Beau Fidler

Beau is a founding member and Protiviti’s Healthcare Payer Practice Leader. He has over 22 years experience providing operational, financial, and IT consulting and internal audit services across the healthcare industry. In addition to leading numerous business performance improvement and payment integrity initiatives, Beau has experience serving over 325 health plans across Medicare, Medicaid, and commercial lines of business. Prior to rejoining Protiviti, Beau was Vice President of Advisory Services, Commercial Accounts, and Enterprise Implementations at Health Management Systems (HMS) where he worked directly with health plan executives to exceed their program goals through innovative solutions to their toughest challenges. Earlier, Beau founded and was President of RBF Resources, a boutique healthcare management consulting firm, responsible for end-to-end management and operations, and began his career at Arthur Andersen in its Healthcare Technology Risk Consulting practice.

Major Projects

• Implemented multiple business performance improvement solutions for state Medicaid agencies and health plans to maximize revenue/premiums, reduce costs, minimize provider abrasion, and improve health outcomes. Examples include: program assessments, benchmarking, design, and implementation; technology and workflow automation; provider engagement modeling; member risk profiling, data integration; claim scoring, carrier pricing analysis; advanced analytics and reporting; vendor utilization/coordination; safety-net recovery programs; contract management oversight; and business process outsourcing.
• Led payment integrity services for health plans to address a wide range of fraud, waste, and abuse challenges. Examples include: Third Party Liability (TPL); prior authorization; clinical claim reviews; premium management and reconciliation; claim payment rules; credit balance audits; medical plan audits; PBM audits; fraud identification and investigation; and long-term care audits.
• Directed population health management programs for health plans to drive whole-person outcomes. Examples include: risk intelligence, member engagement, utilization management, care management , and social determinants of health solutions.
• Developed and managed large program management office initiatives across multiple healthcare entities. Examples include: QNXT enterprise claims processing system; Health Information Exchange (HIE), data center migration, and a work relative value unit (wRVU) provider compensation model.
• Executed multiple outsourced/co-sourced financial, operational, and IT internal audits and process improvement reviews across the entire provider revenue cycle for several integrated healthcare systems. Examples include: patient access, charge capture, care management, health information management, coding, billing, collections, denials management, and payment accuracy functions.

Areas of Expertise

• Business Performance Improvement
• Payment Integrity
• Population Health Management
• Financial, Operational & IT Internal Audit
• Project Management Office
• System Development & Integration
• Data Analytics
• Revenue Cycle Optimization
• Corporate Governance
• Change Management

Industry Expertise

• State Medicaid Agencies
• Health Plans
• Third Party Administrators
• Health Care Systems
• Physician Groups / Specialties

Education

• B.B.A Finance & Management Information Systems, University of Oklahoma

Professional Certifications and Memberships

• Certified Internal Auditor
• Certified Information Systems Auditor
• Certified Project Management Professional
• Certified Agile Certified Practitioner
• America’s Health Insurance Plans