensuring compliance with company policies, procedures, State and Federal regulatory requirements for operations under their management. Developed the vision and goals for the claims department in compliance with federal and state regulatory guidelines. Oversees and ensures achievement and maintenance of all claims processing standards within established guidelines including benefit configuration, claims adjudication, and provider payments. Partnered with multiple business units, health plans and other stakeholders to establish operational objectives and procedures. Identify and implement operational efficiencies and developed “best practice” policies and procedures. Drive accountability throughout the claim’s organization; hire, develop, and motivate talent to drive success. Responsible for leading a multi-product claim operations team and oversees contract vendors. Handles the end-to-end claims operations processes, develops, and executes process improvement plans with results to improve business outcomes through automation. The position is accountable for policy and procedure development and implementation, departmental maintenance/readiness for internal and external audits, including MAR, SOC 1 and SOC 2 audits on claim controls. Collaborates, meets, and presents to administrative and executive leadership, as well as outside entities/vendors, to ensure organizational goals are being met.

Skills

• Medicaid
• Health Insurance
• Business Analysis
• Medicare
• Provider Relations
• Healthcare
• Business Process Improvement
• Claims
• U.s. Health Insurance Portability and Accountability Act (Hipaa)
• Managed Care