FORT WORTH, Texas, March 03, 2020 — CERIS, a division of CorVel Healthcare, and a leading national provider of payment integrity and prospective claims review for health care payers, has appointed insurance industry veteran Mark Johnson as Vice President of Product Management.
“Mark’s deep expertise in health care, insurance, and policy issues brings extraordinary value to CERiS, as our clients rely more and more on prospective review of claims to make sure the bills are accurate,” stated Corey Albrecht, President of CERIS. “While the industry has previously focused on retrospective review of bills, there is consensus now that reviewing bills in advance of payment is the key to efficiency and accuracy. Mark’s experience and leadership will expand our footprint in these services, adding significant value to our customers.”
“Insurers have a fiduciary responsibility to their stakeholders to ensure that the bills they pay are correct,” commented Johnson. “With prospective review, we help them verify that the figures are accurate based on the procedure, the contract with the provider, and the diagnosis. Fast turnaround of our review ensures that providers are paid well within regulatory requirements for bill payment. We are currently expanding our solutions to offer an even greater breadth of service to our payer clients.”
Prior to joining CERIS, Johnson was an executive at UnitedHealth, the nation’s largest insurer, where he was charged with developing the payment integrity system for the corporation. He also served as director of subrogation and third party liability for Blue Cross Blue Shield of Minnesota. Johnson’s additional experience includes healthcare policy, managing offshore payment operations, oversight of claims services, and a background in clinical care working with pediatric bone-marrow patients.
CERIS, a leader in both prospective and retrospective claims review and re-pricing, combines clinical expertise and cost-containment solutions to ensure the accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, facility repricing, contract and policy applications, review of implants and devices, and primary payor cost avoidance. Its universal chargemaster contains billions of charge items from more than 97% of the nation’s hospitals, helping to ensure accuracy and objectivity of each claim review. On average, CERiS’ services achieve 62% savings on implant claims, 6% savings in network claims adjustments, and 35% savings on out-of-network claims adjustments.