Troy Burek

Experience

• 

  New York State Department of Health

  May 2014 - May 2017

  Student Assistant

  - Provided database support to OHIP’s Durable Medical Equipment support unit call center and utilization review nurses.- Assisted in eMedNY pending claim reviews (approval/denial).- Directly contributed to database development supporting various OHIP contractors.- Generate periodic reports for database applications and provide analysis.- Document application changes, problems and solutions for future reference.

• 

  HMS

  Apr 2018 - Mar 2022

  - Deliver effective strategies and processes to NYS’s Office of the Medicaid Inspector General (OMIG) to reduce costs, advance the quality of care and promote public health.- Work closely with NYS Managed Care Organizations, ensuring capitation payment integrity and enrollment coordination.- Utilize the NYS Medicaid Data Warehouse to identify overpaid claims, target improper payments, and highlight suspect providers.- Own data-driven detection methodology runs for policy-based recovery scenarios and audit review processes to uncover improper payments.- Directly contributed to the recovery of over $350M in improper payments.- Responsible for revenue forecasting, monthly reporting to clients and invoicing of revenue. Show less

  • Program Manager

    Jul 2020 - Mar 2022

  • Data Systems Business Analyst

    Apr 2018 - Jul 2020
• 

  Oscar Health

  Mar 2022 - now

  - Responsible for managing both internal and external stakeholder relationships as part of the Provider Success team in order to advance Oscar’s strategic network goals.- Consistently incorporating analytical insights involving multiple large datasets utilizing SQL, including aggregations, CTEs, filters, and arrays on an ad-hoc basis.- Manage deliverables ensuring team SLAs are met via collaboration tools such as Jira, Appian, and Monday - maintaining 90%+ success rate.- Coach and develop team members, promoting career development and driving high-quality work.- Cross-functional engagement with various pillars within the organization to accomplish goals involving diverse stakeholders and levels of technical capabilities. Show less - Design, optimize, and implement processes and improvements for Oscar’s claims operations platform.- Collaborate with leaders across business units to develop solutions to complicated and multi-faceted item escalations.- Serve as account management for Oscar’s primary platform client, facilitating daily interface and liaising for stakeholders.- Enhanced client’s intake and prioritization alignment processes.- Provide support to engineers, analysts, and other operations team members toproduce insights and viable solutions to various efforts. Show less

  • Operations Manager, Provider Success

    Mar 2023 - now

  • Operations Associate, Process Design and Strategy

    Mar 2022 - Mar 2023