Marc Lucas

Staff Vice President, Risk Adjustment Analytics @Elevance Health

Washington, DC, US

Lead team of 30+ analysts to identify Risk Adjustment Documentation Improvement and Audit Risk Reduction opportunities across Medicaid in multiple markets, Individual and Small Group (ACA), and Medicare Advantage Markets. Improved Medicaid Impact from $120M to $237M despite redeterminationImproved ACA from $562M and $26PMPM to $1.2B and $46PMPMDoubled Medicare supplemental submission improvement from $1.2B to $2.4B from 2022.Identified and captured $137M in Medicare \"Other Revenue\"(ESRD CMS 2728 documentation to move beneficiaries from the community to ESRD model).Screen all Cost of Care Initiatives for Risk Adjustment Impact and prioritize Star and Medicaid Quality incentive screening for quality teams avoiding $100M in net enterprise annual losses while also identifying collaboration opportunities.Develop team and presented \"ACA RADV Rating Factors\" with Society of Actuary (SOA) students at the 2024 Annual Health Conference demonstrating through simulation the small sample volatility of current sampling as well as \"Correlations of Cost of Care and Risk Adjustment\" at the annual SOA ImpACT conference.Reduced delete impact of retrospective reviews from $250M to under $70M.

The George Washington University

Master of Arts, Mathematics

United States Naval Academy

Bachelor of Science, Mathematics