Robert Puglisi

About Robert Puglisi

I am a results-oriented, proven leader with 31 years of experience on the provider and…

Experience

1. Director, Provider Network Support & Strategy

   Amerihealth

   Jul 2022 — Present · Cranbury, NJ, US

   As a key member of the AmeriHealth leadership team, I provide strategic direction for network initiatives, focusing particularly on optimizing healthcare value through activities such as modifier -25 payment reduction and the development of innovative quality and cost incentive payment programs. I have championed continuous process improvement efforts, guiding the organization through complex changes to enhance efficiency and outcomes. Serving as the primary lead for all network priorities and strategic initiatives, I advise the SVP & President of Diversified Markets on potential network redesign and expansion opportunities. In addition, I represent AmeriHealth’s leadership in resolving critical provider issues, collaborating with stakeholders across Operations, Legal, Contracting, Population Health, Government Markets, and beyond. As a key liaison within the Independence Health Group Family of companies, I have facilitated cross-functional partnerships to address urgent business needs in areas such as Network Performance, Network Adequacy, Network Design, Provider Partnerships, Medical Cost Trend Monitoring, and Out-of-Network Cost Containment, consistently driving high-impact solutions that align with organizational goals.

Education

• The College of New Jersey

  BA, Political Science

  1988 — 1992

• Monmouth University

  MA, History

Skills

• Physicians
• Process Improvement
• Hipaa
• Medicare
• Healthcare Information Technology
• Managed Care
• Provider Relations
• Healthcare
• Healthcare Management
• Strategic Planning
• Revenue Cycle
• Healthcare Consulting
• Medicaid
• Hospitals
• Emr
• Healthcare Industry