Michael McGauley
EVP, Data Mining Operations Payer Performance Studio @Healthworks
Signup · Get unlimited contacts
WORK HISTORY
EVP, Data Mining Operations Payer Performance Studio @Healthworks
Louisville, KY, US
The HealthWorks Payer Performance Studio helps payers reduce medical spend, lower administrative costs, and strengthen compliance—while protecting provider relationships and minimizing abrasion.Led by experts who pioneered modern payment integrity and have run cost containment from every angle—payers, providers, and CMS—the Studio combines AI-powered technology, proprietary analytics, and unmatched operational expertise to deliver results that stand up in the real world.Through the acquisition of Forensic Claims Solutions, the Studio now includes the Sleuth© contract compliance platform and a library of advanced data mining algorithms that simplify complex audits, predictively price contract terms across networks, and identify inappropriate payments with precision. These capabilities strengthen our ability to give payers defensible, predictive insights that prevent mispayments and improve financial performance.Our services span medical records review, data mining and contract compliance, member monitoring subrogation, provider retraction and collection, credit balance automation, and secure electronic communication. Each is designed to maximize accuracy, reduce waste, and strengthen compliance—without adding abrasion.As part of the broader HealthWorks platform, the Payer Performance Studio sits alongside the Provider Performance Studio to create alignment, clarity, and collaboration across the healthcare system. Together, these connected capabilities are designed to transform payer–provider interactions and make healthcare work better for everyone.With HealthWorks, payers move beyond recovery into Process Integrity—embedding accuracy into the payment process itself, so issues are prevented before they escalate. The result: measurable savings, streamlined operations, and a more resilient healthcare system.
EDUCATION
University of Louisville
Bachelor of Science - BS
SKILLS
ABOUT MICHAEL MCGAULEY
Unwavering Passion for Driving Unprecedented Growth, Profitability, and Staff PerformanceOperations and sales executive with an impressive track record of generating multimillion-dollar sales growth and expanding revenue streams. Respected for re-evaluating current practices, identifying ineffective patterns, streamlining operations, and solving tough problems. Committed to improving bottom-line profitability while achieving the highest levels of customer satisfaction. Extensive success in hiring, training, leading, and motivating top-performing teams.
This profile is compiled from publicly available professional sources. Unifers is not affiliated with or endorsed by LinkedIn. Request removal of this profile.