Joe is Protiviti’s Healthcare Payer Segment Leader based in the New York City office. In this role, he assists health plans, dental & vision plans, Pharmacy Benefit Managers (PBMs), and First Tier, Downstream, and Related entities (FDRs) on a vast array of projects, including strategic, process improvement, program management, regulatory, member experience, enterprise risk, IT consulting, digital, and design initiatives. Prior to joining Protiviti, Joe worked at UnitedHealthcare where he led a large team responsible for multiple Government Programs initiatives in eight states (NY, NJ, PA, CT, MA, RI, DE, and VA). Before UHC, Joe held positions at Health Alliance Plan and Blue Cross Blue Shield of Michigan.
- For a regional commercial payer, built a Medicare Advantage plan (MA-PD) from the ground up, which included developing a go-to market strategy, operating models, P&Ps, and internal controls. Worked closely with the company’s C-Suite to complete Part C and Part D applications and submitted to CMS.
- For a large Blues Plan, developed the future state operating model for its Medicare Operations function—designed/implemented the structure, roles & responsibilities, and reporting processes
- For a large regional health plan, led an engagement to improve processes for monitoring member experiences and experience-improvement initiatives by utilizing valuable Appeals & Grievances data
- For a top-three payer, revamped its Medicare risk assessment process and improved the organization’s ability to properly identify, classify, and mitigate Medicare risks
- For a large payer-owned PBM, advised on how to implement adequate controls to ensure data was shared appropriately between the PBM and the payer, but not between the payer and its competitors.
- For a top five payer, enhanced its vendor (FDR) Oversight Program; created new process flows, scorecards, delegation agreements, and vendor attestations
- For a large Manage Care pan, serve as a SME to the Chief Audit Executive and provide guidance and advice as the Internal Audit department conducts various types of audits
- For a healthcare tech startup in the Midwest, led an engagement to develop its compliance program--drafted all compliance policies, formed the compliance committee, and implemented monitoring processes
Areas of expertise
- Health Plan Strategy
- Member Experience
- Operating Model Design
- Medicare Part C and Part D
- Compliance Program Effectiveness
- FDR Oversight
- Risk Management
- Internal Controls
- External Audit Preparation
- Policy & Procedure Development
- HIPAA Privacy
- J.D. – Law, Michigan State University
Professional Memberships and Certifications
- Health Care Compliance Association (HCCA)