FRANK BALCO, JR.

1614 Longfellow Drive 856-354-8294

Cherry Hill, NJ 08003 fbd7ac14@westpost.net
HEALTHCARE SENIOR MANAGER
Claims Operations... Process Re-engineering... Call Center Operations...
Membership Management... Medicare / Medicaid (Governance)
* Senior-level professional offering a unique blend of operations leadership and
infrastructure management experience within the healthcare industry. Innate abi
lity to motivate and empower cross-functional teams to optimize productivity and
solve problems, resulting in significant improvements to business processes and
customer satisfaction.
* Strategic thinker who has engineered start-ups, saved tremendous dollars in co
sts, and facilitated new business. Change agent with strong focus on assessing c
ustomer needs and integrating with practical business issues from an operational
and technological perspective.
* Track record of implementing start-up operations, staff training programs, and
compliance initiatives. Diversified experience in member management, call cente
r operations, and claims administration for multi-billion dollar insurance carri
er (i.e. public and private). Highly skilled in managing Medicare, Medicaid, and
private insurance programs.
CORE COMPETENCIES
Administration... Business Re-engineering... Government Relations... Budgeting..
. Key Account Management
Start-Up Operations... Claims Management... Performance Metrics... Reporting...
Staff Training Programs
Project Management... Strategic Planning... Cost Reductions... Call Center Opera
tions... Compliance... Auditing
Systems Implementation... Product Management... Market Strategies... Process & P
rocedure Development
PROFESSIONAL EXPERIENCE
INDEPENDENCE BLUE CROSS, Philadelphia, PA * 1979 to 2010
Manager*Government Programs Enrollment (2007 to 2010)
Directed daily business affairs and overall operations of beneficiary enrollment
and ongoing account maintenance for Medicare and Medicaid Programs. Revamped be
neficiary enrollments involving learning requirements, setting up systems, and p
roducing rapid turnaround for member enrollments. Developed and administered all
staff training initiatives. Oversaw 250 indirect reports in implementing progra
m for complex and fast-growing healthcare product line (Medicare Advantage). Sup
ervised 60+ direct reports.
* Achieved full compliance with all CMS audit regulations and guidelines, includ
ing collateral development and distribution along with beneficiary account manag
ement.
* Spearheaded ongoing maintenance of member management systems designed to strea
mline reporting and data collection process; successfully identified discrepanci
es and investigated eligibility requirements.
* Partnered with training department to develop extensive curriculum that develo
ped staff to be more qualified and efficient and who could provide a higher leve
l of customer service.
* Collaborated with IS department to identify problems and develop system enhanc
ements; developed and wrote comprehensive business requirements. Participated in
efforts for testing and implementing system.
* Administered front-end mailings to beneficiaries with 70+ variations to notifi
cation letters. Additionally developed 350 unique letter templates and identifie
d processes for determining accuracy of distribution.
Manager*Claims Adjustment Services (2005 to 2007)
Selected to lead new division accountable for reducing duplication along with ha
ndling provider inquiries and other adjustments. Led design and implementation o
f logistics, facilities, hiring, and training. Developed improved system for opt
imizing workflow process in order to receive and process inquiries from provider
s more efficiently.
Oversaw entirely new production unit, consisting of 60+ staff tasked with identi
fying and resolving duplicate claims payments. Devised and executed all processe
s and procedures to meet corporate, account, and regulatory standards. Created a
nd administered staff training programs. Developed and implemented system change
s designed to provide accurate and consistent application of claim adjudication
rules. Managed all external vendors and auditing firms.
* Managed accounts receivable processes to resolve overpayments resulting from i
naccurate claims adjudication or unidentified premium receipts. Orchestrated new
area to record, deposit, and track monies; implemented process to secure A/R's
and investigate proper location for incoming checks.
* Led conversion of outdated legacy systems to enterprise-wide vendor replacemen
t claims system. Reduced systems exceptions from more than 300,000 to less than
4,000 annually.
* Participated as member of committee responsible for developing workload manage
ment system that resulted in accurately recording documentation and significantl
y increasing user satisfaction rates.
* Pivotal in reducing and eliminating duplication through initiating business pr
ocess and technology changes.
* Charged with setting performance benchmarks as member of Corporate Executive
Delegation Oversight Committee.
Manager*Claims Processing Services (1996 to 2004)
Hand-picked by senior management to launch start-up operations for division acco
untable for AmeriHealth and Keystone POS products servicing 500,000+ members. Or
chestrated strategies and action plans to meet organizational goals. Oversaw tra
ining and development. Monitored and reviewed vendor claim functions. Acted as l
iaison between delegated vendors and outside auditors. Reviewed, analyzed, and p
resented results to IBC Oversight Committee. Supervised 80+ staff.
* Designed and implemented strategic planning, organizational structure, process
re-engineering, and facilities. Created and implemented extensive training prog
ram along with reporting system within new division.
* Eliminated antiquated claims processes through efforts in identifying discrepa
ncies and instituting computerized process to compare information from two diffe
rent systems.
* Developed procedures that subsequently reduced duplication to about 2%, a 98%
accuracy rate (down from 72% duplicate processing) which reduced costs and also
resolved problems for providers and members.
* Collaborated with IS to develop standards and provide national exposure for un
ique systems platform.
Manager*Dedicated Accounts (1996 to 1997)
Promoted to position for handling 12 high-volume key accounts ranging from 300 t
o 10,000+ members in areas of customer service, claims, enrollment, and quality
assurance. Oversaw compliance for account specific corporate performance and ser
vice agreements. Selected as Account Liaison to resolve problems and reduce memb
er complaints, including site reviews and onsite staff management. Supervised 80
+ staff members.
* Developed and implemented focused training for customer service and employee r
eview process. Instituted training efforts for dedicated team members and collab
orated with training department to create curriculum.
* Worked closely and cooperatively with systems department to identify reports n
eeded to assess issues, claim problems, and account discrepancies; also created
reports to identify, analyze, and develop solutions.
* Restructured reporting format to provide consistency across accounts and prope
r analysis of comparative data for performance metrics.
* Served on Corporate Planning Committee with goal of developing market strategi
es to ensure high account retention rate, secure new clientele, and increase mar
ket share. Tasked with cross-training staff members on techniques to ensure effi
ciency, customer service, and computer accuracy.
Held increasingly accountable positions during earlier tenure-Supervisory positi
ons included Processing Services, Dedicated Accounts, Private Business Claims, M
ajor Medical Claims
TRAINING AND SEMINARS
Extensive professional development in the areas of leadership, management, and c
ommunications
1614 Longfellow Drive * Cherry Hill, NJ 08003 * 856-354-8294 * fbd7ac14@westpost
.net