Ryan Wilkie

About Ryan Wilkie

Oversight of operations for region comprised of 30+ clients (health plan and state direct accounts) and over 10M Medicaid, Commercial, and Medicare lives. As well as oversight of top tiered provider operations and trade organizations throughout the region. • Lead of driving organizational business decisions to accomplish prioritization of IT projects company-wide. • Focused on short term and long-term initiatives that would improve operational efficiency, increase client satisfaction and facilitate growth in the region.• Lead Value Based Purchasing for Northeast Region. Built a pipeline of providers for VBP expansion and improved clinical key performance indicator (KPIs) within Northeast region.• Responsible for maintaining accuracy for plan performance guarantees as well as all informational, and financial reporting• Oversees the operations team that is responsible for the implementation from end-to-end for all new products and upsells • Develops talent plans for direct reports and reviews all talent plans for entire region(s) staffing and prepares direct reports for continued growth within the team and organization. • Responsible for the development of regional operational blue chip goal development and implementation across all market/region(s) of oversight. Accountable for all operational strategy, including but not limited to network recruitment/access, client operational design, system design, claims workflows, data exchange workflows, and covered services. Develops the regional operational goals across multiple markets and trains staff on annual goals.• Meets with Market Presidents and Senior leaders on the Account Management team to review annual strategic growth and operational goals. • Meets weekly with Directors and SVP’s of all shared service lanes (claims, EDI, Network, IT) to review regional initiatives/projects/problems and drives teams to overall solutions across multiple functional lanes.• Responsible and accountable for the teams that oversee all client reporting and analytics activities and ad hoc request. Decision maker on escalated priorities and ensuring that all reporting is appropriately prioritized across shared services and clients. • Audit management, which required the review of UM, HR, credentialing, and appeal policies, and NCQA accreditation standards. • Expertise in legacy UI configuration between Network, Claims, and Clinical• Knowledge of all operations including, Credentialing, Provider Relations, Clinical, Member Services, Claims, and Account management

Experience

1. Vice President Operations

   Carelon

   Mar 2023 — Present · Boston, MA, US

Education

• University of Massachusetts Lowell

  Bachelors, Finance and Management

  2003 — 2006

Skills

• Mutual Funds
• Call Center
• Process Improvement
• Team Management
• Call Centers
• Training
• Leadership
• Management
• Recruiting
• Employee Benefits
• Business Process Improvement
• Insurance
• Microsoft Excel
• Customer Retention
• Policy
• Business Analysis
• Finance
• Analysis
• Data Analysis
• Customer Service
• Operations Management
• Project Management
• Forecasting
• Relationship Management
• Hipaa
• Access
• Microsoft Office
• Software Documentation
• Team Building