Josh G.

Experience

• 

  Modivcare

  Vice President, Business Intelligence & Strategic Growth

  Apr 2025 - Present

  • Lead a team focused on the identification of EBITDA and revenue growth opportunities, creation of business intelligence reporting, and the development of business disciplines despite significant data limitations and
  • market nuances.
  • Oversaw the delivery of $2.3M in value for cases with negative EBITDA due to unsustainable Caregiver rates.
  • Developed the Caregiver Forecast Model which is now critical to objective and disciplined capacity allocation.
  • Created the Composite Score Index & Model which measures the quantity and quality of Caregivers delivered.
  • Developed Executive reporting (MOR) on Branch performance across Financial, COGS, Workforce, and Reputation & Compliance Metrics.
• 

  UnitedHealth Group

  Vice President, Healthcare Economics

  Feb 2022 - Mar 2025

  UnitedHealth Group helps people live healthier lives and helps make the health system work better for everyone.

  • Lead a team focused on Risk Adjustment Analytics for prospective HouseCalls, retrospective Chart Review, Physician Claim Review, and In Office Assessments.
  • Drive analytics to project a program's ability to accurately and completely capture member conditions.
  • Focus analytics on Risk Adjustment impacts, unit yields, member identification and prioritization, HCC recapture and prevalence, and revenue projection inputs/guidance for Medicare Advantage and Medicaid membership.
  • Provide revenue projection guidance to senior leaders across various programs.
  • Set strategy and vision for the team and establish key relationships with other teams to drive collaboration.
  • Develop and support Chart Review strategy and analytics for the Medicaid business and external MA business.
• 

  UnitedHealth Group

  Senior Director, Healthcare Economics

  Nov 2017 - Feb 2022

  • Lead a team focused on Internal Client Analytics for prospective HouseCalls and retrospective Chart Review.
  • Drive analytics with the intent to accurately and completely capture member conditions.
  • Focus analytics on Risk Adjustment impacts, unit yields, member identification and prioritization, HCC recapture and prevalence, and revenue projection inputs/guidance.
  • Provide revenue projection guidance to senior leaders.
  • Built monthly valuation analytics package for the HouseCalls program.
  • Set strategy and vision for the team and established key relationships to drive collaboration.
  • Oversee development of Tableau-based client analytics packages.
  • Created and led GIVE, the largest UHG on-campus volunteer event, packing >135,000 meals for MN children.
  • Completed the Executive Development Program (EDP) as part of 2019C2, focused on improving CAHPS/HOS to raise STAR ratings.
• 

  UnitedHealth Group

  Director, Network Programs - Optum International

  Sep 2015 - Nov 2017

  • Own the strategy and implementation of Inpatient Grouper (IPG), an inpatient coding methodology built specifically for Brazil.
  • IPG groups inpatient admits into homogenous codes to advance provider and payer analytics and reimbursement.
  • Responsibilities included financial analysis & modeling, clinical data analytics, client proposals, directing team members, and training hospital leaders and operators.
  • Presented the business case, methodology, and client proposals to senior leaders (Amil & prospective clients).
  • Built the model and drove IPG financial impact of R$3.9M in 2016 for Amil.
  • Developed solutions for operations issues such as partial bills, outliers, patient transfers, and OPME.
  • Drove delivery of an analytics package in Tableau for providers, payers, and other industry entities.
  • Led IPG through the Optum Accelerate Process.
  • Supported clients with financial models, forecasts, CBAs, and alternate reimbursement frameworks.
  • Created Quad analysis and established new metrics to facilitate fee schedule remediation for owned hospitals.
• 

