Tom Gross is a director with Baker Tilly’s digital solutions practice. He has experience in healthcare analytics, process improvement, application development and enterprise software implementation.
Prior to joining Baker Tilly, Tom worked with leading national and regional healthcare organizations, implementing industry leading electronic health records (EHR) revenue cycle software and engaging client leadership to manage organizational change.
- Coordinated requirements, development, and testing across all business functions of a large, multistate dental and vision payer’s core claims administration system implementation. Developed communication, change management, and program plans to drive and track project health. Acted as the liaison between software vendor and client teams, including executive sponsors
- Led an electronic data interchange (EDI) member eligibility file standardization and process improvement initiative for a multistate dental and vision payer. Managed client small and medium-sized enterprises (SMEs) through the development of a premium group facing EDI processing standards “companion guide” to encourage data and format compliance and improve data accuracy and processing time. Defined business logic and requirements for an EDI intake engine tool designed to scrub and normalize non-standard member eligibility data prior to ingestion into client’s core claims administration system
- Managed the cross-product software delivery life cycle for a multistate, multi-line of business health plan’s value-based care program with a focus on scalability. Led release planning efforts and provided oversight for data model and front-end user interface design for new, value-based care payment models
- Led design and build of a repeatable Healthcare Effectiveness Data and Information Set (HEDIS) quality data extract and ingestion process to support Center for Medicare and Medicaid Services (CMS) quality rating system (QRS) reporting for a national health plan. Managed the rollout of a data structure to support required processing and reporting, scoring algorithms and Tableau dashboards to enable visualization of CMS quality score data across multiple hierarchies
- Led a reporting workstream for a multistate health insurer’s reimbursement analytics engine, responsible for analyzing provider reimbursement data. Revamped reporting tools, including Cognos, to support ICD-10 conversion and future insurance product offerings
- Managed on time and on budget EHR revenue cycle implementations across four distinct healthcare organizations, achieving a 16% increase in provider payment volumes at a U.S. News and World Report Top 5 Hospital
Location
Walnut Creek, CA
Education
Bachelor of Business Administration in marketing – process management and consulting
The College of William and Mary
(Williamsburg, Virginia)