Rj Santilli

Director of Operations Claims and Credentialing @MVP Health Care

Schenectady, NY, US
MOBILE NUMBERS
+91 *********19

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WORK HISTORY

Jan 2024 — Present

Director of Operations Claims and Credentialing @MVP Health Care

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Schenectady, NY, US

Responsible for strategic oversight and vision for Commercial Claims, Medicaid and Medicare claim teams, Provider Data Management and Credentialing teams, and Training and Documentation team. Lead department comprised of 4 direct reports, 3 managers, Associate Director, and 117 indirect staff. Drive operations performance against NYS and CMS standards. Work with MVP leadership on membership retention and growth and represent MVP during sales presentations. Accountable for claims efficiency and effectiveness programs and oversight of workforce management for Claims and Provider Data teams. Collaborate with Network on provider-retention and growth strategies. Meet with providers on escalated issues. Identify and drive cost-containment opportunities.

EDUCATION

1990 — 1992

Siena University

Accounting

1992 — 1994

Hudson Valley Community College

Associates, Business Administration

SKILLS

MedicaidLeadershipEmployee BenefitsHmoVisioMedicareBusiness AnalysisU.s. Health Insurance Portability and Accountability Act (Hipaa)Call CentersHealthcareInsuranceProcess ImprovementCall CenterHealthcare Information TechnologyClaimStrategic PlanningAccessHealth InsuranceManaged CareBusiness Process ImprovementTrainingCustomer ServiceHipaaTeam BuildingManagement

ABOUT RJ SANTILLI

Director of Operations Claims and Credentialing

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Rj Santilli — Director of Operations Claims and Credentialing at MVP Health Care in Schenectady, NY, US | Unifers