Todd Allen

Background

About Todd Allen

Over 20 years experience in the healthcare industry on both the delivery and insurer sides. On the provider/delivery side I have experience working for a diagnostic imaging group, a skin surgery group and Kaiser in Southern California. On the health plan side I have worked for Aetna, Blue Shield of California, Anthem Blue Cross of California, and Cigna. I have had extensive management and project management experience in both areas. The bulk of my career (and passion) has centered around healthcare economics/analytics. My experience in the industry is pretty well rounded. Government contracting (Aetna CHAMPUS TRICARE division- Manager of Government Contract Administration), ACOs, Medicare Risk, Network Operations, regional Medical Economics, and national Medical Cost Analytics. Managing a very successful tool and reporting team gave me the opportunity to work closely with a variety of functional areas (Network, Care Management, Underwriting, Capitation, and Legal). Experience/Areas of focus:~ ACOs ~ Medicare Risk Payment (HCC and RAF improvement)~ Project management ~ ICD10 Conversion ~ Medical Cost Trend Drivers ~ Impact of claim system releases on medical cost ~ International health business (challenges and opportunities)~ Outlier physician analysis (domestic and international)~ Large scale presentations/training ~ Managing health care programmers (regional, national and off shore teams)~ Regional oversight of Charge Master audit functions ~ Regional oversight of over-payment data mining functions ~ High performance networks ~ Financial contract modeling - Contract performance review.~ Large scale data extraction, manipulation and reporting ~ Overseeing application development related to health care cost analytical models and process automation (regional and national)~ Compliance ~ Non-par claim reduction strategies ~ Price transparency efforts ~ Thorough understanding of contracting principles/reimbursement methodologies, charge master auditing, capitation leakage, claim overpayment, drivers of unit cost and utilization trends