Executive Vice PresidentSteve Balcerzak offers nearly 20 years of experience with the Health Care Financing Administration – re-named the Centers for Medicare & Medicaid (CMS) – plus 16 years serving GHG clients. His broad experience within CMS covered all facets of CMS operations in managed care contracting. His knowledge of CMS operations as related to product development, demonstrations, and Medicare Advantage applications, compliance, and enforcement activities is especially valuable to companies with interest or questions in any area of Medicare contracting.
At CMS, Mr. Balcerzak served as the Director of the Performance Review Division within the Health Plan Purchasing and Administration Group. In this capacity, he was responsible for conducting and initiating reviews of managed care contractors that were referred to his division for enforcement action. His division initiated the first intermediate sanctions against managed care contractors, reviewed corrective actions, and restored the contractor to full operations. He worked closely with the Office of the Inspector General as contractors were reviewed to assess civil money penalties for non-complaint actions. In addition, Mr. Balcerzak served on the Department of Justice Managed Care Fraud Working Group, which coordinated activities of the various federal agencies that purchased managed care services for their constituencies.
Over the past 16 years at GHG, Mr. Balcerzak has served an ever-broadening cross-section of clients. Beginning with basic applications for Medicare Advantage and Part D contracts, his work includes the development of Medicare Advantage operations, development of compliance plans for both health plans and their vendors, resolution of dual eligible enrollments, service area appeals, rehabilitation of clients under sanction, and reconsiderations for Star Ratings as well as consultation with risk adjustment vendors on CMS requirements. He has also worked with clients seeking managed care demonstrations and Accountable Care Organization (ACO) contracts.
With the passage of the Affordable Care Act, Mr. Balcerzak has concentrated on regulatory requirements that Qualified Health Plans must meet. His focus has been the development of client-facing services that GHG can provide in application projects through GHG Compliance Services, sales agent needs through Sales Sentinel™, and enrollment reconciliation through GHG’s Valencia™. With the initiation of insurance programs through the Federal and State Marketplaces, GHG has begun serving new and existing clients as they offer services in this new and emerging environment.
Mr. Balcerzak has a BS from the University of Scranton, an MSW from Marywood University, and an MBA from Loyola University in Baltimore.