Experience: Medical Review: Case Management: Pharmaceutical: Other: • Joint Commission Hospital Designations and Criteria • Contracts/Negotiations • Transplant Contracting • Hospital Rate Negotiations • Provider Education • Patient Education • Coordination of Benefits • Resource Location: Local, County, State, Not for Profit • Medicare and Medicaid Guidelines ? Medicare Quality Initiatives (HEDIS) (MIPS) ? ICD 10 and CPT Coding § Hierarchical Condition Categories (HCC) Codes • Social Security Guidelines • Plan Document Language ? Self-Insured ? Grandfathered Plans ? Common Plan exclusions: subrogation, legal, custodial care, covered under state services. • Development of Policy and Procedure • Development Statement of Work • Work Flow • Call Center Flow and Metrics • Advanced use of Microsoft • Evaluation and Interpretation of raw data