  UnitedHealth Group

  Network Director

  Sep 2015 - Nov 2017

  • Owned the strategy and implementation of Inpatient Grouper (IPG) built specifically for Brazil.
  • IPG groups inpatient admits into homogenous codes to advance provider and payer analytics and reimbursement.
  • Responsibilities included financial analysis & modeling, clinical data analytics, client proposals, CBAs, forecasts, directing team members, and training hospital leaders & operators.
  • Presented the business case, methodology, and client proposals to senior leaders (Amil & prospective clients).
  • Built the model and drove IPG financial impact of R$3.9M in 2016 for Amil.
  • Created Quad analysis and established metrics (modified contribution margin and Branch/Product reimbursement delta) to facilitate fee schedule remediation for owned hospitals.
• 

  UnitedHealth Group

  Associate Director Healthcare Economics

  Aug 2013 - Sep 2015

  • Lead a team of analysts to support segment efforts toward the Affordability Agenda.
  • Designed and built the M&R Market Analytics Model for C-suite, aggregating and ranking markets by membership, financial, clinical, competitive, and STARs metrics.
  • Managed complete turnover on the team within the first year and recruited and trained new analysts.
  • Collaborated with UCS, OptumHealth, Network Pricing, and sister HCE teams to improve alignment.
  • Drove creative initiatives to fill gaps to budget and bend medical cost trend.
• 

  UnitedHealth Group

  Associate Director of Finance

  Aug 2013 - Sep 2015

  • Directed a team of analysts to support the Affordability Agenda and communicate the value of analysis to senior leadership.
  • Designed and built the M&R Market Analytics Model aggregating markets by membership, financial, clinical, competitive landscape, and STARs.
  • Developed reports to highlight potential risks with corporate initiatives and opportunities to bend medical cost trend.
• 

  UnitedHealth Group

  Manager - Clinical Ops & Vendor Mgmt

  Feb 2011 - Aug 2013

  • Managed the UHC M&R member eligibility process and reports for MA/Dual/Chronic/Inst membership across multiple platforms - this includes the monthly creation of the Ovations Medicare Workbook (Source of Truth), the
  • Specialty Membership file, and providing guidance/solutions to OptumHealth to improve eligible member benefit accuracy.
  • Became a SME on NICE/COSMOS membership eligibility as it relates to Benefit Plans and OptumHealth Facet Account codes.
  • Created largely automated, intuitive, and sustainable processes for monthly reporting – thus reducing human dependencies and opportunities for errors.
  • Created and implemented Back-End Audit report and process which validates program mapping to OptumHealth Facet Account codes, thus improving the approval/denial of benefits for members.
  • Developed eVisor Process and Payment report to validate stratified membership with OptumHealth.
  • Streamlined Eligibility & Payment process for OptumHealth – formula improvements reduced the established report from 80+ to 4 tabs; thus saving many vendor hours each month, decreasing the TAT, and eliminating
  • inaccuracies each billing cycle.
  • Discovered and drove solution to 2011 terminated membership billing which resulted in a 9 month vendor expense savings of over $500k.
• 

  UnitedHealth Group

  Clinical Operations Manager

  Feb 2011 - Aug 2013

  • Managed the UHC M&R member eligibility process and reports for all lines of business across multiple platforms.
  • Created the monthly Medicare Workbook (Source of Truth) and the Specialty Membership file.
  • Built largely automated and sustainable processes for monthly reports, forecasts, and Back-End Audit reports to improve approval/denial of benefits.
  • Developed a streamlined Eligibility & Payment process for OptumHealth, reducing the report from 80+ tabs to 4.
  • Discovered and drove the solution for 2011 terminated membership billing, driving savings of >$500k.
• 

  Target

  Senior Financial Analyst

  Sep 2010 - Jan 2011

  • Responsible for PFresh Remodel Valuation Analysis which includes insight coordination and model enhancements to more accurately forecast portfolio IRR’s; in addition to the use of break-even calculations and lever
  • sensitivities.
  • Increased granularity in model capability with the addition of Mix of Lift and Sales Lift flexibility by volume tranches while also revisiting valuation assumptions that impact the IRR such as Sales Loss Avoidance and
  • Construction Capital.
  • Capital Investment analysis to factor in annual remodel complexity fluctuations, merchant scope adjustments, related strategy Sales Lift impact, and scope removal opportunities to optimize capital investments.
  • Provided Portfolio analysis on 2013 and remaining stores while introducing multiple scenarios as impacted by the levers at our disposal.
• 

