Jeff De Los Reyes

Senior Vice President, Healthcare Analytics and Risk Adjustment Solutions

 

Jeff De Los Reyes is a Senior Vice President of Healthcare Analytics and Risk Adjustment Solutions at GHG. In this role, health plans and providers look to Jeff to provide Consulting services to enhance, optimize, and ensure superior outcomes related to revenue accuracy and compliance across all Government and State Sponsored Programs (Medicare, Medicaid, and ACA).

Jeff brings over 15 years of healthcare experience focusing on all areas of risk adjustment including developing comprehensive and complementary retrospective and prospective programs, ensuring accurate and complete encounter data submissions, and supporting revenue projections for Actuarial and Financial reporting. His experience includes developing strategies and initiatives to optimize health plan and provider risk adjustment operations and ensure compliance with Federal and State regulations. Jeff also brings valuable experience and industry insights in using data and analytics to drive successful outcomes and implementing technology solutions for risk adjustment programs including the use of Natural Language Processing and provider EMR integration. In addition, Jeff has helped to structure and design value based provider contracts and provider incentive programs to drive improvements in quality and premium revenue accuracy.

Prior to joining the GHG team, most recently, Jeff was responsible for enterprise risk adjustment, revenue management and encounter data submissions at EmblemHealth. He led the health plan strategy, redesign, and execution of a comprehensive end-to end risk adjustment program across Medicare Advantage, Medicaid, and ACA membership. He was accountable to provide leadership to a cross functional team to ensure successful outcomes related to clinical documentation improvement and provider engagement initiatives, encounter data integrity and submissions (RAPS, EDS, EDGE and Medicaid), compliance support, revenue projections, and chart review and abstraction.

Prior to EmblemHealth, Jeff spent 8 years at Optum in a variety of risk adjustment roles at OptumInsight including leading product and program strategy, provider engagement and client services. His experience at Optum also includes providing consulting services for payers and providers as senior consultant supporting the Risk Adjustment practice area at Optum Advisory services. Prior to Optum, Jeff held senior management roles at a Medicaid Managed plan in NYC.

In addition, Jeff also brings strong experience in vendor management and oversight as well as creating synergies and identifying points of integration across health plan and provider teams including Risk Adjustment, Quality, and Network Management.

Jeff received his MBA from the University of Connecticut and a Master’s degree from Boston University.

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