David Hargrove
SENIOR MANAGER
David has over 20 years in healthcare, focusing on helping clients optimize processes and drive results for payer and provider operations. He served key project roles for the implementation, integration, and/or upgrade of commercially available and custom software solutions to help improve ROI, financial accuracy, and timely payments to providers and members. David’s education includes a Bachelor of Business Administration from the University of Texas, Arlington.
Experience
Engagement Manager for PMO Resources Providing Integration Between Two Large Regional Hospitals
Provided program oversight for Business Office, Cancer Care Center, and Revenue Cycle. Responsible for all engagement economics.
Engagement Manager for Medicare Advantage Maximum out of Pocket (MOOP) Overages
Worked with operations including IT, to develop process flows for varying refund processes including First Tier Down Stream Entities (FDRs).
Project Lead for Managed Medicare Advantage Provider Disruption Resolution
Delivered recommendations to improve provider satisfaction and increase visibility between the plan and the provider community.
Engagement Manager Responsible for the Remediation of CMS Sanctions of Medicare/Medicaid Claims
Responsible for claim Corrective Action Plans (CAPS) needed to demonstrate to CMS that the sanctions were resolved.
Delivery Lead for a High-Intensity Care Model (HICM) for a Large Regional Blue Plan
Worked closely with provider relations to identify chronically ill patients and align them to providers to reduce inpatient hospital stays.