Michael Fletcher
- Role
- Director, National Claims Administration at Kaiser Permanente
- Location
- Claremont, CA, US
- LinkedIn followers
- 500 followers
About Michael Fletcher
Healthcare executive with over 20 years of experience in managing diverse operations and…
Experience
Director, National Claims Administration
Aug 2016 — Present
Headed Special Services (appeals) and Research and Resolution Team (claims rework and provider disputes) during Tapestry AP go-live and stabilization • Reviewed and evaluated compliance with Medicare, Medicaid, and Department of Managed Health Care (DMHC) claims processing requirements • Developed and monitored control processes in collaboration with Claims Compliance team to improve regulatory audit outcomes across all lines of business (exceeded 90% departmental success goal in both 2020 and 2021) • Directed various special projects to successful completion including member reimbursement process optimization and implementation of foreign claim vendor (Falck Global)
Skills
- Medicare
- Compliance Management
- Hipaa
- Healthcare Industry
- Quality Improvement
- Regulatory Affairs
- Electronic Medical Record (Emr)
- Medicare Part D
- Privacy Law
- Employee Benefits
- Health Policy
- Customer Service
- Compliance
- Medicaid
- Managed Care
- U.s. Health Insurance Portability and Accountability Act (Hipaa)
- Contract Negotiation
- Healthcare
- Health Insurance
- Claim
- Health Care Compliance
- Contract Management
- Training
- Medicaid Managed Care
- Medi-Cal
- Hmo
- Appeals
- Government Agencies
- Disease Management
- Insurance
- Healthcare Consulting
- Medicare Advantage
- Program Management
- Grievances
- Utilization Management
- Revenue Cycle
- Benefit Administration
- Medical Compliance
- Leadership
- Ehr
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