  Park Nicollet Health Services

  Senior Operations Analyst

  Aug 2008 - Sep 2010

  Park Nicollet is an integrated care system that includes Methodist Hospital, Park Nicollet Clinic, Park Nicollet Foundation, Park Nicollet Institute and TRIA Orthopaedic Center. Park Nicollet is based in St. Louis Park, Minnesota and has more than 8,200 team members.

  • Leveraged prior health care knowledge to deliver directional and specific analysis for equipment, resources, and procedures in concise, intuitive reports.
  • Delivered a report summarizing all $53M Plan key initiatives to C-level executives and the Board, then enhanced it to track progress for internal customers and external lenders.
  • Provided financial leadership on the DermPath initiative, forecasting savings of $1.2M and defining organizational and clinician impacts.
  • Championed and established a journal entry threshold, improving Operations Analysts' utilization and reducing non-value-add time for management.
  • Researched Excel formulas, functions, and toolpacks to innovate and taught peers best practices and shortcuts.
  • Enhanced monthly reports to expedite write-ups using formula-driven commentary.
• 

  UnitedHealth Group

  Senior Financial Analyst

  Feb 2007 - Aug 2008

  • Researched and analyzed top-priority hospital and physician contracts for remediation and provided ad-hoc analysis across providers and ancillary services.
  • Created a Skilled Nursing Facility pricing tool based on CMS RUG pricing with accurate calculations and a user-friendly design.
  • Routinely conducted training for the national network team on the SNF pricing tool.
  • Built the Master Price Point Document implemented for national Physician and Specialist contracting and created standard and specialty approval fee schedules.
  • Presented results and recommendations to encourage fact-based pricing and strategy decisions and leveraged MapPoint for analysis.
• 

  UnitedHealth Group

  Program Financial Analyst

  Mar 2005 - Feb 2007

  • Managed Capital Projects financially and conducted monthly review meetings.
  • Customized and developed Excel reports for forecasting, reporting, and variance analysis on capital programs with an expense forecast of >$5.0M.
  • Communicated program status to executives and project teams.
  • Analyzed program history to identify trends and compiled cost components to create forecasts and report on forecast risks and deviations.
  • Assisted vendor relationship management and dispute resolutions, saving $100k+ in vendor payments.
• 

  CARLSON MARKETING GROUP

  Staff Accountant

  Sep 2003 - Mar 2005

  We’ve moved! In the fall of 2011, Groupe Aeroplan started to conduct business under the new brand name Aimia and Carlson Marketing is now operating under our new identity Aimia. To learn more, visit our new LinkedIn page or our newly redesigned global corporate website. Carlson Marketing designs and delivers loyalty programs that drive acquisition, retention and measurable results across multiple vertical markets and is supported by capabilities in strategic planning, creative, mobile, media, employee engagement, events, awards, technology and data analytics.

  • Audited all Travel program P&Ls and assured accuracy of sales and costs prior to monthly financial close.
  • Created and entered journal entries including reclasses and accruals/deferrals.
  • Created monthly balance sheets to assist in tracking current program status and adjusted estimates monthly.
  • Developed streamlined processes to improve efficiency and increase available information.
  • Served as a driving member of the Revenue Accrual Project Team and representative for CMG Travel.

• CARLSON COMPANIES, INC

  AP Coordinator/Intern

  Mar 2003 - Sep 2003

  CARLSON COMPANIES, INC is a company.

  • Produced project reports and coordinated daily A/R and A/P for the Leasing Department.

• DIVINE, SCHERZER, & BRODY LTD

  Tax Intern

  Feb 2002 - Apr 2002

  DIVINE, SCHERZER, & BRODY LTD is a company.

  • Prepared and filed tax returns for clients, including tax liability calculations.